Catheter, Stoma & Skincare Formulary

Transcription

1 Catheter, Stoma & Skincare Formulary Version 11 Contents: December 2018 Catheter products Stoma accessories Skin care products Prescribing Indicator Second Line Special Consideration Community nurses/district nurses: Items not listed in this formulary are non-formulary. If needed for a particular patient, an exception reporting form should be completed (available on SCH website). Catheters Initial catheterisation: the catheters listed in this formulary can be ordered by community nurses through NHS Supply Chain for initial use only. Long term catheter use: a prescription should be requested from GP practice. Stoma and skin care products Stoma products: request a prescription from GP practice. Skin care products: (excluding stoma skin care products) patients to be advised to purchase skin care products GP practice staff Wherever possible formulary items should be prescribed. If a non-formulary item is required, an exception reporting form should be completed (available on WSCCG & IESCCG website)

2 Catheter Products Intermittent Catheters 1. Single-use Intermittent Catheters (single use) Intermittent catheterisation allows patients to empty their bladder when the normal functioning of the bladder is impaired. A single use catheter is inserted into the bladder by the patient to drain the bladder and is then removed. The frequency of use will depend on the patients clinical need and in normal circumstances may be up to 5 times daily for bladder emptying. *In certain circumstances some patients may require more frequent bladder emptying, including those with neurological and spinal conditions. This cohort of patients, following assessment by a qualified nurse in this field, may require bladder draining every 3 hours or up to 10 catheters per day* Appliance Product details Gauge/ CH size Cost per pack (pack size) Comments Usual quantity to order Teleflex Flocath Quick Male 40cm Female 20cm (30) Integral saline solution Protective sleeve for touch free application Approx. use in normal circumstances 4-5 catheters per day / 4-5 packs per Teleflex Liquick Base Male Female 6-14 Paediatric (60) Higher Quantity Pack For patients requiring a more flexible catheter Approx. use 4-5 catheters per day / 2-3 packs per Second Line Coloplast Speedicath Wellspect Healthcare LoFric Primo Compact Option Male Female (30) Male (30) Female 15cm/20cm (30) Paediatric (30) Quantities may be higher for patients with neurological / spinal conditions For patient selfcatheterisation Approx. use 4-5 catheters per day / 4-5 packs per Speedicath Compact Male Female Compact size for rapid use when mobile/out of home OR poor dexterity Pre Lubricated May be a 2 nd product at lower quantities on repeat

3 Pathway considerations for Intermittent catheterisation Patients may be assessed and commenced on intermittent catheterisation from the following settings: Acute: Ipswich Hospital / West Suffolk Hospital - Urology Clinic - Urogynaecology Clinic Community: Suffolk GP Federation - Bladder and Bowel Community Service When considering patient appliance overuse or changes in patient clinical need, patients should be assessed by their GP and if required referred back to the service which commenced the treatment. Relevant contacts: Suffolk GP Federation Bladder and Bowel Service: Ipswich Hospital central number: West Suffolk Hospital central number:

4 Indwelling Catheters and Accessories Appliance Product details Gauge/ CH size Cost per pack (pack size) Comments Usual quantity to order 2. Long-term indwelling catheters (use for up to 12 weeks) Rüsch Sympacath AquaFlate Hydrogel Coated Latex with prefilled syringe L.I.N.C All-Silicone catheter with prefilled syringe and Lidocaine Gel Second Line Rüsch Brillant AquaFlate All-Silicone catheter With prefilled syringe Bard Biocath Hydrogel Coated Male Female Male Female Male Female (1) Paediatric use only 5.57 (1) 6.11 (1) Paediatric 5ml (1) 1 st Line *Contains LATEX* 2nd choice or patients with latex allergy *Includes lidocaine gel with pack* 2 nd line choice or patients with latex allergy Paediatric only *Contains LATEX* 1 catheter every 4-12 weeks In normal circumstances 1 catheter can last 12 weeks Suprapubic catheters or complex conditions may require more frequent changes 3. Catheter maintenance solutions Sodium chloride 0.9% OptiFlo S Bard 50ml 3.42 Uro-Tainer NaCl 0.9% Braun 50ml 3.45 Solution G Used to unblock a catheter Usually not on repeat unless requiring regular bladder wash outs OptiFlo G (Suby G) Bard 50ml Uro-Tainer Twin (Suby G) Braun 2x30ml sachets 3.54 (50ml sachet) 4.85 (2 x 30ml sachets) For patients prone to encrustation. Used as regular maintenance to prevent blockage Usually not on repeat unless requiring regular bladder wash outs 4. Catheter lubricating gel Cathejel Lidocain Female 8.5g 1.10 Male 12.5g 1.15 For catheter insertion Contains Lidocaine *Not required for LINC catheters that include Lidocaine gel PRN for use at each catheterisation 5. Catheter valves (change every 7 days) Care Flo catheter valve L.I.N.C 7.59 (5) Lever tap Qufora Catheter Valve Qufora 8.50 (5) Alternative to leg bag *Assessment of bladder function is necessary before using this product* 4 valves per Month

5 Incontinence Sheaths and Accessories Appliance Product details Gauge/ CH size Cost per pack (pack size) Comments Usual 6. Incontinence Sheaths (External Catheter) Prosys Flofit Self Adhesive Silicone Sheath Standard Pop-on Wide Band 24mm 28mm 31mm 35mm 40mm (30) Second Line Jade Ultra Flex Extra Clear Sheath Small Medium Intermediate Large 25mm 29mm 32mm 36mm 41mm (30) Use 1 sheath per 24 hours *Ensure patient is correctly measured prior to use* Approx. use 1 sheath per day / 1 pack per Extra large 7. Sheath Accessories Barrier Film Wipes Coloplast Conveen Prep Wipes 1 st Line Contains Alcohol Smith & Nephew Secura Barrier Film Wipes (Alcohol-free) Sheath prep wipes Barrier film Wipes Box of Box of wipe used at each sheath change Approx. every 24 hours High Quantity Pack 2 boxes every 3 s Adhesive Remover Great Bear GB Soft Skin No Sting Medical Adhesive Remover Spray Great Bear GB Soft Skin No Sting Medical Adhesive Remover Wipes Aerosol Spray 50ml 9.32 Wipes Pack of To aid sheath removal when required 1 can of spray per 1 box of wipes per

6 Drainage Bags and Accessories Appliance Product details Gauge/ CH size Cost per pack (pack size) Comments Usual quantity to order 8. Leg Drainage Bags Direct inlet 5cm To maintain a closed system overnight leave the leg bag connected and connect a night bag to the leg bag. Qufora Leg Bags Use for 7-10 days Choice of lever tap or T tap 500ml 750ml Short tube 10 cm 22.40(10) All Qufora leg bags can be drained at degrees, which is an advantage for people with poor manual hand dexterity. Approx. 1 box every 2-3 Long Tube 30cm All long tube leg bags have spare connectors, but cutting tubing for adjustment is not recommended LINC Medical Systems LINC Flo Leg Bag Use for 5-7 days 350ml T tap only 500ml Lever tap / T-tap 750ml T-tap only Direct 10cm tube Direct 10cm tube 30cm tube Direct 10cm tube 30cm tube (10) Each box comes with 10 pairs of leg bag straps (10) To maintain a closed Approx. 1 box system overnight leave the every 2-3 s leg bag connected and connect a night bag to the leg bag (10) Second Line Teleflex Rusch Leg Bag Use for 5-7 days *Choice of lever tap or slide tap* 350ml 500ml 750ml 10cm tube 30cm tube 10cm tube 30cm tube 10cm tube 30cm tube (10) Each bag comes with 2 leg bag straps (10) (10) To maintain a closed system overnight leave the leg bag connected and connect a night bag to the leg bag Approx. 1 box every other 9. Belly bag (use for up to 28 days) Teleflex Rusch Belly Bag B1000 *Patient must have functioning bladder musculature to use product* 1 litre Twist tap (1) For patients where a leg bag cannot be Connected *Not suitable for external catheters or nephrostomy tubing* 1-2 bags per

7 Appliance Product details Gauge/ CH size Cost per pack (pack size) Comments Usual quantity to order 10. Disposable Single Use Night Drainage Bags Qufora Non-sterile Single use bags Linc-Flo Non-sterile Single use bags 2 litre 90cm tube 2.05 (10) 100cm tube 2.13 (10) First choice single use tear perforated edge to empty *may not be appropriate for patients with poor dexterity* First choice single use Twist off tap 1 bag per night 3 boxes per Second Line Teleflex Non-sterile Single use bags with slide tap outlet 2 Litre 120cm kink resistant tube 9.55 (30) *higher quantity* Single use bag with slide tap outlet Includes 1 x bed hanger per pack 1box every 11. Reusable Night Drainage Bags Qufora drainage bag with tap outlet Use for 7-10 days Linc-Flo drainage bag with tap outlet Use for 5-7 days 2 litre lever tap / T-tap Second Line Reusable Drainage Bag with 120cm inlet tube 120cm antikink tube 9.57(10) Change every 7-10 days (10) Change every 5-7 days 1 box every 2-3 s *If patient using bags more frequently consider daily single use bags as alternative* Teleflex Rusch night drainage bag 2 Litre lever / slide tap 120cm kink resistant tube (10) Change every 5-7 days Each bag has integral bed hanger 1 box every 2-3 s 12. Accessories Leg bag holders Small 24-40cm Clinisupplies Prosys sleeves Clinisupplies Prosys Leg bag straps Medium 36-50cm 7.61 (4) Large 40-65cm P10LS (10) Washable PRN use Approx. every 4-6 s G-strap Clinisupplies Prosys Retainer Strap Adult (5) Abdominal (5) Washable PRN use Approx. every 4-6 s

8 Stoma Accessories Product Quantity Price Comments Usual quantity to order 1. Barrier films (used with each bag/flange change) 3m Health Care Cavilon No Sting Barrier Film Pump Spray StoCare Protect Barrier Film Wipes 28ml 5.79 Used on skin that is broken, sore or weepy to promote healing Salts Barrier Film Wipes 2 nd Line For selected patients only (diabetics, palliative patients and difficult stomas) 1 box/bottle per 2. Skin fillers Hollister Adapt Paste 60g 4.00 Dansac Soft Paste 50g 3.74 Oakmed Paste 2 nd Line 56g 7.69 Used as a sealant for creases and crevices 1-3 per 3. Sore Skin Accessories Orabase paste S103 30g 2.16 Used to heal around stoma Not for regular use Coloplast Brava Powder 25g 2.45 Convatec Orahesive Powder 25g 2.50 OstoMart OstoSEAL Protective Powder 50g 4.92 For wet skin, short term use 1-3 per Higher quantity tubes may last longer Ilex Skin Protectant 2 nd Line 57g Discharge solidifying agents Bullen Absorbian Sachets 30 sachets Opus Deogel 200ml 8.05 Opus Deogel Sachets 2 nd Line 50 sachets Absorbs effluent Mainly for ileostomies 1 per Respond Ostosorb 150 sachets *Higher Quantity Option* 5. Flange extenders Salts Flange Extender with Aloe Coloplast Brava Elastic Tape Dansac X-tra Strips Extends adhesion of bag. Especially if patient has a hernia 1-2 boxes per Ostomart Astoa

9 Product Quantity Price Comments Usual quantity to order 6. Mouldable washers Salts Barrier Rings Thin / with Aloe Salts Barrier Rings Standard / with Aloe Hollister Adapt Barrier Rings 48mm Pelican Cohesive Slims Small 2 nd Line Pelican Cohesive Seals Small 2 nd Line / / Used on problem stomas An adhesive sealant to fill creases/crevices around stoma 1-3 box per Higher amount of packs may be required when prescribing lower quantity packs Dansac TRE Seal 30mm 2 nd Line Adhesive Removers (Sprays/Wipes) (used with each bag/flange change) StoCare Remove Adhesive Remover Spray Opus Lift Plus 360 / with Citrus 360 Dansac Easy Spray Adhesive Remover Spray 2 nd Line Respond Ostomart OstoPEEL Adhesive Remover Spray 2 nd Line StoCare Remove Non-sting Adhesive Remover Wipes Salts Adhesive Remover Wipes 2 nd Line 8) Belts and Support Coloplast Brava Belt (standard XL size) Oakmed Adjustable Ostomy Belt 100cm 50ml ml ml ml wipes wipes belt Used each time stoma bag is changed Sprays are more cost effective than wipes Use to secure and support ostomy pouches in position 1-3 cans per (depending on frequency of bag changes) Maximum quantity 3 per year Restrictions Stoma support garments and clothing - Level 3 Following specialist recommendation only (Level 1 and 2 garments are OTC items) Deodourants, cleansers and soaps are not clinically necessary and prescribing of these products will not be supported in Suffolk. Please refer to CCG Website for Ostomy Accessories List - Prescribing Indictor for further prescribing guidance Contacts: Ipswich & East: Suffolk GP Federation Community Stoma Nurses: Debbie Cooper, Sarah Skingley West Suffolk Community Stoma Nurse: Bernadette Ambrose Ipswich Hospital Trust Stoma Nurses Sharon Stopher, Sally Power West Suffolk Hospital Stoma Nurses Katie Lloyd, Ann Hubble

10 Skincare (OTC) = Item is available for patients to purchase over the counter Product 1. Soap Substitute Emulsifying ointment (OTC) Epimax (OTC) Zero AQS cream (OTC) Dermol 500 Lotion (OTC) Only if infection present or frequent complication 2. Emollients (Leave on preparations) Where required in Primary Care for patients with chronic skin conditions e.g. psoriasis or eczema, prescribe larger tubs i.e. 450/500G only. Where use is intermittent, smaller packs are required or simply dry skin - these are available to purchase. Lanolin based products e.g. E45 or Exocream are not routinely recommended for chronic skin conditions due to allergy risk Epimax (OTC) lsomol gel (OTC) Zeroderm ointment White soft paraffin 50% / liquid paraffin 50% ointment (OTC) Second Line This is equivalent to Diprobase Cream. Can be used as a soap substitute. Low fire risk This is equivalent to Doublebase. Low fire risk. This is equivalent to Hydromol ointment (lanolin free) and Epaderm ointment. High fire risk High fire risk Ultrabase cream (OTC) Emollient preparations - Restricted Use Emollin spray Low fire risk 2 nd line Usually only on advice from specialist where: Sore and inflamed skin so unable to spread cream/lotion Where access to the affected site is difficult High fire risk Dermol cream (OTC) Zeroveen cream (OTC) Only if infection present or is a frequent complication Usually only on advice from specialist Restricted to paediatric use where they are unable to tolerate other emollients; ACBS borderline substance for patients with endogenous and exogenous eczema, xeroderma, ichthyosis and senile pruritus associated with dry skin only

11 3. Emollients with urea Emollients - Restricted Use imuderm (OTC) Balneum Plus cream (OTC) Eucerin Intensive lotion Calmurid cream (OTC) Dermatonics Once Heel Balm cream Equivalent to Balnuem cream Usually only on advice from specialist Usually only on advice from specialist Usually only on advice from specialist Inpatient use only on advice from specialist 4. Emollient bath and shower preparations Soap substitutes available OTC include: Epimax ZeroAQS Dermol 600 bath emollient may be used if recommended by a specialist for infected atopic eczema for 14 days Aveeno bath oil may be recommended by a specialist where there is an issue with paraffin based products There is a lack of good evidence to support the prescribing of these items. These should only be prescribed at the request of secondary care in exceptional circumstances. Patients should be encouraged to wash with soap substitutes Usually only on advice from specialist Restricted to paediatric use where they are unable to tolerate other emollients; ACBS borderline substance- for patients with endogenous and exogenous eczema, xeroderma, ichthyosis and senile pruritus associated with dry skin 5. Barrier Preparations Barrier Cream 1 st Line Conotrane Cream (OTC) 100g tube 0.88 Sudocrem (OTC) Primary Care only- use 1st line For use on intact skin. Primary Care only Barrier Cream 2 nd Line Medi-derma S Barrier Cream - 2 nd Line 90g tube 5.95 For use where Conotrane trialled and failed - can be used on damaged skin. Barrier Ointment and Incontinence Cleanser Restricted use Medi Derma-Pro Skin Protectant Ointment (equivalent to Proshield) Medi Derma-Pro Foam & Spray Incontinence Cleanser (equivalent to Proshield) Barrier Films 115 tube 8.50 For severe moisture excoriation 250ml bottle 5.95 Trial for up to 2 weeks *When skin integrity restored return to 1 st line barrier cream* Medi Derma Barrier film applicators (for use on peri-wound skin) 1ml Applicators (5) 3.70 Medi Derma Barrier Film Pump Spray 30ml spray 5.35 For use on moisture damaged skin around wounds, skin fold and creases.

12 6. Pressure sore prevention and low friction products Pressure reducing gel or foam pads are not an alternative to appropriate pressure relieving equipment, and will still require an appropriate clinical skin and pressure relief assessment, undertaken by a clinician within this field of expertise. Pressure reducing gel pads are not for use over broken skin. 10x10x0.3 cm x10x1.2 cm Gel pressure relieving strips Aderma Dermal Gel Pads Kerrapro Gel Pads Dyna-Tek Foam Positioning Products 20x20x0.3 cm x5x0.3 cm x2.5x0.3 cm 5.55 Heel Standard Heel Extra Large Sacrum/Ankle Wrap x2.5x0.3 cm x5x0.3 cm x10x1.2M cm x10x0.3 cm 4.30 Heel Sacrum/Ankle Foot & Heel protector (pair) 3.99 Devon Utility Pad 3.87 Not to be used over broken skin Gel pressure relieving pads for vulnerable intact skin Does not replace appropriate pressure relieving equipment Gel pressure relieving strips Not to be used over broken skin Gel pressure relieving pads for vulnerable intact skin Not for use as seating pressure relief

13 Silk Garments Product Size Price Comments DermaSilk: Facial Mask Body Suit Briefs Shirt Roll Neck Shirt Round Neck Tubular Sleeves (pair) Leggings (pair) Gloves (pair) Pyjamas (set) Knee Length Undersocks (2 pairs) Undersocks (per 2 pairs) Infant Child Teen Size Adult Size s s s s s s s years years years years years years years Adult Small XXL Adult (Male) Small XXL Adult (Female) Small XXL cm long cm long s s s s s s s years Adult (Male) Small XXL Adult (Female) Small XXL Small Child Medium Child Small Adult Medium Adult Large Adult years years years years Standard Length Longer Length Child Child Child Adult 5½ - 6½ Adult 7-8½ Adult 9-10½ Adult Silk garments can be washed repeatedly and reused 2 pairs of garments to be ordered at one time (one to wear / one to wash) Silk garments are restricted products - for the use of patients with severe skin disorders, causing the skin to become very fragile, for example Epidermolysis Bullosa

14 Process for Reviewing Formulary Products IS THE PRODUCT ON FORMULARY? NO YES DOES THE PRODUCT NEED TO BE ADDED? DOES THE PRODUCT NEED TO BE REMOVED? YES NO YES NO COMPLETE THE EXCEPTION REPORTING FORM SECTIONS 1 & 3 COMPLETE SECTIONS 1 & 3 OF EXCEPTION REPORTING FORM COMPLETE SECTIONS 1 & 2 OF EXCEPTION REPORTING FORM NO ACTION REQUIRED ATTACH TWO COMPARATIVE CONTROLLED STUDIES/BEST SUPPORTING EVIDENCE SEND TO TRALEE LASHLEY Medicines Management Team, Endeavour House, Russell Road, Ipswich IP1 2BX OR TO TRALEE.LASHLEY@NHS.NET FORMS WILL BE DISCUSSED AT TISSUE INTEGRITY & APPLIANCE GROUP (TIAG) MEETING (HELD EVERY 3 MONTHS) A DECISION WILL BE MADE AT TIAG MEETING DECISIONS WILL BE AVAILABLE ON THE SCH INTRANET