Primary Care Prescribing Guidelines for Stoma (Adult)

Transcription

1 Primary Care Prescribing Guidelines for Stoma (Adult) These prescribing guidelines are designed to give support to primary care prescribers continuing the care of patients with stomas, to ensure high quality and cost effective ongoing prescribing of stoma products. The guidance has been written by City Hospitals Sunderland Stoma Care Nurse Specialists in conjunction with SCCG Medicines Optimisation Team for use in all patients within Sunderland CCG. There are many factors that need to be considered when selecting a stoma product such as: What product is suitable for the patient? What does the patient prefer and why? Is the product comfortable and convenient for the patient? Therefore, it is important that the CHS Stoma Care Nurse Specialists are involved in any recommendations or prescribing decisions around stoma care. Contact details and clinic information can be found in Appendix 1. New Patients All new patients discharged from hospital are given the choice of having their stoma prescriptions supplied by either a dispensing appliance contractor (DAC) or through a local community pharmacy. The patient has the right to change whoever dispenses their products at any time. Guidance on dispensers of stoma products can be found in Appendix 2. On discharge from hospital, all patients should be supplied with a minimum of 14 day supply of stoma products. Following discharge, patients are reviewed by the stoma care specialist nurses on a fortnightly basis for four visits. This is because the stoma will be oedematous for the initial 6-8 weeks following surgery and will reduce and change in shape during this time, therefore products may need to be accordingly during this period. GP practices will only be notified of the prescription the patient requires, once the Stoma Care Nurse Specialists are satisfied that the product will be that prescribed longer term. All communications from secondary care regarding recommendations for stoma products will contain the code of the product to be used, to enable prescribers to select the appropriate item from their prescribing systems. All patients are advised to allow two weeks for their prescription to be generated and dispensed by either a DAC or local community pharmacy to allow for raising a prescription and dispensing to occur whilst the patient still has sufficient supplies. Existing Patients It is recommended that patients with a stoma have their care reviewed every 6-12 months, or sooner if there are problems This review should be completed by the CHS Stoma Care Nurse Specialists Prescribing of Appliances The choice of stoma appliance is specific to patient needs, and therefore the choice of product for patients is unrestricted to allow for the most appropriate product to be supplied Guidance on the quantities which are expected to be used by patients is contained in Appendix 3 and should be used to ensure that stoma appliances are supplied in appropriate amounts Prescribing of Accessories Stoma accessories should not be routinely required for patients with a stoma Most accessories are only required for short periods of time to combat a specific problem associated with a stoma and once resolved, the accessory is no longer needed A list of accessories with usual quantities and preferred brands and have been developed for use locally and are available in Appendices 4 and 5

2 Appendix 1 Contact information for Stoma Care Nurse Specialists City Hospitals Sunderland Stoma Care Service Stoma Care Nurse Specialists: Maralyn Boyd, Susan Rodda, Rosemary Jobling. Routine clinic access GPs can refer patients for review by the Stoma Care Nurse Specialists and are commissioned to provide both hospital and community services for patients in Sunderland area. A Home visit service is offered for housebound patients or any patients being discharged following surgery. Drop in clinic Available to all stoma patients Every Tuesday 09:00 12:00 No appointment required Located at Chester Wing Outpatients Department Availability Monday - Friday 8: 18:00 Address: Sunderland Royal Hospital Kayll Road Sunderland SR4 7TP Tel: Ext Fax:

3 Appendix 2 Dispensing of stoma appliances and accessories The Dispensing Appliance Contractor (DAC) favoured by City Hospitals Sunderland is Charter Healthcare: Tel However, a full list of dispensing appliance contractors can be found at: A full list of pharmacies can be found at: Flange cutting All pre-cut stoma products are circular. Some stomas are irregularly shaped and therefore there is a requirement for pouches to be cut to an individual template DAC s offer a bespoke cutting service. This is often a reason why an individual may choose their service. Some community pharmacies can also provide a cutting service. Patients who require this should check that the pharmacy is able to do this for them before taking their prescription to be dispensed. Bags and wipes Both DACs and community pharmacies are required to supply bags and wipes when dispensing stoma appliances and are reimbursed for the supply of these items when they dispense these products

4 Appendix 3 Stoma appliance quantities Type of stoma Type of appliance Frequency of appliance change Quantity prescribed per month Colostomy Large bowel stoma Usually formed stool One piece closed appliance Two piece closed appliance Changed 1-3 times a day Flange 2-3 times a week - 90 pouches : Usually packed in boxes of -15 flanges : Usually packed in boxes of 5 or Ileostomy Small bowel stoma Semi-formed or loose output Average volume mls One piece drainable appliance Two piece drainable appliance Pouch 1-3 times a day Changed every 1-2 days Flange times a week pouches : Usually packed in boxes of 15 - pouches : Usually packed in boxes of or -15 flanges : Usually packed in boxes of 5 or (1 or 3 boxes per month) Convex Pouches To be used only on recommendation of stoma care nurse specialist One piece closed appliance Two piece closed appliance Pouch - every 1-2 days Changed 1-3 times a day Flange 2-3 times a week 15 - pouches : Usually packed in boxes of or - 90 pouches : Usually packed in boxes of or (3-9 boxes per month) - 15 flanges : Usually packed in boxes of 5 or (1-3 boxes per month ) For flush/retracted stomas or those in a crease. Sometimes need a belt attachment One piece drainable appliance Pouch 1-3 times a day Changed every 1-2 days - 90 pouches : Usually packed in boxes of or 15 - pouches : Usually packed in boxes of or Two piece drainable appliance Flange 2-3 times a week -15 flanges : Usually packed in boxes of 5 or Stoma Caps Used over a mucous fistula and in conjunction with colostomy irrigation Pouch every 1-2 days Stoma cap every 2-3 days 15 - pouches : Usually packed in boxes of or 1 box alternate months

5 Appendix 4 Stoma accessories - use and quantities Accessories Notes Frequency of use Quantity Adhesive remover wipes or spray To aid removal of appliance. Used each time stoma appliance Barrier creams Barrier creams are not usually recommended as Apply when bag is as they reduce adhesion of bags/flanges. directed by stoma care nurse specialists Belts Usually worn with a convex appliance. Washable and reusable. Deodorants Should not be required. If pouch is correctly fitted, Not routinely required no odour should be apparent except when bag is emptied or. Household air freshener is sufficient in most cases. Discharge solidifying agents To change consistency of stool within the pouch. A sachet that is placed into the pouch to thicken watery contents. Used each time stoma appliance emptied Drainable bag fasteners For use only with older appliances where fasteners are not part of the appliance. As required for bag changes Flange extenders/retention strips Used for increased pouch wear time. Used each time stoma appliance Powders Used for protection of excoriated/bleeding skin. Used each time stoma appliance Protective rings Used for skin protection and useful to fill skin Each time appliance creases. Protective wafers Used with patients with allergy related skin Short term use only problems or to protect a skin dressing/wound. Skin fillers (pastes) Used to fill skin creases. Not usually for long term Used each time stoma appliance use. Skin protective wipes May be used on skin that is irritated/inflamed to Apply when bag is as promote healing. Should not be used usually for directed longer than 3 months. Underwear Should not be prescribed unless the patient develops a parastomal hernia and/or has been advised to wear support underwear by the stoma care nurse specialist N/A 2-3 cans per month 1 tube alternate months 3-6 per year Not routinely required 1-2 boxes per month 1 box per month 1-2 boxes per month 1 powder tube alternate months As per appliance Short term use only 1-2 tubes per month 1 box every 1-2 months Advice on pair?

6 Appendix 5 Stoma accessories preferred products Accessories Company Recommended products Code Quantity Cost Adhesive remover spray CD Medical Peel Easy 50ml spray ml 7.20 Brava Adhesive Remover Spray 50ml ml 8.84 WipeAway WAP 50ml 6.50 Adhesive remover wipes Ostomart OstoCLEAR adhesive remover wipe MRW1 (box) 8.97 Barrier creams Aspen Medical Europe Sorbaderm Barrier Cream 28 92g M Cavilon Cream 3392E 92g 8.12 Ostomart Ostoguard Barrier Cream RMC! 60g 4.81 Belts As per appliance Use belts with recommended product only Discharge solidifying agents Ostomart Ostosorb 3g Sachets PFW6 150 sachets Clinimed Morform sachets Flange extenders/retention strips Brava Secuplast hydro Aloe SPHA Ostomart Astoa hydrocolloid flange extenders (large) (wide) AFEL AFEW Powders Convatec Orahesive Powder S6 25g 2.42 Brava Ostomy Powder g 2.36

7 Protective rings Mouldable rings: Thin Standard Large Hollister Adapt Oval Convex Barrier Rings (22-38mm) Flextend Adapt Oval Convex Barrier Rings (-48mm) Flextend Convex Barrier Rings (38-56mm) Flextend Adapt Oval Mouldable Rings: 48 x 2.0mm 48 x 4.2mm SMST SMSS SMSL Peake Medical Varimate Resist Hydrocolloid washer VMR Protective wafers Convatec Duodern Extra Thin xcm S each Protective wafer cm xcm 15cm x 15cm Skin fillers (pastes) Convatec Stomahesive PW PW1515 S5 5 60g Orabase paste S3 g 2.08 Hollister Adapt S90 57g 3.86 Barrier film (wipes) Periprep Sensitive PPS1 50 wipes CD Medical Clinifilm Skin Protective wipe 0718 wipes M Health Care Cavilon Stoma Wipe 3344E wipes 23. Lubricating/neutraliser Gel Ostomart OstoZyme TCB6 0ml pump 7.85