Klassifikation von Hautläsionen bei Stomaträgern mit dem ... · PDF filePage 1 Nina...
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Page 1 Nina Dammler, Brand Management Stomaversorgung, Coloplast GmbH,Hamburg 09. April 2011 Klassifikation von Hautläsionen bei Stomaträgern mit dem DET-Score
Klassifikation von Hautläsionen bei Stomaträgern mit dem ... · PDF filePage 1 Nina Dammler, Brand Management Stomaversorgung, Coloplast GmbH,Hamburg 09. April 2011. Klassifikation
Nina Dammler, Brand Management Stomaversorgung, Coloplast GmbH,Hamburg09. April 2011
Klassifikation von Hautläsionen bei Stomaträgern mitdem DET-Score
Presenter
Presentation Notes
Purpose of this workshop: To have an interactive workshop with SCNs; provide participants with the knowledge of how to use the Ostomy Skin Tool and allow them the practical experience of using the tool with case studies Introduction: It includes suggestions for promoting interactive discussion for each slide Includes suggestions for follow up questions and discussion points. Each slide has a purpose, suggestions for interactivity and, in some cases, background information This information is also included in the notes to the template slides Interactivity: The workshop session is intended to be interactive. Participants will have access to a computer to practice using the online version of the Ostomy Skin Tool. Voting by show of hands can be used to gather answers to questions and allow you, the facilitator, to quickly assess the responses
Der Bedarf für eine konstante und einheitliche Bewertung
- Eine Vielzahl von Stomaträgern erleidet eine Hautkomplikation im Laufe der Zeit ( Ergebnis der DialogStudie in Deutschland ca 59%)
- Viele Stomaträger sind sich ihrer Hautirritation nicht bewusst. - In der Literatur keine allgemein akzeptierten, einheitlichen Hinweise zur
standardisierten Bewertung und Beschreibung der Hautirritationen- Bislang keine Verfahren zur einfachen Messung und Beschreibung
ZIEL: Beschreibung von parastomalen Hautirritationen in einer einheitlichen Sprache
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11 April 2011
Der Bedarf für einheitliche und akkurate Bewertung
Wie würden Sie dieseHautkomplikation bewerten ?
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Mild
Mittelschwer
Schwer
Presenter
Presentation Notes
Purpose: Introduce the challenges in assessing peristomal skin problems Interactivity: This slide builds: Ask participants how they would assess this skin problem Ask participants to vote for mild, moderate, severe or don’t know Click the slide changer to reveal results from a previous vote from another group of nurses to highlight the variation Discuss the variation between answers, highlighting the challenges in consistent assessment Ask participants how they would communicate skin assessments between other healthcare professionals Additional information: A common language to describe the condition of the peristomal skin would increase communication and opportunities for collaboration among healthcare professionals as well as the clinical advantages, standard definitions for peristomal skin disorders would make research studies more comparable. This would help build a better evidence base on which to base ostomy care practice
Das Ostomy Skin Tool ist eine standardisierte Möglichkeit um:
1. Die stomaumgebende Haut nach objektiven Gesichtspunkten zu bewerten
2. Die peristomalen Hautirritationen gemäß Ihrer Ursache zuzuordnen3. Pflegeempfehlungen für peristomale Hautirritationen zu geben
Dieses Tool wurde entwickelt um Stomapflegekräften die Möglichkeit zu geben, Hautzustände in einer einheitlichenSprache zu beschreiben
Das Tool wurde durch zwei Studien validiert:• Die ”Ostomy Skin Tool” Validierungs-Studie• Im Rahmen der ”Coloplast DialogueStudie”: eine großflächige multinationale Studie, wo das Ostomy Skin Tool in der täglichen Praxis validiert wurde
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Presenter
Presentation Notes
Purpose: Provide an overview of the Ostomy Skin Tool including what is designed to do Key points: Currently in the literature there is no standardised way of categorising the condition of the peristomal skin, including the presence and severity of skin disorders Few clinical trials have examined the peristomal skin, and all used different clinical approaches to describe and define skin disorders. It is therefore difficult to compare and contrast these studies As a result of these gaps in the literature, several articles emphasise the need for a standardised international classification system Background information: The Ostomy Skin Tool was designed to provide stoma care nurses with a standardised way to score the peristomal skin objectively according to the extent and severity of the disorder, to categorise disorders according to their cause, and to provide guidance on care based on the literature and on advice from expert nurses A study was conducted to assess the reliability, variability and validity of the Ostomy Skin Tool. Results show that: Intra-nurse agreement in two assessment sessions was “substantial to almost perfect” indicating good reliability Inter-nurse agreement (between 20 nurses) was “moderate to substantial” indicating good reliability; good agreement between the nurses also indicates that the variability of the Ostomy Skin Tool is low There was a good correlation between the DET Score and global scores, indicating that the Ostomy Skin Tool is valid As we know from yesterdays presentation, use of the Ostomy Skin Tool has also been validated in daily practice through the Coloplast DialogueStudy, which was an extensive global study
Ostomy Skin Tool: Bietet eine strukturierte Bewertung des Hautzustandes
Von Stomapflegekräften für Stomapflegekräfte entwickelt
Inneke ClaessensUtrecht, The Netherlands
Jose Luis Cobos Serrano Madrid, Spain
Birgitte Dissing Andersen Herlev, Denmark
Kirsten DahlMalmø, Sweden
Angie PerrinOxford, UK
Svatava NovákováÚsti nad Labem, Czech Republic
Elizabeth EnglishAdelaide, SA, Australia
Lina Martins London, Ontario, Canada
Gabriele SternBocholt, Germany
Annick RibalBordeaux, France
Gabriele RoveronRovigo, Italy
Kathy TavernelliCleveland, OH, USA
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Presenter
Presentation Notes
The Ostomy Skin Tool will provide ostomy care nurses with a way of assessing the peristomal skin It also provides a common language to describe the peristomal skin The Ostomy Skin Tool was developed by a group of 12 expert ostomy care nurses. It is designed by nurses for nurses and it aims to meet the needs of as wide a range of ostomy care nurses as possible
Wofür ist das Tool gedacht ?Das Tool hat zwei Elemente für die Bewertung und Verbesserung des Zustandesder peristomalen Haut:
1. Der DET-score: beurteilt wird der Zustand der peristomalen Haut
Hauterosion Farbveränderung Hypergranulation :• Bietet eine Methode zur Bewertung der peristomalen Haut zu einem
bestimmten Zeitpunkt• Bewertet, ob sich der Hautzustand über einen gewissen Zeitraum verbessert oder
verschlechtert hat.
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Presenter
Presentation Notes
Purpose: Explain what the Ostomy Skin Tool was designed to do and what it was not designed to do Key points: The tool is designed to establish the condition of the peristomal skin at the time of the consultation It can measure if there has been an improvement or degradation of the skin over the time period between consultations It will help to cut down the amount of time it takes a nurse to evaluate a disorder, how it occurred and how it can be treated It can provide guidance for care and alert nurses when further treatment or a referral is required It is only meant to be used by stoma care nurses for the evaluation of peristomal skin It is not meant to predict the skin deterioration or to predict the occurrence of a skin disorder It is not meant to assess the extent of care needed The tool was designed in association with the Coloplast Global Advisory Board, an expert panel of stoma care nurses from Europe, North America and Australia
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Wofür ist das Tool gedacht ?
Der AIM (Assessment (Analyse ), Intervention (Intervention)und Monitoring (Monitoring) ) Guide für die parastomalePflege:Kategorisiert peristomale Hautirritationen anhand ihrer UrsacheBietet eine Pflege-Anleitung um den peristomalen Hautzustand zu verbessern
Der DET-Score:Die Bewertung der Haut
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Untersuchung und Bewertung der peristomalen Haut anhandvon 3 Bereichen:1. Farbveränderung (Discolouration) 2. Erosion (Erosion)3. Hypergranulation (Tissue Overgrowth)
Maximale Punktzahl (Score) in jedem Bereich:• Größe der betroffenen Fläche: max 3 Punkte• Schweregrad: max 2 Punkte
Die Ermittlung erfolgt in allen drei Bereichen nach der gleichen Vorgehensweise.
1. Schritt:Ermittlung der betroffenen Fläche :Keine Veränderung = 0 Punkte< 25 % der Fläche ist betroffen = 1 Punkt25-50 % der Fläche ist betroffen = 2 Punkte> 50% der Fläche ist betroffen = 3 Punkte
2. SchrittErmittlung des SchweregradsPunktzahl 1 oder 2 (Bilder und Beschreibung helfen bei der Orientierung)
Die am schwersten betroffenen Fläche ist für die Bewertung heranzuziehen
Normale Haut
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Punktzahl = 0
Anwendung des OST in der pflegerischen Praxis
1. Bereich: Farbveränderung
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Stoma
Fläche derFarb-veränderung
Haftfläche
Anwendung des OST in der pflegerischen Praxis
Punktzahl 2
Anwendung des OST in der pflegerischen Praxis
Farbveränderung• Fläche ‣ Punktzahl ist 3• Schweregrad ‣ 2Erosion• Fläche ‣ Punktzahl ist 3• Schweregrad ‣ 2Hypergranluation• Fläche ‣ Punktzahl ist 0• Schweregrad ‣ 0
Total DET score = 10
2008-10-07
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Presenter
Presentation Notes
This photo demonstrates Ms. M.’s peristomal skin condition on readmission to hospital on October 7, 2008. Please note that this photo was taken after ostomy powder had already been applied to extremely macerated, excoriated skin with evidence of copious moisture and pinpoint bleeding. Given this presentation and the patient history leading up to this, a diagnosis of irritant contact dermatitis is most likely. (Review DET scores on slide)
Das Online - Ostomy Skin Tool: Bewertung einerHautirritation
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Presenter
Presentation Notes
Purpose: Direct participants to the Ostomy Skin Tool Training section and ‘Start DET score training’ Interactivity: This slide builds: Ask all participants to go to a computer terminal/laptop All computers should be open at the Ostomy Skin Tool page and direct participants to the ‘Start DET score training’ section Ask participants to try scoring one of the case study skin disorders in pairs or in small groups You may wish to circulate round the room to answer any questions
Hautuntersuchungsbogen:Ermittlung des DET-Scores anhand eines Fallbeispieles
Fläche Schweregrad Punkte
3 2 5
2 1 3
0 0 0
8DET score
Presenter
Presentation Notes
Purpose: Summarize DET score for this case Key points: Total DET score for this case is 9
Der DET-Score bei mehreren Besuchen
Besuch 1 Besuch 2
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TOTAL = 9 TOTAL = 6
Die klinische Einteilung
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11 April 2011
Grenzwerte: 0-3 : keine bis geringe Hautschädigung4 - 7: moderate Hautschädigung8 - 15. schwere Hautschädigung
Über den AIM Guide für peristomale Hautpflege(Analyse, Internvention und Monitoring
• Wurde entwickelt um eine praktische Führung zurKategorisierung von peristomalen Hautirritationenzu bieten:• Anhand ihrer Ursache• So dass die passende Pflegemaßnahmen
ergriffen werden können
• Er bietet Pflegeleitlinien mit leicht anwendbareneBehandlungs-Algorithmen für unterschiedlicheDiagnosen
• Der Guide basiert auf einer gründlichenRecherche in der Stoma- und Hautliteratur
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Presenter
Presentation Notes
Purpose: Provide an overview of the AIM Guide Key points: The AIM Guide for Peristomal Skin Care was developed to provide practical guidance for categorising peristomal skin disorders according to their cause so that appropriate care can be initiated The guide is based on a thorough review of the ostomy and dermatology literature This search highlighted that: Many publications refer to complications associated with ostomies but there is little published on the most appropriate options for managing these complications There are no universal definitions, standardised guidelines or recommendations available. Many simply suggest that education in the proper care of a stoma is essential to minimise the risk of developing peristomal complications
AIM Guide für Peristomale Hautpflege
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Presenter
Presentation Notes
Purpose: Provide an overview of the AIM Guide using the Ostomy Skin Tool online resource Key points: The AIM Guide for Peristomal Skin Care provides practical guidance for categorising peristomal skin disorders according to their cause so that appropriate care can be initiated
Bewertung der HautDET-Score
Behandlungskonzeptfortsetzen
Abgleichung der optischenVeränderung mit Beschreibungen im
AIM Guide zur Hautpflege
Bestimmung der Diagnose-Kategorien
Anwenden derPflegeempfehlungen
Gesunde Haut UNGESUNDE HAUT
BeobachtungFortschritt
Wieder-BEWERTUNG
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Anwendung des Ostomy Skin Tools
Presenter
Presentation Notes
This flow chart shows how to use the AIM guide in practice. As Lina has already described, the first step is to assess the peristomal skin using the DET score. � If the skin is healthy, continue with the usual care and monitoring routine. Re-evaluate the skin as necessary.� If the skin appears unhealthy, observe the changes in the skin and determine a diagnosis category using the AIM (Assessment, Intervention and Monitoring) Guide for Peristomal Skin Care ��This will allow the most appropriate diagnosis category or categories to be determined as there may be more than one cause. ��Once a diagnosis has been made, follow the corresponding guidance for care ���Patients should then be monitored and re-evaluated to check that their peristomal skin condition is improving. � In addition to medical care, it is vital that all patients receive both psychological support and educational information to help them maintain healthy peristomal skin.
Online - Ostomy Skin Tool über www.coloplast.com
• Sie können das Tool überdie coloplast.com website jederzeit über diesenLink erreichen:
Purpose: Summarise the benefits of the Ostomy Skin Tool online Key points: As we have been using today the Ostomy Skin Tool online is user-friendly digital version can be easily accessed via the Coloplast website Key features include: Easy to navigate and user-friendly Ability to print out DET Scores and AIM Guide care guidance notes for each patient Training sections to practice using the DET Scoring system and AIM Guide and includes several practice case studies Easily accessible Practical Care Tips section and glossary
Standardisierte, einheitliche Sprache zur Beschreibung des Hautzustandes
Monitort Verbesserung/ Veränderung der Haut über einen Zeitraum
Kategoriesiert die Ursacheeiner peristomalen
Hautirritation und identifiziertBehandlungsmöglichkeiten
UnterstütztKommunikation
im klinischen BereichBietet Zeitersparnis
Hilft bei der Rechtfertigungdes Einsatzes von
pflegerischen Ressourcen
UnterstütztDatensammlung und
Dokmentation
Verbesserte Ausbildungder Stomapflege and Erfahrungsaustausch
Anwendung des OST in der pflegerischen Praxis
UnterstütztKommunikation
mit Kostenträgern
Presenter
Presentation Notes
[Explain the following in the context of the case study that has just been presented] With the OST, ostomy care nurses can: Use standard, common language to document condition of peristomal skin (both normal and compromised) Monitor peristomal skin condition over time (improvements, deteriorations) Categorise the cause of a peristomal skin disorder to determine and initiate appropriate interventions Facilitate communication between clinicians within and across different settings Potentially save time Help to justify use of clinical resources Support data collection and documentation - important for increasing knowledge and improving the quality of stoma care Improve ostomy care education and best practice using a validated Tool
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11 April 2011
..... auf dem Bremer Pflegekongress am 11./12. MaiWorkshopthema:Die Bedeutung und Einschätzung des peristomalenHautzustandes - Ein interaktiver Workshop
Neues OstomySkin Tool ab Mitte Mai erhältlich
Literatur OstomySkinTool/Validierung DET
1. Lina Martins et al, Elizabeth A Ayello, Ineke Claessens, Anne Steen Hansen, LisHentze Poulsen, R Gary Sibbald, Gregor B Jemec. The Ostomy Skin Tool:tracking peristomal skin changes British Journal of Nursing, 2010;19(15):960-4
2. Elizabeth A. Ayello et al. Validation of an instrument to assess peristomal skin conditions (Ostomy Skin Tool). Poster WOCNWCET 2010
3. Faber I. Die Beurteilung der peristomalen Haut – Wie gut ist gut?. MagSi 2010; 54(12): 32-3
4. H.Braunwarth. Die Beurteilung der peristomalen Haut: Das Ostomy Skin Tool. Heilberufe in Druck
