North of Tyne APC 1. Prescribing Guidelines for Stoma Accessories (Adult)

Transcription

1 North of Tyne APC 1 Prescribing Guidelines for Stoma Accessories (Adult) November 2015 (Third party ordering link updated June 2017) (Review November 2017) Background This guideline has been developed by a group of healthcare professionals including nurse specialists across the north of Tyne area (see contact details on page 6) and pharmacists employed by Newcastle upon Tyne Hospitals FT and NECS. The guideline is intended for use by prescribers to give guidance on the types of stoma accessories available and the appropriateness of prescribing, a list of recommended products and usual quantities to prescribe. Principles All accessories to be used under advice of stoma care nurse (SCN) specialist If quantities ordered exceed those listed without good reason, refer patient to stoma care nurse specialist Stoma 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 Stoma will be oedematous for initial 6-8 weeks, reducing and changing shape during this time. Therefore products often need to be accordingly during this time. The stoma will be reviewed by SCN regularly and any necessary changes made. Guidance for issuing prescriptions requested by a third party are available on the North of Tyne Area Prescribing Committee website: pdf This guidance incorporates a set of guiding principles to support the management of prescriptions requested by third parties, such as appliance contractors. 1 Representing Newcastle Upon Tyne Hospitals NHS FT, Northumberland HealthCare FT, Northumberland Tyne & Wear NHS FT, Newcastle North and East CCG, Newcastle West CCG, North Tyneside CCG, Northumberland CCG, Community Pharmacies North of Tyne 1

2 Prescribing Guidelines for Stoma Accessories (Adult) Accessories Notes Frequency of use Quantity Adhesive remover 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 2-3 cans per month 1 tube alternate months Belts Usually worn with a convex appliance. Washable 3-6 per year and reusable Deodorants Should not be required. If pouch is correctly fitted, Not routinely required 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 Used each time stoma appliance 1-2 boxes per month sachet that is placed into the pouch to thicken watery contents emptied Drainable bag fasteners N/A As required 1 box per month Flange extenders/retention strips Used for increased pouch wear time. Avoids use of tape Used each time stoma appliance 1-2 boxes per month Powders Used for protection of excoriated/bleeding skin Used each time stoma appliance 1 powder tube alternate months Protective rings Used for skin protection and useful to fill skin Each time appliance As per appliance creases. To be used under advice of stoma care nurse only Protective wafers Short term use only Short term use only Skin fillers (pastes) Skin protective wipes Used to fill skin creases. Not usually for long term use Short term use only (acute prescription): May be used on skin that is irritated/inflamed to promote healing. If used for > 3 months, refer patient to stoma nurse Used each time stoma appliance Apply when bag is as directed 1-2 tubes per month 1 box every 1-2 months 2

3 Prescribing Guidelines for Stoma Accessories Recommended products (Adult) Accessories Company Recommended products Code Quantity Adhesive remover CD Medical Peel Easy 50ml spray ml Coloplast Brava Adhesive Remover Spray 50ml ml CS Bullen Trio Niltac Sting Free Medical Adhesive Remover Spray 50ml TR1 50ml Barrier creams Aspen Medical Europe Sorbaderm Barrier Cream 28 92g Clinimed LBF Barrier Cream 3823 g Belts As per appliance Use belts with recommended product Discharge solidifying agents Bullen Trio diamonds TR5 0 sachets Opus Healthcare Limited Absorbogel sachets Flange extenders/retention strips Coloplast Salts Ostomart Brava Secuplast hydro Ostofix SPHA2 SPH 1 DWF80 DFW Powders Convatec Orahesive Powder Ostoseal S6 25g Ostomart Protective Powder ABP1 25g Protective rings Dansac Gxtra Seals: 20mm mm 40mm 50mm /40 725/50 Dansac Seals: 20mm

4 mm 40mm 50mm Hollister Seals: Adapt Barrier Rings (48 mm) Flextend M Adapt Barrier Rings (98mm) Flextend M Adapt Convex Barrier Rings (17-26mm) Flextend Adapt Convex Barrier Rings (27-36mm) Flextend Adapt Convex Barrier Rings (37-46mm) Flextend 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 Coloplast Protective wafers Convatec Duodern Extra Thin xcm S161 Skin fillers (pastes) Convatec Stomahesive S5 60g Orabase paste S3 g Hollister Adapt S90 57g Skin protective wipes Clinimed Clinishield Wipes wipes CS Bullen Trio Silesse Sting Free Barrier Wipes TR3 wipes 3M Health Care Cavilon Stoma Wipe 3344E wipes 4

5 Prescribing Guidelines for Stoma Appliances (Adult) 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 Pouch 1-3 times a day pouches : Usually packed in boxes of Ileostomy Small bowel stoma Semi-formed or loose output Average volume mls One piece drainable appliance Two piece drainable appliance Changed every 1-2 days Flange times a week 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 For flush/retracted stomas or those in a crease. Sometimes need a belt attachment 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 Pouch 1-3 times a day 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 ) - 90 pouches : Usually packed in boxes of or One piece drainable appliance Changed every 1-2 days 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 Pouch every 1-2 days 15 - pouches : Usually packed in boxes of or Stoma Caps Used over a mucous fistula and in conjunction with colostomy irrigation Stoma cap every 2-3 days 1 box alternate months 5

6 Contact information for Stoma Care Nurse Specialists (Adult) Newcastle Acute Hospitals Allison Sharpe, Deborah Hall & J u l i e M c D i n e Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP Newcastle Community Jacqui Clish Walkergate Centre Scrogg Road Walker Newcastle upon Tyne NE6 4EY Northumbria Healthcare (shared Acute & Community) Chris Watson Claire Ryan Kelly Henderson North Tyneside Community Hazel Moore and Diane Thomson Victoria Therapy Centre Hawkeys Lane North Shields NE29 0SF Monday - Friday 8: am to 5:00 pm Tel: Fax: Amanda Logan & Darren Vernon Freeman Hospital Freeman Road High Heaton Newcastle upon Tyne NE7 7DN Monday Friday 8: am to 5:00 pm Tel: Julia Hall Monday Friday 9.00 am to 5.pm stomacareservice@northumbriahealthcare.nhs.uk; Monday - Friday 8. am to 5:00 pm Tel No: Fax No: Monday Friday 8:00 am to 5:00 pm Tel: Fax: