Preventing dehydration-related readmission: an education protocol after new ileostomy placement.

Date of Publication


Project Team

Stuart L. Whitney, Ed.D., RN, CNL & Carmel Thomas, MSN, RN


Background: Patients with a new ileostomy had a nationwide, all-cause 30-day readmission rate of 30% in 20131 and contributed to over $94 million in healthcare expenditures2. Cause of readmission is often multifactorial; however, dehydration remains the predominant cause presenting in 40% of patients.

Purpose: This project aims to establish a standardized post-operative ileostomy education protocol consisting of a teaching checklist, dehydration handouts, and intake/output charts to increase early patient autonomy with ostomy care and reduce dehydration-related readmissions.

Methods: Inpatient nurses at a Level-1 Trauma Center in the Northeast were contacted to complete a pre-implementation survey to gather qualitative information about current practices. Survey data and current guidelines were assimilated to create a proposed post-operative educational protocol. Patient discussion via teach-back method and a post-education feedback survey assessed feasibility of the protocol. Inpatient nurses completed a post-survey to assess practice changes. Descriptive statistics and thematic analysis were used to analyze survey responses.

Results: Thirty-five out of 46 nurses completed the pre-survey; forty-three percent (n=15) felt very confident providing education. Implementation was August 31, 2020 through December 31, 2020. Twenty-five patients received education. Reasons for readmission during this time were dehydration (n=1) and pelvic abscess (n=2). One hundred percent of patients (n=22) found the materials very helpful. Eighteen out of 42 nurses completed the post-survey; seventy-eight percent (n=14) felt very confident providing education.

Conclusion: A standardized protocol containing a teaching checklist, education materials, in-hospital early engagement, observed management, and post-discharge tracking of intake/output is an effective method for decreasing dehydration-related readmissions.

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