Guidelines for the prescribing of Stoma Additional Products Preferred in Primary Care

Transcription

1 Guidelines for the prescribing of Stoma Additional s Preferred in Primary Care he Specialist Stoma Nurses across Dorset have agreed a Stoma Care Additional Preferred Formulary; the most cost effective products have been selected on the advice and exience of the local stoma nurses. Stoma care additional products are prescribed for individual patients to help prevent sore skin and other problems developing with the stoma. New patients will be started on these formulary choices, existing patients should be reviewed when seen in clinic or during domiciliary visits to ensure formulary choice products are prescribed (if clinically appropriate). Patients seen by the stoma clinic will be issued with 14 days supply. he Stoma clinic will inform the GP of the patient s stoma repeat products. his information must specify quantities required for a 28-day iod. he patient should also be issued with a list of products prescribed for them, along with the recommended quantities for a s supply or frequency to order if required less often. Stoma clinics and GP practices must not provide retrospective prescriptions when requested by appliance contractors, dispensing practices or community pharmacies. All prescriptions with the appropriate quantities must be ordered by the patient or stoma clinic at least 14 days before they are needed. GP practices should have a process for checking the quantities and frequency of repeats and contact the patient if there is a query. If the GP practice, feel the patient is regularly over-ordering the stoma nurse should be contacted to follow this up. Stoma products should be issued on a separate FP10 prescription to the patient s regular medication. Stoma FP10 prescriptions should be sent to the patients nominated dispensing organisation for stoma products (this may be different from the patients regular dispensing organisation). If a GP has a patient receiving non-formulary stoma items and/or large quantities and has not had a recent review, the patient should be referred to their local stoma clinic (Poole General Hospital, Royal Bournemouth & Christchurch Hospital or Dorset County Hospital), details are listed on page 8 (he patient may also self-refer). If in doubt, contact the patient s Local Stoma Nurse (contact details on page 8) 1

2 Flow chart for requests for stoma additional products preferred on FP10 prescription Has the patient had/requested the stoma additional item before? Yes No Is the additional item on the Dorset Formulary? No* Yes No Has the patient tried an alternative within the same category before? (e.g. a different type of adhesive spray) Yes Check the quantity requested is appropriate (see table 1) No Refer to Specialist stoma nurse at RBCH, PCG or DCH. (Contact details on pg. 3) Yes Issue an FP10 prescription. (Do not add onto the repeat medication list, to avoid over-ordering) *he practice can suggest a formulary choice alternative or continue with the prescription request until a review takes place. Appropriate quantities should be issued to the patient (see table 1 for further guidance). 2

3 SOMA CARE ADDIIONAL PREFERRED PRODUC LIS his guide is for first line choices for most stoma patients. he list does not preclude other products where there are specific clinical reasons that make a first line option inappropriate. For further advice / guidance please contact the Stoma Care eam el: (Dorchester) or (Bournemouth) and (Poole) ype Manufacturer Name Adhesive Remover Spray Adhesive Remover Wipes Hollister Ltd Dansac Ltd Dansac Ltd CliniMed Ltd Adhesive Remover Spray (formally WipeAway Plus) Adapt No-Sting medical adhesive remover aerosol Dansac EasiSpray adhesive remover Dansac non-sting adhesive remover spray Appeel No sting medical adhesive remover wipes Adhesive Remover Wipes (formally WipeAway Plus adhesive remover sachets) 50ml WAP ml ml ml p 30 WAP p 1-4 bottles 1-3 packs o aid gentle adhesive removal preserving skin integrity. Effective for ileostomy and urostomy removal especially. o aid gentle adhesive removal, preserving skin integrity. 1 wipe should be used bag. 3

4 ype Manufacturer Name Barrier Wipes Filler/Sealing Paste Convaec Ltd OstoMart Ltd CliniMed Ltd Pelican Ltd Niltac Sting Free medical adhesive remover wipes Barrier Film Wipes (formally Peri-Prep sensitive no sting protective film wipes) OstoGuard no sting protective skin barrier film sachets LBF Sterile no sting barrier film wipes 30 R p 30 PPS p 30 RMC p p Cohesive Paste 60g Dansac Ltd Soft Paste 50g Stoma Paste 60g SP Paste Convaec Ltd Orabase Paste 30g S packs 1-2 tubes 1-2 Protects fragile skin. Protects skin from harmful effects of contact with stoma output. 1 wipe should be used bag. Prevents leaks by filling creases or providing reinforcement to adhesive seal. Pelican paste for use on sore or broken skin as contains no alcohol. AMBER - for protective paste for Peristomal or Mucosal Ulceration or Mucocutaneous Separation. Should only be a recurring item for patients with prolapsed stoma. 4

5 ype Manufacturer Name Flange Extenders Various Various 1-3 strips AMBER Individual choice based on patient needs only to be initiated by stoma nurse Provide extra adhesive area Mouldable Seals Collars Hollister Ltd Pelican Ltd Various Adapt barrier ring 48mm mm Adapt slim barrier ring 48mm Cohesive slims washer small 48mm Ostomy cohesive seal large 98mm SecuPlast mouldable hin 30 SMS seals Large 10 SMSL mm SAR25 SecuPlast Aloe ring 32mm SAR mm SAR mm SAR45 Various 1 1 Prevent leaks by reinforcing adhesive seal, act as filler. AMBER Individual choice based on patient needs; only to be initiated by stoma nurse 5

6 ype Manufacturer Name Lubricating Deodorant Hollister Ltd OstoMart Ltd Adapt Lubricating Deodorant Adapt Lubricating Deodorant Sachets OstoZyme Multi Odour Neutralising Lubricating Gel 236ml p sachet 300ml CB squirt / sachet Amber only after a trial of baby oil or alternative simple measures Protective Powder Convaec Ltd Orahesive powder 25g S Hollister Ltd Adapt stoma powder 28.3g AMBER only to be initiated by stoma nurse; Protective powder for broken skin or Mucocutaneous Separation. Solidifying agents OstoMart Ltd OstoSorb gel 3g sachets 30 PFW p/sach 150 PFW p/sach 1 AMBER only to be initiated by stoma nurse hickens liquid output to aid management. Pouch Clips Variable 10 1 box 6

7 ype Manufacturer Name Deodorising Spray Odour Eliminating Spray (Formally FreshAire) Appliance Belts Variable Variable Variable 50ml FA year AMBER Deodorising spray is only to be initiated by stoma nurse. AMBER - For use with convex es mainly; provides extra security and reinforces seal. Stoma Bridges Opus Clearway Bridge Mini p each Clearway Bridge p each 2 AMBER Used to help prevent leaks caused by pancaking of stool when problem not solved by simple measures Protective wafer/dressing *s correct March 2018 Drug ariff Protective wafers are NON-FORMULARY please use a dressing from the wound formulary found here. he Following Items are non-formulary and prescribing in primary care would not be expected: Underwear (except for hernia support underwear which is considered Amber Skin Cleansers and Washes Stoma Filters Liquid or aerosol adhesives (only sprays and wipes as above) Gauze swabs 1 Per Pouch Protects skin in cases of contact dermatitis. o cover wounds/ulcers etc. and allow adhesion. 7

8 For PIPs Forum (Patients Industry Professionals Forum) Stoma prescribing guidelines please click on the link below: Stoma Nurse Contact Details: GPs may refer patients to the Stoma clinics, or patients may self-refer. he stoma clinics available across Dorset are listed below; Dorset County Hospital NHS Foundation rust Vikki Andrews - Lead Nurse - Stoma Care eam elephone: Ext: stomacare@dchft.nhs.uk Royal Bournemouth and Christchurch Hospitals: Jane Wijeyekoon Stoma Nurse Specialist elephone: stoma.care@rbch.nhs.uk Poole Hospital NHS foundation rust racy Lees - Stoma Nurse Specialist elephone: stoma.care@poole.nhs.uk Guidelines for the prescribing of Additional s in Primary Care were adapted from the Wiltshire CCG Guidelines for the prescribing of stoma appliances and in conjunction with the Stoma Nurses from DCH (Vikki Andrews), RBCH (Carla McDonald) and PGH (racy Lees) with the Medicines Management eam NHS Dorset CCG. Written By Medicines Management eam January 2017 Approved By Dorset Medicines Advisory Group March 2017 Reviewed By Stoma nurse specialists (DCH, PHF, April 2018 RBCH) Approved By Dorset Medicines Advisory Group May 2018 Review Date May 2019 or before, in the light of new evidence and / or recommendations 8