Appendix B: Stoma Care Accessory Products Prescribing Guidance

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1 Appendix B: The aim of this guidance is to: Provide some basic information to prescribers and other healthcare professionals on the use of stoma care accessories Assist in the prescribing decisions of stoma care products in primary care. All stoma appliances expected to be initiated by stoma specialist and there for AMBER on the formulary This guide provides a list of the most clinically cost effective stoma care products within each product group as listed in the Drug Tariff. Suggested prescribing quantities have been indicated where possible. Pricing information has been taken from the Drug Tariff May 207. The products highlighted in BOLD are identified as offering best value in terms of clinical efficacy and cost effectiveness. Colorectal Nurse Specialists are available to assess and reassess all stoma patients and make recommendations for the best management of the individual. They are available for consultation where any problems in stoma management arise. Colorectal Nursing Service Contact Details: see Stoma Toolkit 207 Original July 20 (amended Dec 203, May 207) Prices may fluctuate on a monthly basis, the most up to date pricing information can be found via Drug Tariff, accessible online via

2 Adhesive Flange Extenders/strips Coloplast Ltd Brava elastic tape 20 strips Clini Med Ltd Pelican HydroFrame extenders Hydroframe flange extenders Pelican Contour Flange Extender 30 strips 20 WAF M33 WAF H Security frames (sometimes called flange extension or retention strips) offer additional security to an appliance, by providing a reliable and effective way to secure a pouch, and to prevent leaks. These are hydrocolloid based products and used to secure bags or flanges to the skin where patient requires added security or used to reinforce seals in patients with leakage problems., Plasters often cause allergic skin reactions and may leave adhesive residue Individuals currently receiving prescriptions for adhesive discs, rings pads or plasters should be referred for review to stoma nurse specialist as there is a very limited role for use of these products. The selected products listed are more appropriate and should replace adhesive tapes and plasters etc. Salts Healthcare Secuplast Aloe 30 SPHA

3 Adhesive Removers (AR) Sprays//Wipes Salts Healthcare WipeAway Adhesive Remover 50ml aerosol Coloplast Ltd Brava Adhesive remover 50ml spray CD Medical Peel-Easy 50ml aerosol OstoMart OstoCLEAR 30 sachets MRW 9.23 TR Adhesive removers are used to facilitate removal of any adhesive residues & to reduce skin trauma on removing appliance. There are 3 types of adhesive removers (ARs) - silicon based oil based & alcohol based and available in 2 types of application device - sprays & wipes. Formulary choices are all silicone based products. Wipes may be more useful for the elderly and/or individuals with reduced or limited dexterity or where problems of excess adhesive residue exist. Sprays are suitable for general use and usually more cost effective to prescribe. Only products considered to be price equivalent are included. All silicon based adhesive remover products are interchangeable without compromise to patient care. 3

4 Odour Neutralising + Lubricating products Coloplast Ltd Skin Powders OstoZyme Multi 300ml TCB Used for problems of pancaking in patients with poor dexterity. Coloplast Brava Lubricating Deodorant OstoMart OstoZyme Odour Neutralising 240ml x 8ml TCB Pancaking causes leaks of stoma output between the flange and skin leading to excoriation of the skin around stoma site and can be uncomfortable and messy to change. Conva Tec Ltd Orabase Paste 25g S Powders are sprinkled around the stoma to heal sore weepy or wet peristomal skin and enable Coloplast Ltd Brava Ostomy Powder 25g adherence of stoma appliances. Usually only used for ileostomy and sometimes urostomy patients. The Hollister Ltd Adapt Stoma Powder Ostomart powder has Aloe Vera incorporated into powder. Patients should only require powder every 2 months as they should be used liberally. Pancaking is a term used to describe where the stoma output collects around the stoma instead of going down into the bag, It can occur when there is not enough air in the bag to allow output to go down to the bottom of the pouch. A few drops of oil e.g. baby oil &/or covering the filter with filter covers supplied in each box of stoma bags can help prevent problems of pancaking. If a patient is continually receiving repeat prescriptions for powders they should be referred for review by stoma specialist nurse. 4

5 Skin Barrier Wipes & Sprays Salts Healthcare Peri-prep sensitive no sting protective wipe Coloplast Ltd Brava Skin barrier wipe 30 sachets Skin barrier creams Brava Skin barrier spray OstoMart OstoGuard No sting protecti skin barrier film 30 sachets 50ml PPS Barrier wipes & sprays protect the skin from the corrosive effects of stoma output. All the wipes listed apart from Salts periprep wipes are silicon based. Oil and alcohol based wipes are no longer recommended as barrier wipes of choice. 30 RMC3 2.0 Cavilon has not been included at present, although there is a stoma wipe available. Patients may already be using a product that suits their skin, so consider this when changing repeat prescriptions. CliniMed Ltd LBF barrier cream 30g Creams if used as an alternative to barrier wipes for sore skin should be OstoMart OstoGuard 20 RMC applied around stoma, left for 2 Barrier Cream sachets minutes then wiped off to prevent OstoMart OstoGuard Barrier Cream 60g RMC 4.95 failure of adhesive. Barrier creams sachets may be more cost effective to prescribe as tubes of cream can work out to be more expensive due to the amount of product waste. Cavilon barrier cream is not suitable for use as barrier protection for stoma patients. Barrier creams are also used for patients that have had ileo-anal pouch surgery for post-op care. All silicon based barrier wipes are interchangeable without compromise to patient care. Peri-prep wipes PPS is a patented water based wipe and offers an alternative cost effective non silicon based barrier wipe option but as it contains a small amount of alcohol to facilitate evaporation it should not be used on very sore or excoriated skin. Skin Pastes & Fillers 5

6 Conva Tec Ltd Salts Healthcare Dansac Ltd Stomahesive paste Cohesive paste Soft paste 60g 60g 50g S05 SP Pastes are used to fill skin dips and creases around stoma sites to secure pouch to prevent leakage. They are particularly used for problematic stomas and fistula care. Seals (washers) Continued over page These products should only be prescribed under the recommendations and supervision of a stoma nurse specialist. Product List is as specified in drug tariff. Hollister Ltd Coloplast Ltd Adapt barrier rings 98mm Adapt barrier rings 48mm Convex barrier ring (7-26mm Convex barrier ring (27-36mm) convex barrier ring (37-46mm) Adapt oval convex rings (22-38mm) Adapt oval convex rings (30-58mm) Adapt oval convex rings (38-56mm) 2.5mm (8-48mm) 2.5mm (27-57mm) 2.5mm (34-64mm) Seals and washers are used on peristomal skin that has crevices, fistulas or scar tissue making skin surrounding stoma uneven. Used in patients with problems of leakage are due to either a difficult sited stoma (eg in a skin fold) or recessed or flat stomas (ie stomas flush to the skin). Off centre seals are available from Dansac that are not on this guide, please seek advice from your local stoma/colorectal nurse. (please see misc) Large seals are particularly indicated in the care of fistula management. Use will depend on the depths of skin folds etc but prescription requests for more than 2 x 60g tubes per month should be reviewed. Product choice is under advice from stoma specialist nurses. The choice of product is generally governed by the type of problem causing the leak. Seals and washers are easily mouldable to all the body contours to ensure increased comfort and fit. Some seals are available in a convex range for stoma that is in dips/creases to help prevent leakage problems. 6

7 Salts Healthcare 4.2mm (8-48mm) 4.2mm (27-57mm) 4.2mm (34-64mm) Secuplast Mouldable Seals Thin Secuplast Mouldable Seals Standard Secuplast Mouldable Seals Large SMST SMSS SMSL

8 Discharge Solidifying Agents Opus Healthcare Absorbagel sachets These are thickening agents designed to absorb moisture from C S Bullen Ltd Absorbian Sachet Plus 30 UFAS OstoMart OstoSorb 3g sachets 30 PFW stoma output thereby reducing likelihood of leakage and reducing frequency of pouch emptying. Liquid stools have increased tendency to leak. Discharge solidifying products are considered to be interchangeable. Their use should be reserved for those patients with high or excessive watery output in high output ileostomies unresponsive to drug treatment strategies and dietary measures to control excessive fluid loss. Loperamide capsules or codeine should be considered first line measures to try in the control of diarrhoea or excess fluid loss in stoma patients as it offers a more cost effective prescribing option. Methylcellulose (celevac) tablets are also licensed for use in the control of colostomy and ileostomy output. Methylcellulose is a hydrophilid colloid which absorbs water causing it to swell to a soft gel of uniform consistency. 8

9 Filters & Bridges Opus Healthcare ClearWay Stoma Bridge Stoma bridges can help the stool to drop to the bottom of the pouch, thus helping to prevent pancaking for colostomy patients Patients using some of these older products should be considered for review by stoma nurse specialist Miscellaneous Items Continued over page Dansac Ltd Seal (off centre) These seals have an off centre hole, 20mm suitable for problematic stomas, increased absorbancy properties, so 30mm effective in wet areas. 40mm mm Salts Healthcare Dermacol Dermacol is a collar that helps to Up to 20mm 30 DC provide a leak-proof barrier around the base of the stoma, helping 23mm 30 DC prevent output from coming into 26mm 30 DC contact with the skin. Dermacol is suitable for use with all types of 29mm 30 DC appliances. 32mm 30 DC mm 30 DC mm 30 DC Coloplast Ltd Protective sheets Protective sheets are used to protect 00x00mm peristomal skin for problematic stomas and fistula management. 50x50mm The appropriate size should be used 200x200mm to prevent wastage. 9

10 Conva Tec Ltd Stomahesive wafers 00 x 00 mm 5 S x 200 mm 3 S Coloplast Ltd Coloplast Ltd Peak Medical Ltd Conva Tec System 2 Belt S Belts are used to attach to belt loops Coloplast Brava Belt onto stoma pouches that have belt loops attached (usually convex) to Dansac Ostomy Belt white50cm Beige00cm Beige 50cm 7.78 help secure and position pouch adequately. They can be washed and used again. Welland Freestyle Vie Belt Salts Adjustable Ostomy Belt Brava Belt, Standard Size Brava Belt XL Brava Belt (for SenSura Mio) standard XL EuroTec Adjustable Elastic Ostomy Belt (50mm) BLTS0 White standard White Large AB0 00cm beige Pelican Small (60-75cm) Medium (75-90cm) Large (90-0cm) X Large (0-30cm) XX Large (30cm and above) Pelican Adjustable Ostomy Belt SB 50 S SB 50 M SB 50 L SB 50 XL SB 50 XXL

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