Authors: (including presenting author): :
Lau SM(1), Cheung YFE(1), Shit KYF(2), Lui PSG(3), Chan HYS(3), Cheung YS(1), Yu YM(1)
Affiliation: :
(1)Department of Surgery, North District Hospital, (2) NTEC Wound Services Team, Department of Surgery, Prince of Wales Hospital, (3) Department of Dietetics, North District Hospital
Keyword 1: :
Distal limb refeeding
Introduction: :
Managing patients requiring distal limb refeeding typically leads to prolonged hospitalization, straining healthcare resources and impacting quality of life. Caring for high-output stoma cases with refeeding tubes is particularly challenging. To address this, a collaborative model that utilizes specialized stoma and wound care techniques was developed. This model involves a multidisciplinary team, including Stoma and Wound Nurse, doctors, Nurse Consultant (stoma & wound care), dietitians, ward nurses, caregivers, and community nurses.
Objectives: :
It aims to reduce hospital length of stay, lower emergency readmissions, enhance patients' quality of life, empower caregivers, and maintain nutritional status post-discharge.
Methodology: :
In collaboration with Nurse Consultant (stoma & wound care), we implemented an innovative refeeding tube fixation technique to prevent dislodgment. A comprehensive training regimen for caregivers was established, covering stoma care, complication recognition, and a specialized pouching technique. Collaboration with doctors and dietitians ensured clinical oversight and nutrition monitoring. A dedicated hotline was set up for caregiver support, and community nurses arranged home visits immediately after the first discharge to bolster caregiver confidence. Data on hospitalization duration, emergency admission episodes, and caregiver confidence were collected over six months.
Result & Outcome: :
Before the new model's implementation, the patient faced frequent emergency admissions due to high-output stoma, resulting in acute kidney injury and electrolyte imbalances, with five admissions over six months and a longest hospital stay of 52 days. Following the introduction of the new model, there were no emergency readmissions related to high-output stoma complications. Only two incidents occurred outside office hours, requiring minimal intervention.
Caregiver confidence significantly increased, as indicated by a Likert scale assessment (from 1 pre-training to 4 post-training). Caregivers reported improved skills in pouch management and utilized the hotline about four times for real-time support. Regular outpatient follow-ups indicated stable nutritional status with no decline post-discharge.
In summary, this collaborative model significantly reduced emergency admissions, facilitated a smooth transition to outpatient care, and improved both patient quality of life and nutritional status, effectively minimizing the need for inpatient care.
