An ileostomy is where the small bowel is diverted to the abdominal surface resulting in the formation of a stoma. An Ileostomy can be temporary or permanent and produces loose faeces. Some ileostomates can develop high output in the early postoperative stage. Most will resolve, some will require ongoing treatment and management. While patients are monitored closely according to protocol in hospital once discharged into the community, there appears to be little standardisation. A literature search revealed that existing guidelines are for management of patients in the acute care setting. However, if not adequately prepared and monitored, patients with prolonged high output are at risk of complications including dehydration, acute kidney injury and malnutrition. This article discusses the development of a guideline aimed at improving education, monitoring and ultimately improving outcomes for patients with high-output stomas in the community.

People living with a stoma may, at some point in their stoma journey, experience peristomal skin complications (PSCs). The majority of PSCs occur as a result of leakage of stomal output onto the peristomal skin, which often results from poor templating or selection of stoma appliance. PSCs typically manifest as hot, red, sore and weepy skin. The symptoms can be misinterpreted as signs of infection, and, as a consequence, professionals may incorrectly prescribe a systemic or topical antibiotic. This is especially problematic, as overuse of antibiotics has been leading to greater bacterial resistance to these treatments, and it is increasingly emphasised that they should not be prescribed unless absolutely necessary. However, an experienced clinical nurse specialist in stoma care should be able to correctly diagnose a PSC, prescribe the appropriate treatment and resolved the problem quickly, without the use of antibiotics.

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