Third party prescription request for Continence and Stoma products. August 2013

Transcription

1 Third party prescription request for Continence and Stoma products August 2013

2 DOCUMENT CONTROL Document Location Copies of this document can be obtained from: Name: Address: Medicines Management Team Greater Manchester CSU St James s House Pendleton Way Salford M6 5FW Telephone: Revision History The latest and master version of this document is held on the Medicines Management SharePoint: REVISION ACTIONED SUMMARY OF CHANGES VERSION DATE BY 20/07/2013 J Cheung Initial draft produced for review /08/2013 J Cheung Comments from GMCSU /08/2013 J Cheung Comments from L. Bailey and J. Coleman (Stockport CCG) 13/12/2013 J Cheung Comments from J. Corbett, M. Dade and A. Smith Approvals This document must be approved by the following before distribution: NAME TITLE DATE OF ISSUE VERSION J. Corbett, M Dade and A Smith. (Specialist Nurses) GMMMG Chairs Action Third party prescription request for Continence and Stoma products Third party prescription request for Continence and Stoma products 16/01/ /01/ Distribution This document has been distributed to: NAME TITLE DATE OF ISSUE VERSION GMMMG Third party prescription request for Continence and Stoma products 21/01/

3 THIRD PARTY PRESCRIPTION REQUEST FOR CONTINENCE AND STOMA PRODUCTS Summary Greater Manchester Medicines Management Group (GMMMG) has agreed a set of principles which we expect third parties who order/supply appliances on behalf of patients to adhere to. Patients requiring continence or stoma appliances can have these dispensed either by a dispensing appliance contractor (DAC), a pharmacy contractor or a dispensing doctor. Patients should be made aware that they have a choice as to where their prescription can be dispensed. Prescriptions should only be issued at the request of the patient, patient s carer or by their relevant healthcare professional. If a DAC or pharmacy contractor orders prescriptions on behalf of a patient, the supplier must have a copy of the patient s consent for them to do so. DACs or pharmacy contractors must be able to audit and provide a complete account of requests made, by whom and what was supplied. No continence or stoma products should be supplied to a patient without or in advance of a signed prescription. Retrospective prescriptions will not be issued by the prescriber except in an emergency situation at the request of the patient/ patient s carer/ continence specialist nurse/ stoma specialist nurse/ hospital ward staff. If a DAC or pharmacy contractor requests a prescription post supply, GPs are entitled to refuse to supply a prescription. 2

4 1 Aim The aim of this guideline is to provide guidance to General Practitioners (GPs), dispensing appliance contractors (DACs) and pharmacy contractors on the issue of prescriptions for continence and stoma appliances. 2 Scope The guidance is intended for the following groups: GPs and GP practice staff Practice and District Nurses Continence Specialist Nurses Stoma Specialist Nurses DACs Pharmacy Contractors Medicines Optimisation Teams Care home staff Hospital staff 3 Background 3.1 In 2012/13 Greater Manchester spent over 13 million on continence and stoma products, an increase of over 700K in comparison to 2011/12 spend. 3.2 Continence and stoma appliances are usually provided to patients by a prescription written by their GP or a nurse prescriber. This prescription can then be dispensed by one of the following who provide NHS Pharmaceutical Services: DAC, a pharmacy contractor or a dispensing doctor. 3.3 Problems have occurred in the past where products have been supplied by a dispensing appliance contractor for a patient before a prescription was issued by the patient s prescriber. This has sometimes resulted in patients being sent stock regardless of whether they require the products or not. 3.4 Over-prescribing and over-ordering of continence and stoma products are frequently identified in primary care as an important cause of wasteful prescribing. This guidance aims to support primary care in the prescription management process around cost effective and rational prescribing for continence and stoma products. 3.5 Previous incidents have seen inappropriate items, items being supplied without a prescription, requests for new items without recommendation from allied healthcare professionals, quantities of items being supplied that have not been prescribed and patients not contacted to ascertain their needs. Such erroneous practices create confusion and inaccuracy within the patient s electronic health record and more importantly introduce a risk of patients being supplied the wrong prescription and significant waste. 3

5 4 Recommendations 4.1 Practice s must continuously review the prescribing of continence/stoma items requested by pharmacy contractors, DACs and their agents. If possible, it may be useful to allocate one member of the practice administration team and one GP to deal with all contractor requests for prescriptions requesting appliances. 4.2 The frequency and quantities on a prescription should be guided by any local specialist advice (see Appendix 1). Occasionally some patients may require more frequent or larger quantities than those recommended. If patients are identified as routinely over ordering continence/stoma products it may be appropriate to contact the local continence/stoma advisory service for the individual to be reviewed. 4.3 Prescriptions should only be issued at the request of the patient, patient s carer or by their relevant healthcare professional. If a DAC or pharmacy contractor orders prescriptions on behalf of a patient, the supplier must have a copy of the patient s consent for them to do so and provide the GP practice with details of the patient s authorisation. 4.4 Practice s must record which DAC or pharmacy contractor is being used and who appears to be requesting prescriptions i.e. patient or contractor on the patient s electronic health record. 4.5 DACs or pharmacy contractors must be able to audit and provide a complete account of requests made, by whom and what was supplied. 4.6 Retrospective prescriptions should not be issued by the prescriber except on the rare occasion that an emergency supply has been requested by the patient/ patient s carer/ nurse specialist. If issues arise as a result of this principle please see template letter to DACs or pharmacy contractors in Appendix 2 that can be used to resolve any problems encountered. 4.7 If a DAC or pharmacy contractor requests a prescription post supply, GPs are entitled to refuse to supply a prescription. 4.8 Patients should be encouraged to order the appliance(s) when they get to a defined threshold quantity sufficient to allow time for delivery. 4.9 Patients should be advised to avoid stock piling as products have a recommended shelf life and are influenced by changes in temperature Prescriptions for continence and stoma appliances should be issued on a separate form from the rest of the patient s medication to avoid dispensing problems if a patient chooses to use a DAC and not a pharmacy contractor DACs and pharmacy contractors should not be requesting duplicate prescriptions. If received, do not destroy, but return to the GP practice for cancellation from patient records If it is unclear what the patient is using, contact the patient and/or advisory service for an update. For products that have not been requested for a long time, gain agreement from the prescriber so that these can be deleted from repeat. 4

6 5 References The handling of medicines in Social Care - Royal Pharmaceutical Society. Accessed 29th July NHS England and Wales Electronic Drug Tariff. Part IX. Accessed on 29 th July 2013: Guidance for issuing appliance prescriptions NHS Dorset Accessed 29th July Dorset/Professionals/Community%20pharmacy/GuidanceforissuingapplianceprescriptionsFINAL.p df. Central and Eastern Cheshire Primary Care Trust MMT Focus: Continence and Ostomy Appliance Prescribing. No.25. March Acknowledgements Julia Corbett Continence Clinical Lead Nurse. Central Manchester NHS Foundation Trust Community Services. Amanda Smith Stoma Specialist Nurse. Salford Royal NHS Foundation Trust. Michele Dade Clinical Nurse Specialist Colorectal and Stomacare. Bolton NHS Foundation Trust. NHS Bolton CCG Medicines Management Team Janet Kenyon Prescribing Support Manager. NHS Central and Eastern Cheshire CCGs. Produced by: Jimmy Cheung (Support Pharmacist) GMCSU 5

7 7 Appendices Appendix 1: Continence and Stoma product prescribing guidance In 2012/13 Greater Manchester spent over 13 million on continence and stoma management products. Prescribing can be challenging given the vast array of products available; this guidance should support clinicians on the choice of appliance, appropriate quantities to supply and what information should be included on the prescription. A list of all continence appliances available on FP10 can be found in the Drug Tariff parts IXA and IXB; part IXC lists all stoma appliances. This can be accessed online at These appliances should always be prescribed by brand and not generic; this generally takes the format of the manufacturer s name, a description of the product and the manufacturer s code e.g. Bard (manufacturer) Uriplan 30cm Inlet tube leg bags 500ml (product description) D5L (manufacturers code). If the manufacturers code for the item description is entered, the prescribing system should select the specific product which saves scrolling through a long list. Directions and quantities should always be specified. The use of the term OP (Original Pack) should be avoided and if the patient is trialling a new product, a small quantity should be prescribed (if possible) to avoid waste. One month s supply would be a reasonable duration to supply thereafter. Some patients have their prescriptions delivered by appliance contractors rather than a community pharmacy; these usually order the product on the patient s behalf by letter. The request should have been made before the items are supplied to the patient as prescribers are under no obligation to provide a retrospective prescription for items already supplied by the contractor. In addition to the supply of appliances by DACs and pharmacy contractors, they are also allowed to provide two advanced appliance services: Stoma Appliance Customisation (SAC) This involves the customisation of a quantity of more than one stoma appliance, based on the patient s measurements. The aim of the service is to ensure proper usage and comfortable fitting of the stoma appliance which helps to maintain healthy peristomal skin and improves wear time of appliance, thereby reducing waste. The stoma appliances that can be customised are listed in Part IXC of the Drug Tariff. Appliance Use Reviews (AUR) - The aim of an AUR is to improve the patient s knowledge, help use their appliances more effectively and ensure cost effectiveness of treatment. AUR relates to products listed in Part IXA (qualifying items), Part IXB or Part IXC of the Drug Tariff. Such reviews must be conducted by a specialist nurse or by a suitably trained pharmacist. DACs and pharmacy contractors must notify the Local Area Team and NHS Business Services Authority of their intent to provide such advance services and ensure they meet the terms and regulations of services. 6

8 Continence products The range of products prescribed for urinary management includes catheters, catheter valves, leg bags, night bags, sheaths (plus fixing strips and adhesives), suspensory systems and leg straps/sleeves, catheter solutions and insertion gels. Anal plugs are prescribed for faecal incontinence. When prescribing indwelling catheters, it is important to specify the correct size (ch), balloon capacity and whether it s for male or female use. To improve patient comfort and reduce the risk of urethral trauma, the smallest catheter that provides adequate drainage should be used. Patients should always have a spare catheter available in case of blockage. Table 1 shows the average prescribing quantities per month. Some patients may require slightly more or less than the indicated average. If patients are identified as routinely over ordering continence appliances it may be appropriate to contact the local specialist advisory service for the individual to be reviewed. Table 1: Recommended average quantities of Continence appliances per month CONTINENCE: Appliance Duration Average monthly prescription quantity Prescription Direction Indwelling catheters (Foley catheters) Long-term Short-term Catheters single use PVC or self-lubricating NELATON Up to 12 weeks Can range from 1-4 weeks (check product selection) One (plus one spare) should last up to 3 months 1 to 4 (dependent on product selection and specialist directions) Change as directed up to every 12 weeks Change as directed (dependent on product selection and specialist directions) Usually 5-6 daily 125 ( 5 boxes of 25) Use as required Catheter valves One weekly 5 (1 box) Change weekly Sheaths Usually one sheath per day 30 (1 box) Use one daily Leg bags (drainable) Night bags (drainable) Usually one bag every 5-7 days Usually one bag every 5-7 days 5 (usually supplied in boxes of 10 so one box should last 2 months) 5 (usually supplied in boxes of 10 so one box should last 2 months) Drain as required. Change every 5-7 days Drain as required. Change every 5-7 days Night bags (non-drainable) Usually one bag per day 30 (3 boxes of 10) Use one each night Anal plugs Usually replaced every 12 hours 60 (3 boxes of 20) Replace every 12 hours 7

9 Stoma products Ostomy bags can be either one-piece or two-piece systems. A two-piece system comprises of a flange and separate bag, the flange attaches to the skin and the bag is then attached to the flange. The flange can be left in place and attached to a new bag; flanges are generally replaced every 2-3 days. One-piece systems attach directly to the patient s skin so a flange is not necessary. Ileostomy and urostomy bags can be drainable but colostomy bags cannot be reused and are disposed of once full. Most urostomy patients will use a drainable night drainage bag however some will use non-drainable and replace each night. Patient capability and preference should be considered when choosing an appropriate appliance. Urostomy bags are generally supplied in multiples of 10 whereas ileostomy and colostomy bags are usually supplied in boxes of 30. Flanges may be supplied in packs of 5 or 10. DACs and pharmacy contractors must supply wipes and disposal bags with ostomy products free of charge which do not need to be added to the prescription. A number of accessories are available on prescription which include deodorants, solidifying agents, bag closures, adhesives and adhesive removers, belts, filters, shields and skin protectors and stoma caps; these items require a prescription. Products for the management of tracheostomies include tubes, filters, brushes and masks. Tubes are generally changed every one to two weeks. Table 2 shows the maximum use and average prescribing quantities per month. Some patients may require slightly more or less than the indicated average. If patients are identified as routinely over ordering stoma appliances it may be appropriate to contact the local specialist advisory service for the individual to be reviewed. Table 2: Recommended average quantities of Stoma appliances per month STOMA: Appliance Colostomy one-piece (not drainable /reusable) Colostomy two-piece (not drainable /reusable) Colostomy flange (for use with two-piece bag) Ileostomy one-piece (drainable) Ileostomy two-piece (drainable) Ileostomy flange (for use with two-piece bag) Urostomy one-piece bag (drainable) Urostomy two-piece bag (drainable) Urostomy flange (for use with two-piece bag) Urostomy night bag (drainable) Site and Output Large bowel. Solid. End of small bowel. Semi-solid. Urine drainage. Constant. Maximum use 3 bags per day (90 bags per month) 3 bags per day (90 bags per month) 4 flanges a week (20 a month) 1 bag per day (30 bags a month) 1 bag per day (30 bags a month) 4 flanges a week (20 a month) 1 bag per day (30 bags a month) 1 bag per day (30 bags a month) 4 flanges a week (20 a month) 6-10 bags per month Average monthly prescription quantity 60 bags (2 boxes of 30 bags) 60 bags (2 boxes of 30 bags) 15 flanges (3 boxes of 5) 30 bags (1 box of 30 bags) 30 bags (1 box of 30 bags) 15 flanges (3 boxes of 5) bags (1-2 boxes of 10 bags) bags (1-2 boxes of 10 bags) 15 flanges (3 boxes of 5) 1 box of 10 bags every 2 months Prescription Direction Remove and discard after use Remove and discard after use Change every 2-3 days Drain as required throughout day. Use a new bag every 1-2 days Drain as required throughout day. Use a new bag every day Change every 2-3 days Drain as required throughout day. Use a new bag every 1-2 days Drain as required throughout day. Use a new bag every day Change every 2-3 days Use a new bag every week 8

10 Appendix 2: Template Letter to Appliance Contractor [Name and address of contractor] [Practice Address] [Date] Dear [Appliance Contractor] Re: Prescription request of continence and stoma products Greater Manchester Medicines Management Group (GMMMG) has produced guidance with respect to prescription requests of continence and stoma products. Please note the following: No items should be supplied to the patient in advance of a prescription. Please ensure that you have a valid prescription before making a supply to the patient. It is the policy of this practice not to supply post-dated or post supply prescriptions without prior arrangement. Prescribers will only supply a prescription for appropriate quantities. Repeat prescriptions will not be issued more frequently than [4 weekly]. Changes should not be made to a patient s prescription without the consent of the specialist nurse or patient s GP. Many thanks for your time and co-operation with this matter. If you require any further information, please contact the surgery. Yours sincerely, 9