INTRODUCTION: Pre-operative stoma site marking is a strongly recommended practice for preventing complications and improving the health-related quality of life of intestinal stoma patients. Despite its benefits, this practice is not routinely implemented in clinical practice. OBJECTIVES: This study aimed to increase the rate of pre-operative stoma site marking. METHODS: This evidence implementation project was conducted in three hospitals at the Brandenburg Medical School, Germany. The project followed the seven-stage JBI audit and feedback process recommended in the JBI Evidence Implementation Framework: (1) identification of practice area for change, (2) stakeholder involvement, (3) situational analysis of context, (4) baseline audit of stoma site marking rate, (5) strategy implementation (workshops with surgeons in each hospital to discuss baseline results), (6) 1-year follow-up audit, and (7) assessing the sustainability of practice changes. RESULTS: The baseline audit revealed the following marking rates: 163 of 305 cases (53%) were marked across the three hospitals between 2017 and 2022. Elective cases were more often marked (145 of 200, 73%) than emergency cases (18 of 105, 17%). Barriers included poor physical state of emergency patients, lack of time, memory recall, and communication issues between surgeons and nurses. At follow-up 1 year after the workshops, 86 of 173 cases (50%) were marked (elective cases: 57 of 80, 71%; emergency cases: 29 of 93, 31%). CONCLUSIONS: Audit and feedback did not increase the overall rate of pre-operative stoma site marking, but did improve the rate in emergency cases. A single workshop may be insufficient to effect change. Electronic patient data lacked standardized documentation for pre-operative stoma site marking. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A329.

Center for Health Services Research Brandenburg Brandenburg Medical School Rüdersdorf bei Berlin Germany

Center of Evidence based Education and Arts Therapies A JBI Affiliated Group Faculty of Education Palacký University Olomouc Olomouc Czech Republic

Center of Orthopaedics and Traumatology University Hospital Brandenburg Havel Brandenburg Medical School Germany

Centre for Evidence Based Medicine University of Split School of Medicine Split Croatia

Chair of Epidemiology and Preventive Medicine Department of Hygiene and Dietetics Jagiellonian University Medical College Kraków Poland

Clinic for General Visceral Thoracic and Vascular Surgery University Hospital Ruppin Brandenburg Neuruppin Germany

Cochrane Czech Republic Czech Republic A JBI Centre of Excellence Czech GRADE Network Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

Department of General and Visceral Surgery University Hospital Brandenburg an der Havel Brandenburg an der Havel Germany

Department of Surgery Immanuel Hospital Rüdersdorf Rüdersdorf bei Berlin Germany

Evidence Based Practice in Brandenburg A JBI Affiliated Group Brandenburg Medical School Germany

Faculty of Health Sciences Brandenburg Brandenburg Medical School Germany

Institute for Health Services and Health Systems Research Brandenburg Medical School Rüdersdorf bei Berlin Germany

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Zobrazit více v PubMed

Ambe PC, Kurz NR, Nitschke C, Odeh SF, Moslein G, Zirngibl H. Intestinal ostomy—classification, indications, ostomy care and complication management. Deutsches Arzteblatt Int 2018; 115 (11):182–187.

Pandiaraja J, Chakkarapani R, Arumugam S. A study on patterns, indications, and complications of an enteric stoma. J Family Med Prim Care 2021; 10 (9):3277.

Krishnamurty DM, Blatnik J, Mutch M. Stoma complications. Clin Colon Rectal Surg 2017; 30 (03):193–200.

ILCO. [ILCO in figures: an overview] [internet]. ILCO. Available from: https://www.ilco.de/verband/die-ilco-in-zahlen/. German.

Sauer K, Kemper C, Schulze J, Glaeske G. [BARMER GEK Report on remedies, medical sundries and therapeutic appliance 2013] [internet]. BARMER GEK; 2013 [cited 2020 Nov 2]. Available from: https://www.barmer.de/resource/blob/1027118/1b7a43d86cf4791d9f778bbb9d971f58/barmer-gek-heil-und-hilfsmittelreport-2013-data.pdf. German.

Overall B. JBI evidence summary. Stoma care: preoperative site markings. The JBI EBP Database. 2022; JBI-ES-1210-3.

Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy: a systematic review and meta-analysis. Colorectal Dis 2022; 24 (8):904–917.

Hendren S, Hammond K, Glasgow SC, Perry WB, Buie WD, Steele SR, et al. Clinical practice guidelines for ostomy surgery. Dis Colon Rectum 2015; 58 (4):375–387.

German Cancer Society, German Cancer Aid. [S3 Guideline Colorectal Carcinoma]. Oncology guideline program. German Cancer Society, German Cancer Aid, Association of Scientific Medical Societies in Germany; 2019. German.

Kugler CM, Pieper D, Ambe PC, Grohmann E, Breuing J. [Preoperative stoma site marking]. Coloproctol 2022; 44 (6):411–415.

German Cancer Society. Annual report of the certified colorectal cancer centers. Key figure evaluation 2023. Audit year 2022 [internet]. German Cancer Society; 2023 [cited 2024 Apr 15]. Available from: https://www.onkozert.de/wordpress/wp-content/uploads/2023/11/qualitaetsindikatoren_darmkrebs_2023-A1_230629.pdf?v=58446748. German.

Folguera-Arnau M, Gutiérrez-Vilaplana JM, González-María E, Moreno-Casbas MT, Obarrio-Fernández S, Lorente-Granados G, et al. [Implementation of best practice guidelines for ostomy care and management: care outcomes]. Enferm Clin (Engl Ed). 2020;30(3):176-84. Spanish.

Registered Nurses’ Association of Ontario. Toolkit: implementation of best practice guidelines. 2nd ed [internet]. RNAO; 2012 [cited 2024 Apr 5]. Available from: https://rnao.ca/sites/rnao-ca/files/RNAO_ToolKit_2012_rev4_FA.pdf

Jordan Z, Pilla B, Porritt K, Munn Z, Aromataris E, Lockwood C. Turning the flywheel: mobilizing the JBI model of evidence-based healthcare. JBI Evid Implement 2023; 21 (1):96–100.

Porritt K, McArthur A, Lockwood C, Munn Z. JBI Manual for Evidence Implementation [internet]. JBI; 2019 [cited 2024 Apr 11]. Available from: https://implementationmanual.jbi.global/

Berlin-Brandenburg Statistical Office. [Overview of demographics] [internet]. Available from: https://www.statistik-berlin-brandenburg.de/bevoelkerung/demografie/. German.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016; 25 (12):986–992.

World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

Kim YM, Jang HJ, Lee YJ. The effectiveness of preoperative stoma site marking on patient outcomes: a systematic review and meta-analysis. J Adv Nurs 2021; 77 (11):4332–4346.

Hsu MY, Lin JP, Hsu HH, Lai HL, Wu YL. Preoperative stoma site marking decreases stoma and peristomal complications: a meta-analysis. J Wound Ostomy Cont Nurs 2020; 47 (3):249–256.