(PI-012) New Procedure to Decrease Severe Pain with Peristomal Skin Breakdown

Peristomal skin breakdown can be traumatic and painful to the ostomate. Advances in ostomy products, as well as WOC nursing expertise have led to better outcomes for ostomy patients, but peristomal breakdown remains an issue. “The surgeon's goal is a well-constructed stoma. Unfortunately, this goal is not always achieved, as 10 to 70% of ostomy patients experience some type of peristomal skin problem”. ¹

Methods:

Our homecare agency has certified ostomy nurses. Patients are referred to us with complications that usually include peristomal skin breakdown. They return home after a short hospital visit, a prolonged rehab stay or from nearby wound clinics without WOCN’s.  Often the solution is as easy as changing to a convex wafer, however, the skin damage is usually already present. Patients complain of unbearable pain with care and cannot tolerate peristomal cleaning. This delays the care of the already busy WOC nurse.

Previously, the nurse had to provide care slow enough that the patient could tolerate the pain.  This prolongs the pain and the visit.

Results:

Our quality improvement program involved instituting a new product to decrease pain in the peristomal breakdown.  The patient’s appliance is gently removed, and the topical lidocaine hydrochloride/benzalkonium chloride gel is immediately applied. Within minutes the burning, stinging and pain decreased, and we can proceed with the care needed.

Discussion:

Five patients with severe peristomal breakdown and pain will be discussed. They had pain at 9 or 10/10.  After applying the gel, patients were completely surprised by how much it helped and they tolerate cleaning the peristomal breakdown with just minimal discomfort!  Also, this product did not impact the adherence of the next appliance placed.

This product is now carried by all ostomy nurses in our agency. We have noted decreased visit time, but most of all increased patient satisfaction with our care.