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The Joint Commission Ruling on Stoma Siting

Thursday, April 11, 2013   (9 Comments)
Posted by: Becky Dryden
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Dear WOCN Members,

Per the email sent to the entire WOCN membership on April 11, 2013, please view the WOCN letter of inquiry and The Joint Commission response on stoma siting below:

The Joint Commission Letter >>

The Joint Commission Response >>

Original email sent out to the WOCN membership

April 11, 2013

Dear WOCN Member:

It has come to our attention that in various care settings across the United States, risk and quality management personnel who monitor surgical site marking practice are declaring that stoma site marking is considered out of the scope of practice for the certified wound ostomy and continence (WOC) nurse for ostomy surgical procedures.

The WOCN Society in response to this concern requested from The Joint Commission a clarification of The Joint Commission policy statement UP.01.01.01 and UP.01.02.01 within the National Patient Safety Goals effective January 1, 2013, pertaining to the role of the WOC certified nurse specialist and the vital contribution they play in preoperative patient preparation for bowel and or bladder diversion.

Dr. Robert Wise representing The Joint Commission responded in favor of WOC nurses providing guidance to the surgical team for preoperative stoma siting. Furthermore, pointing out that this procedure is consistent with the WOC certified nurse scope of practice and licensure.

We are hoping this information will be of assistance to you in your professional setting in discussing the role of the WOC certified nurse and stoma siting.

To view the WOCN letter of inquiry and The Joint Commission response, please go to:

The Joint Commission Letter >>

The Joint Commission Response >>

The Society understands there are several state Boards of nursing who have concerns about stoma siting. We trust this information will be helpful for those of you who are in dialogue with your state Boards of nursing regarding this issue.

Please contact us if you require further clarification of this information or have additional concerns regarding this matter.


Kathleen G. Lawrence, MSN, RN, CWOCN
Wound, Ostomy and Continence Nurses Society


Melissa P. Cooper says...
Posted Sunday, April 19, 2015
The surgeons I work with appreciate this help it also helps with patient care continuity and report as well as post op care. Proper placement of stoma is critical in post op care.
Nergis A. Blood says...
Posted Monday, December 2, 2013
Thank you for clarifying this important issue. Location, location, location....:-)
Deborah P. Gray says...
Posted Monday, August 26, 2013
Ultimately the surgeon is responsible for making the surgical and stoma incision. It is the role of the CWOCN to provide, based upon his/her best knowledge and evaluation of the patient, the recommendation for the best site to place the stoma. Ultimately the surgeon makes the final decision, although most will place the stoma where it is marked. I think that the Joint Commission position only clarifies this process. Thanks for the information and clarification as I am sure this has come up for others as I have had this same discussion with our Quality people. Deborah P. Gray MSN,RN,CWOCN,CFCN Nashville, Tennessee
Dianne S. McCollum says...
Posted Wednesday, June 19, 2013
On June 14, 2013 the Mississippi State Board of Nursing: "Nurse Practice Committee determined that it is within the scope of practice of the RN certified as wound, ostomy, continence nurse to mark a surgical stoma site provided: 1. The RN is educated and competent in the procedure. This education and competency must be documented initially and on an ongoing basis; 2. The RN must be certified as a wound, ostomy, continence nurse; 3. There is a medical order for the procedure; 4. The RN practices according to generally accepted standards of practice; 5. All necessary resources are available; and 6. The facility has policies and procedures in place addressing all aspects of the issue. The current position statement on the Board's web site will be updated within the next thirty (30) days." Dianne McCollum RN CWOCN ET Nurse Rush Foundation Hospital Meridian, MS 39301
Becky Carroll says...
Posted Tuesday, April 16, 2013
Posted on behalf of WOCN Society President Kate Lawrence. Dear Janice, Our document speaks to certified nurses as we wish to support the WOC Nursing credentialing body, the WOCNCB. If an institution allows this activity, I am to assume that there are some sort of supportive education for the individual and competency evaluation and policies in place. The WOCN inquiry does not include this situation, and therefor the Joint Commission did not address this question. Thank you for asking. Kate Lawrence, MSN, RN, CWOCN President WOCN Society
Janice S. Hughes says...
Posted Saturday, April 13, 2013
What if the nurse who does the marking is not certified but part of a WOC team at the hospital?
Melissa P. Cooper says...
Posted Friday, April 12, 2013
After reading both the letter to joint commission and their response letter I thought it was clear the joint commission needs the surgeon to mark the site of the surgical procedure they were in charge of. I did not get that the stoma making procedure was some how minimized in importance at all just that it was separate from the bowel or bladder surgical removal. The joint commission was clearing siding with the WOCN Society. Melissa Cooper, CWOCN
Mike D'Orazio says...
Posted Thursday, April 11, 2013
This particular quote from Dr. Wise is particularly intriguing since it still fails to address the fundamental question of exactly who has ownership in stoma siting, and to what degree: Because the stoma site is secondary to the primary surgical site...the UP (universal protocol) does not apply to stoma site marking." Given technological advances toward minimally invasive surgeries, at what point and place in time will separate surgical or incisional sites become non existent? If surgeons do stomal creations without any separate incisions, will the WOCN then be relegated, again, to the proverbial dustbin? As I had written in past commentaries, language - and more importantly accurate language - does matter very much. To ascribe ownership of a surgical procedure to an incision and minimize the importance of the stoma is foolhardy and reveals a lack of understanding about the profound role of a properly placed and constructed stoma. Ostomates versus incisionmates? Mike ET
Ginger D. Salvadalena says...
Posted Thursday, April 11, 2013
Congratulations on a job well done!

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