A new evidence-based instrument to assess and classify peristomal skin lesions was launched at the 2010 Joint Conference of the Wound, Ostomy and Continence Nurses Society (WOCN) and World Council of Enterostomal Therapists (WCET). The instrument, known as the SACS™ Instrument, represents the first content-validated instrument to objectively assess and classify peristomal lesions by type and location in relation to an individual's stoma.
Peristomal skin lesions are a common complication affecting people with an ostomy. Yet, the means by which lesions are assessed and classified are not currently subjected to a system, method or universal language, such as the National Pressure Ulcer Advisory Panel guidelines did for staging pressure ulcers. There are no operational definitions for peristomal lesion types, which poses particular problems for healthcare professionals within a facility or through the continuum of care settings.
"Advancing the evidence base for WOC nursing is central to the mission of WOCN," said Janice Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, and member of the working group. "Instruments that provide standardized terminology and are content validated, are necessary building blocks to support this process."
Developed to help establish a standard language for peristomal lesions, the SACS™ Instrument allows a healthcare professional to assess and classify a peristomal lesion in three steps. The first step is to assess the Lesion Type (L) per one of the five lesion categories. A visual guide of the five categories provides examples of lesion types showing progressive skin deterioration along with a standard definition for each lesion. Once the lesion category is identified, the second step is to identify the Topographical Location (T) of the lesion in relation to the stoma. A clock face visual using standard quadrant terminology allows the staff nurse or clinician to determine which peristomal quadrants are affected. The third step is to document the Lesion Type (L) and Topographical Location (T) as the patient's SACS™ Classification.
Initially developed by a consensus of Italian healthcare professionals (the Studio Alterazioni Cutanee Stoma, or Study on Peristomal Skin Lesions, study group), the instrument was published in Ostomy Wound Management in 2007, following that, it was endorsed by the Italian ET association (AIOSS) and adopted in Italy. The instrument has been subsequently content validated in the U.S. by a nationally representative sample of ostomy care experts>
Evidence supporting the instrument was presented in a continuing education symposium at the 2010 Joint WOCN/WCET Conference. The SACS™ Instrument was developed and validated by a group of ostomy nurse experts with support from ConvaTec, which also provided an educational grant for the symposium.
"Consistent interpretation of peristomal skin lesions is essential to the practice of ostomy management and improving the quality of life for individuals with a stoma," said Gwen Turnbull, RN, BSEd, ET, also of the working group. "This instrument will help document incidence of peristomal lesions, and in the longer term build greater recognition of the value of ostomy nursing."
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