OHP-003 High output stoma detection and protocol implementation for nutritional and pharmacological support

Background The creation of a stoma for discharge is a common procedure after a bowel resection. It is associated with complications such as high output stoma (HOS) (volume >2000 ml) that involves large losses of water and electrolytes, as well as long-term malnutrition. HOSs are rarely identified and commonly overlooked by clinicians. Purpose To identify inpatients with HOS and assess the benefits of a protocol for HOS management developed by the pharmacy department. Materials and methods A prospective study was performed. All inpatients with new colostomy/ileostomy were included except those who had stayed more than 7 days in intensive care unit after surgery. Informed consent was requested from all inpatients before participation. Daily volumes as well as other variables of interest were collected. A management protocol consisting of 4 phases of action depending on the duration of HOS was implemented by pharmacists (pharmacological and nutritional recommendations), and the effects of it on inpatient outcome were recorded, as well as readmissions because of stoma complications. Results 16 patients were recruited, age range between 23–77 years, 69% men, BMI 26.5 ± 6.8. 56.4% were colostomies and 43.4% ileostomies. Principal cause of stoma formation was colorectal cancer (65.3%) and the median resected length was 24 cm. 75% of patients required nutritional monitoring, 50% were diagnosed with undernutrition (67% protein-caloric and 33% caloric) and 31% were treated with individualised and monitored parenteral nutrition. All patients with HOS had an ileostomy. The underlying cause of HOS was identified in 50% of cases. The protocol was applied in all patients, 75% recovered after the first phase, and the rest after the second phase. There were 3 readmissions due to HOS, one with hypomagnesaemia. Conclusions HOS appears to be a common complication after stoma creation. Nutritional support and electrolytes monitoring are necessary because of a high amount of diagnosed undernutrition. Appropriate treatment is important to prevent readmissions related to HOS. No conflict of interest.