Countywide Continence Service. Products Formulary

Transcription

1 Countywide Continence Service Products Formulary Reference No: Version: 1 Ratified by: G_CS_85 LCHS Trust Board Date Ratified: 14 th February 2017 Name of Originator/Author: Name of approving committee/responsible individual: Date Approved: 18 th January 2017 Date Issued: February 2017 Review Date: January 2019 Target Audience: Distributed via: Suzanna Kinder CNS Continence Jeanette Rimington CNS Continence Steve Whitehead- CNS Continence Allison Temple CNS Continence Lorna Adlington Medicines Optimisation Lead Quality Scrutiny Group Community Nursing Staff Website / Intranet Chair: Elaine Baylis QPM Chief Executive: Andrew Morgan

2 Continence Products Formulary. Version Control Sheet Version Section/Para/ Appendix Version/Description of Amendments Date 1 New January S Kinder Author/Amended by Copyright 2017 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner 2

3 Lincolnshire Community Health Services NHS Trust Continence Products Formulary Policy Statement Background Statement Responsibilities The Formulary has been developed to promote consistency of product choice across LCHS Trust and to be used as a vehicle for promoting best practice in the use of continence products The products listed in this formulary have been selected by the Continence Formulary working Party, Lincolnshire Community Services NHS Trust, Lincolnshire localities only. Judgement was based on expert opinion and evidence of clinical and costeffectiveness. Compliance with the guidance will be the responsibility of clinical LCHS staff. The guidance has been developed after consultation with Primary Care Practitioners with expertise in this speciality, Information Governance Department, Procurement and the Business Team. Training Promotion of continence and management of incontinence training, product training and care pathways are in place to support staff during the process of prescribing containment products. Dissemination Electronically via the LCHS Website Resource Implication This does not have any financial implications on the organisation. Consultation The guidance has been developed in line with the NHS Litigation Authority (NHSLA) guidelines to provide a framework for staff within NHS organisations to ensure the appropriate production, management and review of organisation wide policies. 3

4 Lincolnshire Community Health Services NHS Trust Continence Products Formulary Contents i) Version Control Sheet ii) Policy Statement 1.0 Guidance on the use of the formulary Urinary catheters Catheter drainage bags Leg bags Night drainage bags Catheter maintenance solution Catheter Valves Tubing and accessories Incontinence sheaths Urinal Systems Training References 17 4

5 1. Guidance on the use of the formulary The products listed in this formulary have been selected by the Continence Formulary working Party, Lincolnshire Community Services NHS Trust, Lincolnshire localities only. Judgement was based on expert opinion and evidence of clinical and cost-effectiveness. The products recommended should be the first choice and would be suitable for the majority of patients. However, patients are individuals and after a clinical assessment it may be appropriate to choose an alternative product, which would be more effective in specific cases. This formulary should be used in conjunction with the continence good practice guide (DH April 2000) and policies, as endorsed by Lincolnshire Community Services NHS Trust. Although most community pharmacies will stock the most common products, 48 hours notice may be required to order some continence products. Always prescribe the quantity rather than original pack (op). OP may be interpreted as a single item or piece. Community pharmacists will be able to advise on the correct pack size. Further advice and support is available from your local Continence Nurse Specialist:- Sue Kinder Clinical Nurse Specialist South West Grantham Community Base Tollemache Road South Spittlegate Level Grantham NG31 7UH Tel: Fax: Allison Temple Clinical Nurse Specialist Continence South East Johnson Community Hospital Spalding Road Pinchbeck Spalding PE11 3DT Tel: Fax: Steve Whitehead Clinical Nurse Specialist Continence North East Single Point of Access (SPA Team) East Lindsey Locality Office, Louth County Hospital High Holme Road, Louth, LN11 0EU Tel: Fax:

6 Clinical Nurse Specialist Continence North West The Contact Centre John Coupland Hospital Ropery Road, Gainsborough DN21 2TJ Tel: Fax: Requests for items to be added to the formulary should be directed to your local Continence Nurse Specialist or The Clinical Medicines Team. Prices correct as of August 2016 Drug Tariff 6

7 2. Urinary Catheters - Attention is drawn to NSPA RRR02, female urinary catheters causing trauma to adult males, issued 30 April Vigilance is urged when prescribing or using catheters in men. - A prescription must be authorised by the prescriber prior to any ordering/delivery of catheters, this will prevent excessive ordering, both in quantity and frequency. - All catheters listed have universal fittings for any make of leg or night bags. - If problems persist i.e frequent re-catheterisation, bypassing, blocking, contact your local Continence Nurse Specialist for advice. - Prescribe two urinary catheters initially and then one at a time. Foley Catheters: For short/medium term use Adult Recommended use up to 28 days TELEFLEX RUSCH PTFE AQUAFLATE. PTFE coated latex with sterile water filled syringe for balloon inflation and empty syringe for balloon deflation Usual Quantity Male Cat. No DP ml balloon Size CH 2.16 each 1 every month Female Cat. No DP ml balloon Size CH 2.16 each 1 every month Foley Catheters: For long term use Adult Recommended use up to 12 weeks 1 st Choice: CLINISUPPLIES LTD PROSYS ALL SILICONE 2 way, 10ml balloon and prefilled syringe with sterile water. Usual Quantity Male Cat. No PCF12M10 PCF18H10 10ml balloon Size CH 5.64 One every 12 weeks Female Cat. No PCF12F10 PCF18F10 10ml balloon Size CH 5.64 One every 12 weeks 7

8 2 nd Choice: TELEFLEX RUSCH SYMPACATH AQUAFLATE Hydrogel coated latex with sterile water filled syringe for balloon inflation and empty syringe for balloon deflation. Usual Quantity Male Cat. No DA ml balloon Size CH 6.07 each One every 12 weeks Female Cat. No DA ml balloon Size CH 6.07 each One every 12 weeks 3 rd Choice: COLOPLAST Folysil X-Tra silicone open ended catheter with pre-filled syringe for balloon inflation and empty syringe for balloon deflation Usual Quantity Standard Length Cat No. AA8C12- AA8C18 Balloon Size 10 Size One every 12 weeks Nelaton Catheters: For Intermittent Self Catheterisation - These are for single use only - Suitable for patients with incomplete bladder emptying e.g neurogenic bladder disorders, particularly patients with multiple sclerosis, spina bifida, diabetes and spinal cord injuries - Patients need good dexterity and cognitive ability - Help to reduce catheter associated urinary tract infections - How many a patient uses a day depends on their medical reason for single use ranging from 1 to 5 times daily 1 st Choice MACGREGOR Qufora Two step (sterile nelaton catheter need to add water) Usual Quantity Male Cat No Size per pack 86p each 30 (1 pack) per month maximum 4 Female Cat No Size per pack 86p each 30 (1 pack) per month maximum 4 8

9 2 nd Choice B BRAUN MEDICAL Actreen Hi-Lite gel lubricated single use nelaton catheter Usual Quantity Male Female Cat No. Cat No E Size per pack E Size per pack 1.48 each 30 (1 pack) per month Maximum each 3 Rd Choice B BRAUN MEDICAL Actreen Glys set (nelaton catheter with urine drainage bag) Usual Quantity Male Cat No E E Size per pack of each 30 (1 pack) per month Maximum 4 Female Cat No E E Size per pack of each 3. Catheter drainage bags 3.1 Leg bags - All catheter drainage bags connected directly to a catheter should be sterile - Leg bags may be worn in different positions on the leg i.e inside thigh/calf, which is an individual choice, and this will determine the length of the inlet tube. - Maintaining a closed drainage system (i.e not removing the leg bag when attaching a night bag) reduces the risk of infection - The leg bag must remain connected to the catheter an linked to the night bag if additional drainage capacity is required overnight - If a bag becomes contaminated or disconnected from the catheter, it must be changed Leg bags should be changed every 5 to 7 days (manufacturer s recommendation) No more than one box of ten should be issued on alternate months (6 x 10 boxes per year) 9

10 1 st Choice L.I.N.C MEDICAL LTD Leg Bag 10 piece per box, 1 pair of elasticated Velcro straps with silicone snake for comfort, a pair of scissors is included with the adjustable tubes Size Cat. No. Cost per ml 10cm tube with tap LM350MD-T ml Direct inlet T-tap LM350SD-T ml 10cm tube with swivel LM350MD-S ml 10cm tube with tap LM500MD-T ml 30cm tube with tap LM500LD-T ml 10cm tube with swivel LM500MD -S ml Direct inlet tube lever tap LM500SD-L ml Direct inlet tube, T-tap LM500SD-T ml 10cm tube (short) with swivel LM750MD-T ml 30cm tube (long) with tap LM750LD-T Usual Quantity 10 every 2 months ( 1 pack every 2 months ) 2 nd Choice TELEFLEX MEDICAL RUSCH Sterile Leg Bag Size Cat. No. Cost per ml short tube with slide tap ml short tube with lever tap ml long tube with slide tap ml long tube with lever tap ml short tube with slide tap ml short tube with lever tap ml long tube with slide tap ml long tube with lever tap ml short tube with slide tap ml short tube with lever tap ml long tube with slide tap ml long tube with lever tap Usual Quantity 10 every 2 months ( 1 pack every 2 months ) 10

11 3.2 Night drainage bags - Sterile FOR PATIENTS IN THEIR OWN HOMES AND RESIDENTIAL HOMES: Sterile drainable 2 litre night bags to be connected directly to catheter For indwelling catheters only Drainable night bags should be changed every 5 to 7 days (manufacturer s recommendation) No more than one box of ten should be issued on alternate months (6x10 per year) 1 st Choice TELEFLEX MEDICAL RUSCH Sterile 2 litre drainable night bag Cat No. Cost per 10 Usual Quantity lever tap per every 2 months slide tap per every 2 months 2 nd Choice UNOMEDICAL LTD (CONVATEC) CARELINE E4 night bag Sterile 2 litre with lever tap Cat No. Cost per 10 Usual Quantity IDC per every 2 months 11

12 Night drainage bags non-sterile FOR COMMUNITY PATIENTS NURSING AND RESIDENTIAL HOMES Non-drainable night bags (single use) connected to the leg bag to maintain a closed system. - Suitable for night time use for the collection of urine from indwelling catheters or urinary sheaths - The position of the bag should be below bladder level to enhance drainage - Non-drainable night bags are the preferred option as single use reduces the risk of infection. No more than three boxes of ten should be issued monthly 1 st Choice TELEFLEX MEDICAL Non sterile 2 litre bag single use, T-tap Cat No. Cost of pack Usual Quantity for a pack of 30 32p per bag 1 pack per month (max 30 per month) 2 nd Choice UNOMEDICAL CARELINE Non sterile 2 litre bag single use, T-tap Cat No. Cost of pack Usual Quantity LBH 3.35 for a pack of 10 34p per bag 3 packs per month (max 30 per month) 12

13 4.0 Catheter Maintenance Solutions Only as part of a treatment programme - There should be a clinical rationale for use - Should be used to prolong the life of the catheter, thus avoiding the trauma/risks of increased catheterisations - Should only be used to treat indwelling catheters in prevention of encrustations, or to dissolve crystal formation to maintain patence of the catheter - It is good practice to cut open catheters on removal, from those patients where blocking is a problem to see if the lumen is blocked by sediment deposit or crystals - Two sequential instillations of a small volume are more effective than a single administration (Getliffe 2000) - Bladder instillations or washouts must not be used to prevent catheter associated infections (Nice 2012) Product Cat No. Size Cost Usual Quantity Urotainer Twin Suby G (3.23% citric acid) Urotainer Twin Solution R (6.0% citric acid) Bard Optiflo Sodium chloride 0.9% I I 2 x 30 ml 2 x 30ml Only if clinical rationale on advice from Continence Team CSS50 50ml 3.36 For one-off catheter blockages to avoid catheter change where possible 5.0 Catheter Valves - For use with indwelling catheters only - These provide a discreet alternative to drainage bags - Should be changed every 5 to 7 days - Contraindicated in: o Reduced bladder capacity o No bladder sensation o Cognitive impairment o Poor manual dexterity No more than one packet (5) should be prescribed 13

14 L.I.N.C MEDICAL SYSTEMS LTD Cat No. Cost per 5 Usual Quantity Care flo catheter valve CF per month 6.0 Tubing and Accessories - It is extremely important that both the catheter and leg bag are well supported to reduce traction and trauma to the bladder neck and urethra. - The fixation strap is used as a retaining strap which secures the tubing or catheter firmly and comfortably against the leg acting as a shock absorber for indwelling catheters. - GB fix It strap and Urisleeve are washable and reusable - Urisleeve can be used as an alternative or alongside leg straps, particularly good for frail skin, or problems with straps digging into or rubbing against the legs as it distributes the weight of the urine more uniformly Pack of 5 GB fix It straps should last four to six months Pack of 4 Urisleeves should last for six months Box of 5 Catheter Clips should last a month GREAT BEAR HEALTHCARE LTD Cat No. Cost per 5 Usual Quantity GB Fix It Strap Short 10646C pack of 5 every 6 months GB Fix It Strap Adult 10644A GB Fix It Strap Abdominal 10645B Gb Fix It Strap Adjustable 150cm (cut to fit) 10647D BARD URISLEEVE Cat No. Cost per 5 Usual Quantity Small (24-39cm) pack of 4 every 6 months Medium (36-55cm) Large (40-70cm) Ex-Large (65-95cm) Optimum Medical Cat No Cost per 5 Usual Quantity Ugo Fix Gentle ( catheter clip) pack per month 14

15 7.0 Incontinence Sheaths - Can offer a valuable alternative method of urinary continence management for men - It is important to accurately assess for type and size of sheath using manufacturer s measuring device, prior to prescribing - Sheaths should be changed every 23 hours - Ordering more than one box of thirty per month may indicate poor fit, refer to continence team for advice - The sheaths listed below are latex free It is recommended one box of thirty should be sufficient per month 1 st choice MACGREGOR HEALTHCARE LTD QUFORA self adhering silicone Urisheath Size Cat No. Cost per 30 24mm mm Standard 31mm mm mm mm mm Short 31mm mm mm Usual Quantity 30 every month 30 every month 2 nd Choice ROCHESTER MEDICAL LTD Freedom Transfix silicone sheath Size Cat No. Cost per 30 Usual Quantity Style 1 (self-adhering, standard sheath) Style 2 (self-adhering, short sheath) Style 3 (self-adhering extra 25mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF mm TF every month 30 every month 30 every month 15

16 wide adhesive band) 36mm TF mm TF Urinal Systems With proper cleansing and care, each appliance should last for 6 months Urine Directors BEAMBRIDGE MEDICAL Cat No. Cost Usual Quantity Beambridge Adult funnel - Short Beambridge Male funnel Beambridge Lady funnel Female director/positioner per 6 months per 6 months per 6 months Urinals MANFRED SAUER UK LTD Pocket sized (when not in use) reusable urinal for men and urostomy/ostomy appliance users 1.1 litre capacity Cat No. Cost Usual Quantity Uribag Uribag per 6 months Uribag F (Females capacity 1.2 litre) Uribag F per 6 months BEAMBRIDGE MEDICAL LTD Cat No. Cost Usual Quantity Bridge urinal with tap (to be used with drainage bag) 6-18 T per 6 months 16

17 9.0 Training The formulary will be used as a training tool by the Continence Advisory Service to promote best practice, and will be included in all study days that the service presents :See ESR and training booklet for guidance 11.0 References - Addison R, Foxley s, Mould C (2008) Catheter Care RCN guidance for nurses. Royal College of Nursing London - Getliffe K, Hughes SC, Le Claire M (2000) the dissolution of urinary catheter encrustation. BJU Int: 85:1: Jones S, Foxley S, Brooks A, Dunkin J (2008) Evidence care of urinary catheters and drainage systems. Nursing Times; 103: NHS Quality Improvement Scotland (2004) Best Practice Statement: urinary catheterisation and catheter care. Available from - NICE (March 2012) Infection Control: prevention of Healthcare-associated Infection in Primary and Community Care. Clinical Guideline 139. NICE, London. Available from - NPSA RRR02, Female urinary catheters causing trauma to adult males, available at - Pratt RJ, Pellowe CM, Wilson JA et al (2007) Epic2: National Evidence-based Guidelines for Preventing Healthcare Associated Infections in NHS hospitals in England - Robinson J (2006) Selecting a urinary catheter and drainage system. British Journal of Nursing 15:19 17

18 Monitoring Template Minimum requirement to be monitored Monitor compliance in accordance with this policy Process for monitoring e.g. audit Under instruction from Organisationalwide policy for the development and management of policies and procedural documents. Informed by staff/ manager feedback Responsible individuals/ group/ committee CNS Continence Team Adult Integrated Quality Scrutiny and Clinical Governance Policy Forum Matrons Frequency of monitoring/audit Responsible individuals/ group/ committee (multidisciplinary) for review of results Bi-annually CNS Continence Team Clinical Governance Group Responsible individuals/ group/ committee for development of action plan CNS Continence Team Clinical Governance Group Responsible individuals/ group/ committee for monitoring of action plan CNS Continence Team Clinical Governance Group 18

19 Appendix 2 Equality Analysis Name of Policy/Procedure/Function* Service Operating Plan for Triaging Continence Assessment by Administration staff Equality Analysis Carried out by: Sue Kinder CNS Continence Date: 16/01/17 Equality & Human rights Lead: : Director\General Manager: Jane Scrafton *In this template the term policy\service is used as shorthand for what needs to be analysed. Policy\Service needs to be understood broadly to embrace the full range of policies, practices, activities and decisions: essentially everything we do, whether it is formally written down or whether it is informal custom and practice. This includes existing policies and any new policies under development. 19

20 Section 1 to be completed for all policies A. B. C. D. Briefly give an outline of the key objectives of the policy; what it s intended outcome is and who the intended beneficiaries are expected to be Does the policy have an impact on patients, carers or staff, or the wider community that we have links with? Please give details Is there is any evidence that the policy\service relates to an area with known inequalities? Please give details Will/Does the implementation of the policy\service result in different impacts for protected characteristics? The products listed in this formulary have been selected by the Continence Formulary working Party, Lincolnshire Community Services NHS Trust, Lincolnshire localities only. Judgement was based on expert opinion and evidence of clinical and costeffectiveness No NO NO Disability Sexual Orientation Sex Gender Reassignment Race Marriage/Civil Partnership Maternity/Pregnancy Age Religion or Belief Carers Yes No If you have answered Yes to any of the questions then you are required to carry out a full Equality Analysis which should be approved by the Equality and Human Rights Lead please go to section 2 The above named policy has been considered and does not require a full equality analysis Equality Analysis Carried out by: S Kinder CNS Continence Date: 17/01/17 20