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Executive Summary

Enhanced Recovery After Surgery

Best Practice Guideline for Care of Patients With a Fecal Diversion

Miller, Debbie; Pearsall, Emily; Johnston, Debra; Frecea, Monica; McKenzie, Marg The Ontario Provincial ERAS Enterostomal Therapy Nurse Network

Journal of Wound Ostomy & Continence Nursing: January/February 2017 - Volume 44 - Issue 1 - p 74–77
doi: 10.1097/WON.0000000000000297
Ostomy Care

Enhanced Recovery After Surgery (ERAS) is a multimodal program developed to decrease postoperative complications, improve patient safety and satisfaction, and promote early discharge. In the province of Ontario, Canada, a standardized approach to the care of adult patients undergoing elective colorectal surgery (including benign and malignant diseases) was adopted by 15 hospitals in March 2013. All colorectal surgery patients with or without an ostomy were included in the ERAS program targeting a length of stay of 3 days for colon surgery and 4 days for rectal surgery. To ensure the individual needs of patients requiring an ostomy in an ERAS program were being met, a Provincial ERAS Enterostomal Therapy Nurse Network was established. Our goal was to develop and implement an evidence-based, ostomy-specific best practice guideline addressing the preoperative, postoperative, and discharge phases of care. The guideline was developed over a 3-year period. It is based on existing literature, guidelines, and expert opinion. This article serves as an executive summary for this clinical resource; the full guideline is available as Supplemental Digital Content 1 (available at: to this executive summary.

Debbie Miller, MN, RN, CETN(C), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Emily Pearsall, MSc, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Debra Johnston, MN, RN, CETN(C), University Health Network, Toronto, Ontario, Canada.

Monica Frecea, MScN, RN, CETN(C), Mount Sinai Hospital, Toronto, Ontario, Canada.

Marg McKenzie, RN, Surgery Mount Sinai Hospital, Toronto, Ontario, Canada.

Correspondence: Debra Johnston, MN, RN, CETN(C), University Health Network, Toronto General Hospital, 200 Elizabeth St, 9ES Rm. 300, Toronto, ON M5G 2C4, Canada (

The Ontario Provincial ERAS Enterostomal Therapy Nurse Network (Nurse Champion Lead: Marg McKenzie; ETN Steering Committee: Debbie Miller, Debra Johnston, Monica Frecea; Participants: Kathleen Callaghan, Shelley Chisholm, Gisele Clement, Leslie Heath, Jo Hoeflok, Lina Martins, Joanne McKeown, Vicki Meyouhas, Debbie Olson, Nancy Parslow, Kina Pelletier-Carson, Suzanne Sandhu, Sarah Suresh, Linda Thomas, Cheryl Thompson, Julie Tjan-Thomas, Anne Voll-Reitzel).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2017 by the Wound, Ostomy and Continence Nurses Society.