Continence Formulary (for Adults)

Transcription

1 Coastal West Sussex Clinical Commissioning Group Continence Formulary (for Adults) Sussex Community NHS Trust Date of issue: October 2012 Review date: October 2013 Brighton and Hove Hove Polyclinic Nevill Ave Hove North Team Haywards Heath HC Heath Road Haywards Heath South Team Downlands Business Park Lyons Farm Worthing Version number 1

2 Continence Formulary This formulary is a guide for all healthcare professionals that prescribe or request prescriptions for patients that require products due to either bladder or bowel dysfunction. The intention is that this formulary must be used for all new patients and for current patients when a re-assessment of their needs is completed. The formulary will be reviewed on an annual basis and at this point any amendments or additions will be considered. Where ever possible there is a continuity of product use between primary and secondary care, and this has been achieved by joint working on this formulary. The term specialist in this formulary (highlighted in blue, bold and italics) refers to Bladder and Bowel Specialist Nurses, Urology Specialist Nurses and Urologists. This formulary was authored by Hilary Chiffins, Lead Specialist Continence Nurse for Sussex Community NHS Trust, with input from primary care, secondary care and the Medicines Management Team at Coastal West Sussex CCG. The information contained within is intended for use by healthcare professionals within West Sussex and Brighton and Hove. We have made every effort to check that the information is correct at the time of publication. NHS West Sussex/ Brighton and Hove City PCT/Sussex Community NHS Trust does not accept any responsibility for loss or damage caused by reliance on this information. All prices taken from the July 2012 Drug Tariff 1

3 Contents Page Urinary Catheters 3 Long term indwelling catheters 4 Lubricants 4 Catheterisation packs 4 Urinary catheter valves 5 Catheter restraining straps 5 Catheter maintenance solutions 5 Leg bag holders 6 Urinary catheter leg bags 6 Urinary catheter bed bags/2litre bags 6 Miscellaneous catheter supplies 7 Intermittent urinary catheters 7 Sheaths and leg bags 8 Anal plugs 10 Faecal collectors 10 Anal irrigation 11 Continence appliances 11 Other useful information/links 12 Index 13 2

4 Urinary Catheters All patients with an indwelling urinary catheter need to be reassessed at each catheter change to see if they are suitable for a trial without catheter. Choice of product depends on: Assessment Patient choice Local guidelines (SCT NHS Trust) Smallest size that provides adequate draining should be used to avoid bypassing problems. Only catheters that have a balloon filled with 10mls of sterile water should be used. Male/standard length urinary catheters must always be used for men. Female length urinary catheters are suitable for ambulant female patients, but not usually for obese, bed or chair bound female patients. All patients with supra pubic urinary catheters should be re-catheterised with male/standard length catheters. Long term catheters can stay insitu up to 12 weeks. All urinary catheters should be: Prescribed in single units. Prescribe 3 initially, but 2 on repeat. The following urinary catheters are suitable for both urethral and supra pubic catheterisation. Silicone Male / Standard length (add size to end of order ) Product Gauge/Ch size Drug Tariff Price 1 st choice AA8A Coloplast Folysil silicone nd choice DA3101 Rusch Brilliant Aquaflate Specialist DG3101 Rusch Brilliant Silflate Silicone female (add size to end of order ) Product Gauge/Ch size Drug Tariff Price 1 st choice AA8B Coloplast Folysil silicone nd choice DA2101 Rusch Brilliant Aquaflate Specialist DG2101 Rusch Brilliant Silflate Hydrogel Male / Standard length (add size to end of order ) Product Gauge/Ch size Drug Tariff Price 1 st choice D2264 Bard Biocath nd choice DH3101 Rusch Sympacath Aquaflate Specialist Hydrogel Female length (add size to end of order ) Product Gauge/Ch size Drug Tariff Price 1 st choice D2268 Bard Biocath nd choice DH2101 Rusch Sympacath Aquaflate Specialist The following indwelling urinary catheters should only be prescribed if recommended by a Bladder and Bowel Specialist Nurse. Open ended silicone (add size to end of order ) This catheter is suitable for both urethral and supra pubic use and may be a useful alternative for patients who have repetitive bypassing and blocking problems. Product Gauge/Ch size Drug Tariff Price AA8C Coloplast Folysil Standard length only (long term catheter 12 weeks)

5 Anti-infection urinary catheter (add size to end of order ) Urinary catheter impregnated with nitrofurazone which works non-systemically to inhibit bacterial growth. This catheter should only be used for long term catheterised patients with a history of symptomatic urinary tract infection or those who are at a greater risk of developing bacteraemia. (N.B. Restraining strap included in price) Product Gauge/Ch size Drug Tariff Price 952 Rochester ReleaseNF Standard length only (long term catheter 12 weeks) Silver alloy coated catheter (add size to end of order ). Urinary catheter reduces bacterial adherence and minimizes biofilm formation. D2365 Bardex I.C. Foley Catheter. Standard length (28 days only) D2369 Bardex I.C. Foley Catheter. Female Catheter (28 days only) Lubricant gels for urinary catheterisations Product Gauge/Ch size Drug Tariff Price 12S-22S S-16S 949 The following lubricants come in disposable syringes with/without local anaesthetic for instillation into the urethra prior to catheterisation which can help reduce injury to the urothenium and subsequent risk of possible urethral damage. Lubricants with anaesthetic should be used for both male and female urethral catheterisations. Prior to use any allergies, sensitivities or contra indications must checked with the patient. Lubricant only is required when carrying out supra pubic recatheterisation. N.B. The first supra pubic recatheterisation carried out in the community must be at least 8 weeks post initial insertion of supra pubic siting carried out in secondary care. Lubricant with anaesthetic Prescribe 5 as single units Product Pack size Drug Tariff price Instillagel 6ml (female) Instillagel 11ml (male) CJL08501 Cathejell with lidocaine 8.5g CJL12501 Cathejell with lidocaine 12.5g Lubricant only Product Pack size Drug Tariff price CJM08501 Cathejell Mono 8.5g 1 80 CJM12501 Cathejell Mono 12.5g 1 85 Catheterisation pack Prescribe 3 Two layer system layer 1 catheter removal kit layer 2 catheter insertion kit VESCP-01 Product Pack size Drug Tariff price Prosys Vesica Clinic Pack Catheterisation procedure pack (contains no catheter or lubricant)

6 Catheter Valves Prescribe 10 as single units every 8 weeks May be used by patient with long term urethral or supra pubic catheters. Prior to a catheter valve being fitted the patient needs to have a risk assessment completed with includes the following points: Have the cognitive awareness to remember to empty their bladder regularly. Have the dexterity to use the valve. Have an adequate bladder capacity. If patient has had surgery recently consultant agreement has been sought. Catheter valves must be changed weekly A Libra Lever Catheter Valve Simpla Catheter Valve BFF5 Bard Flip Flo Catheter Valve Catheter tube restraining straps Prescribe 5 as single units every 4 months Restraining straps must be worn by all patients that have a standard urethral urinary catheter insitu and use a leg bag or a bedbound and use a bed bag to ensure that any traction from the catheter bag is absorbed by the strap. A restraining strap can also help prevent meatal damage. These products are washable and reused. Product Pack size Drug tariff price Simpla G strap (leg Strap) A GB Fix It (leg strap) Abdominal catheter tube restraining straps for supra pubic catheters are available if recommended by a Bladder and Bowel Specialist Nurse, Urology Specialist Nurse or Urologist. Product Pack size Drug Tariff price Simpla G Strap (Abdominal strap) B GB Fix It (Abdominal Strap) Catheter maintenance solutions Prescribe 10 at a time These should only be used once a clear urinary catheter history is documented and a treatment plan has been written for that named patient. Plus it has been established that the patient may benefit from the planned use of a catheter maintenance solution to extend the life of urinary catheter as per treatment plan, or prior to the removal of a urinary catheter to dissolve crystal formation and prevent trauma. Getcliffe et al (2000) suggest that two sequential instillations of a small volume are more effective than a single administration. BBraun Uro-Tainer Twin, have a twin delivery system allowing for this sequential administration. Product Pack size Drug Tariff price Suby G Citric acid 3.23% Twin 2 x 30mls Solution R Citric acid 6% Twin 2 x 30mls FB99849 NaCl 50mls for mechanical flush only

7 Leg bag holders Prescribe 4 as single units every 4 months. To hold urinary catheter leg bag, so reducing the pull on the bladder neck and reducing urethral trauma. The sleeve can be worn on the thigh or on the calf but the area needs to be measured to ensure right size sleeve is ordered. Coloplast Aquasleeve Product Pack size Drug Tariff price Small 24-33cm Standard 34-39cm Medium cm Large cm Extra large 65+ cm Urinary catheter drainage bags Prescribe 10 bags alternate months Leg bags The bags may be worn either on the thigh or the calf and this will determine the length of the inlet tube. There are also different types of outlet taps and this must be a consideration if the patient is self-caring. Urinary catheter bags need to be changed every 5-7 days. More frequently is not normally necessary and could put the patient at increased risk of infection by breaking the closed system more often than necessary. Slide action tap (sterile) Simpla Trident T1 Short tube 350ml leg bag Simpla Trident T1 Short tube 500ml leg bag Simpla Trident T1 Long tube 500ml leg bag Lever action tap (sterile) Simpla Trident 2 Short tube 350ml leg bag Simpla Trident 2 Short tube 500ml leg bag Simpla Trident 2 Long tube 500ml leg bag Single Use 2 litre bags (unsterile) Prescribe 3 packs per month. At night single use 2 litre bags should be attached to the bottom of the leg bag rather than drainable bags. The single use bags do not have any cost implications, when compared against drainable 2 litre bags but are recommended by infection control for use by all patients that have indwelling urinary catheters and require added drainage capacity overnight. Code Product Pack size Drug Tariff Price PSU2 ProSys Non Sterile Night drainage bag 2 litre Drainable 2 litre catheter bags (sterile) Prescribe 10 bags every 8 weeks These 2 litre catheter bags would be for patients that are solely carried for in bed at all times, and do not use a leg bag. They need to be changed every 5-7 days Simpla S5 night bag

8 Belly bags Prescribe 3 every 12 weeks These are positioned on the abdomen. Urine drains into the bag by means of residual bladder pressure. Bag capacity is 1 litre. Bag needs to be changed every 28 days. Product Pack size Drug Tariff price B1000 Rusch Belly Bag 1000ml (short outlet tube B1000P Rusch Belly Bag 1000ml (short outlet tube B1000CT Rusch Belly bag with extra long (60cm) outlet tube useful for wheelchair users There are other types of catheter bags available that are useful for patients with disabilities please speak to the Bladder and Bowel Service for advice before prescribing. Miscellaneous catheter items Prescribe 10 as single items Product Pack size Drug Tariff price Simpla Catheter leg bag straps Sterile water for injection 10mls (plastic vials) Night bag holders These are not available on the NHS, but may be obtained from the following companies if their products are being used free of charge. Company Tel no Simpla (Coloplast) Bed bag stand ProSys (Clini Supplies) Bed bag stand Intermittent Catheters - need to be prescribed as single items There are a wide range of intermittent catheters and therefore each patient needs to be assessed individually so that the correct catheter is prescribed to meet their needs. The practitioner that assesses the patient will be able to guide the prescriber as to what needs to be prescribed and the quantity that needs to be prescribed on a monthly basis. Please note: The prescription for intermittent catheters may need to be changed, either in quantity due to patient s needs, or as the patient becomes more skilled at intermittent self catheterisation the type of catheter requested may alter. Please remember to change the repeat prescription, and delete the old repeat prescription, otherwise there can be a huge cost implication if the wrong catheter is prescribed for your patient. 7

9 Urinary sheaths Prescribe 30 single items every 28 days Sheaths are a useful alternative method to manage urinary incontinence for men. However, it is essential that the sheaths are accurately sized and the appropriate drainage system is prescribed. It is recommended that sheaths are changed every 24 hours to relieve pressure and to allow for personal hygiene. There is a generic leaflet available that gives instructions on how to apply sheaths. (This leaflet is available from the Bladder and Bowel Service). There are several different companies list below, but this is to accommodate for good sizing both for girth fitting and length fitting. Manfred Sauer P-Sure latex free, self adhesive sheath (standard length only) Code Product Pack size Drug Tariff Price Small 20mm mm mm Medium 26mm mm mm Large 32mm mm mm mm Rochester Freedom Transfix 100% clear silicone sheath Code Product Pack size Drug Tariff Price Style 1 Standard length (9cm) TF mm TF mm TF mm TF mm TF mm Style 2 Shorter length. TF mm TF mm TF mm TF mm TF mm Style 3 Standard length with extra wide adhesive TF mm TF mm TF mm TF mm TF mm Conveen Optima latex free self-adhesive sheath Code Product Pack Size Drug Tariff Price Standard length 25mm mm mm mm Shorter length 21mm mm mm mm

10 Coloplast Conveen Security Plus Leg bags Prescribe 10 bags every 8 weeks Non-sterile adjustable anti-kink tubing leg bags for use with sheaths only ml 30cm tubing non sterile ml 50cm tubing non sterile ml 30cm tubing non sterile ml 50cm tubing non sterile Conveen Activa bag is a small thigh bag (250ml capacity) that is useful for sheath use only when dribbling via the penis is experienced when a supra pubic is insitu or if dribbling incontinence is experienced some of the time and the patient doesn t want to use an incontinence pad all of the time ml Conveen Activa 7cm adjustable inlet tube Miscellaneous items - need to be prescribed as single items as indicated in pack size i.e. Conveen prep wipes 54 wipes Product Pack Size Drug Tariff Price Conveen prep wipes used prior to applying 54 wipes 1013 sheaths to add adhesion 3505 Appeel No Sting Medical Adhesive Remover 30 wipes 1483 wipes to ease removal of sheaths 3500 Appeel No Sting Medical Adhesive Remover Spray to ease removal of sheaths 9811 Hollister Retracted Penis Pouch PHN Manfred Sauer p.hold 2cm (Penis Holder) PHW Manfred Sauer p.hold 4cm (Penis Holder) Afex system (imedicare); only prescribe this product if advised to by a Specialist Bladder and Bowel Nurse. A system that can be used by patients that have some voiding control or are urinary incontinent Product Pack size Drug Tariff Price A100-Plus brief Afex Active Starter Pack- 1 High receptacle, 1 pair of briefs, 1 reusable collection bag (500ml 4-6 weeks), 1 cleaning A110-Plus brief A120-Plus brief container, I cleansing solution, 1 instructional DVD. Afex Sedentary Starter Pack1 low receptacle, 1 pair of briefs, 1 reusable collection bag (1200mls 4-6 weeks), 1 cleaning container, I cleansing solution, 1 instructional DVD. Afex Mobility Assisted Starter Pack 1 supersoft ( days) receptacle, 1 pair of briefs, 1 reusable collection bag(1200mls 4-6 weeks ), 1 cleaning container, I cleansing solution, 1 instructional DVD. Brief s: S-08 Waist small M-08 Waist medium L-08 Waist large XL-08 Waist extra large X-08 Waist 2X X-08 Waist 3X

11 Afex Accessories: N.B. This information is for repeat prescriptions only. Briefs (4 required per year) A200- S-08 Waist small A200- M-08 Waist medium A200- L-08 Waist large A200- XL-08 Waist XL A200-2X-08 Waist 2X A200-3X-08 Waist 3X Urine collection bags (9 required per year) A400-V ml vented bag A400-B ml unvented bag A400-L ml leg bag A400-E-08 Extra capacity A400-X ml bed bag Receptacles (3 required per year) A300-L-08 Low receptacle A300-S-08 Low supersoft Receptacle A300-F-08 High Receptacle Extension tubes and Stabiliser systems A700-A-08 Tube assembly complete (9 per year) A700-S-07 Tube stabiliser A710-S-09 Collection bag stabiliser-high grip Anal Plugs (Coloplast) Prescribe 20 at a time as requested. Patient needs to have an assessment by an appropriate healthcare professional prior to being prescribed this product. Anal plugs are used for patients with ano-rectal incontinence problems - most suitable for neurogenic conditions with impaired sensation. Plugs can be left in place up to 12 hours, if inserted correctly, with reasonable degree of comfort. Code Product Pack size Drug Tariff Price 1450 Peristeen Anal Plug Small Peristeen Anal Plug Large Faecal collectors (Hollister) Prescribe 10 at a time as requested Useful for bed bound patients experiencing semi-solid or liquid stools, protecting skin from irritating faecal discharge cm tubing non sterile 500ml cm tubing non sterile 1000ml

12 Anal Irrigation If this option is to be considered for a patient, please refer the patient to either the Bladder and Bowel Service or Secondary Care for a specialist assessment prior to prescribing any equipment so that the patient is well informed about the procedure. If the patient is suitable for anal irrigation they will need to be taught the procedure which will normally be done in the community by the Bladder and Bowel Service. Patients usually need support from the Bladder and Bowel Service when they initially use the system. Peristeen anal irrigation (Coloplast) Please note: Catheters are single use only. Water bag can only be used 15 times Lid and control unit can only be used 90 times Product Pack size Drug Tariff Price control unit, 2 rectal catheters, 1 water bag, 1 strap set, 1 toilet bag control unit, 2 small rectal catheters, 1 water bag, 1 strap set, toilet bag Rectal catheters, 1 water bag Small rectal catheters, 1 water bag Rectal catheters Small rectal catheters Set of straps Tubes and blue connectors Qufora toilet system (Manfred Sauer) If this option is to be considered for a patient, please refer the patient to either the Bladder and Bowel Service or Secondary Care for a specialist assessment prior to prescribing any equipment so that the patient is well informed about the procedure. If the patient is suitable for anal irrigation they will need to be taught the procedure which will normally be done in the community by the Bladder and Bowel Service. Patients usually need support from the Bladder and Bowel Service when they initially use the system. Product Pack size Drug Tariff Price QTS Qufora Starter set. (Pump, water bag, 5 cones, 5 waste bags and toilet bag QTM Qufora monthly set. (Pump, water bag, 15 cones, 15 waste bags and toilet bag Continence appliances - prescribe one only. NB. Items with * need to have two litre drainable catheter bags also prescribed. There are a range of reusable appliances that can be prescribed that patients can use to enable them to remain continent even if their mobility is poor or they are chair or bed bound. Listed below are a range of products, but this is not extensive. Please phone the Bladder and Bowel Service for further advice. The numbers are at the front to this formulary. Product Pack size Drug Tariff Price 6-50T Beambridge male draining jug with tap* Beambridge female saddle urinal Beambridge Lady Jug * Beambridge Bridge urinal Beambridge Funnel * URIbag Manfred Sauer Uribag (male) URIBagF Manfred Sauer Uribag (female)

13 Other useful information/links: Bladder and Bowel Service: Brighton and Hove Office North Office (Haywards Heath) South Office (Worthing) Bladder and Bowel Foundation: Continence Foundation: 12

14 Index Afex Active Starter Pack A100-Plus brief 9 Afex briefs waist 2X A200-2X Afex briefs waist 3X A200-3X Afex briefs waist large A200- L Afex briefs waist medium A200- M Afex briefs waist small A200- S Afex briefs waist XL A200- XL Afex collection bag stabiliser-high grip A710-S Afex high receptacle A300-F Afex low receptacle A300-L Afex low supersoft receptacle A300-S Afex Mobility Assisted Starter Pack 1 A120-Plus brief 9 Afex Sedentary Starter Pack A110-Plus brief 9 Afex tube assembly complete (9 per year) A700-A Afex tube stabiliser A700-S Afex urine collection bags 1200ml leg bag A400-L Afex urine collection bags 2000ml bed bag A400-X Afex urine collection bags 500ml unvented bag A400-B Afex urine collection bags 500ml vented bag A400-V Afex urine collection bags Extra capacity A400-E Appeal No Sting Medical Adhesive Remover spray to ease removal of sheaths Appeel No Sting Medical Adhesive Remover wipes to ease removal of sheaths Bard Biocath female catheter D Bard Biocath male catheter D Bard Flip Flo Catheter Valve BFF5 5 Bardex I.C. Foley Catheter female indwelling catheter D Bardex I.C. Foley Catheter standard length indwelling catheter D Beambridge male draining jug with tap 6-50T 11 Beambridge Bridge urinal Beambridge female saddle urinal Beambridge Funnel Beambridge Lady Jug Cathejell Mono 12.5g CJM Cathejell Mono 8.5g CJM Cathejell with lidocaine 12.5g CJL Cathejell with lidocaine 8.5g CJL Coloplast Aquasleeve leg bag holder Extra large 65+ cm Coloplast Aquasleeve leg bag holder Large cm Coloplast Aquasleeve leg bag holder Medium cm Coloplast Aquasleeve leg bag holder Small 24-33cm Coloplast Aquasleeve leg bag holder Standard 34-39cm Coloplast Conveen Security Plus Leg bags 350ml 30cm tubing non sterile Coloplast Conveen Security Plus Leg bags 350ml 50cm tubing non sterile Coloplast Conveen Security Plus Leg bags 500ml 30cm tubing non sterile Coloplast Conveen Security Plus Leg bags 500ml 50cm tubing non sterile Coloplast Folysil silicone female catheter AA8B 3 Coloplast Folysil silicone male catheter AA8A 3 Coloplast Folysil Standard length indwelling catheter AA8C 3 Conveen Activa 250ml 7cm adjustable inlet tube Conveen Optima latex free self-adhesive sheath shorter length 21mm Conveen Optima latex free self-adhesive sheath shorter length 25mm Conveen Optima latex free self-adhesive sheath shorter length 30mm Conveen Optima latex free self-adhesive sheath shorter length 35mm Conveen Optima latex free self-adhesive sheath standard length 25mm

15 Conveen Optima latex free self-adhesive sheath standard length 30mm Conveen Optima latex free self-adhesive sheath standard length 35mm Conveen Optima latex free self-adhesive sheath standard length 40mm Conveen prep wipes used prior to applying sheaths to add adhesion GB Fix It (leg strap) 10644A 5 GB Fix It (Abdominal Strap) 10645B 5 Hollister faecal collector 50cm tubing non sterile 1000ml Hollister faecal collector 50cm tubing non sterile 500ml Hollister Retracted Penis Pouch Instillagel 11ml (male) Instillagel 6ml (female) Libra Lever Catheter Valve 10540A 5 Manfred Sauer p.hold 2cm (Penis Holder) PHN 9 Manfred Sauer p.hold 4cm (Penis Holder) PHW 9 Manfred Sauer P-Sure latex free, self adhesive sheath large 32mm Manfred Sauer P-Sure latex free, self adhesive sheath large 35mm Manfred Sauer P-Sure latex free, self adhesive sheath large 37mm Manfred Sauer P-Sure latex free, self adhesive sheath large 40mm Manfred Sauer P-Sure latex free, self adhesive sheath medium 26mm Manfred Sauer P-Sure latex free, self adhesive sheath medium 28mm Manfred Sauer P-Sure latex free, self adhesive sheath medium 30mm Manfred Sauer P-Sure latex free, self adhesive sheath small 20mm Manfred Sauer P-Sure latex free, self adhesive sheath small 22mm Manfred Sauer P-Sure latex free, self adhesive sheath small 24mm Manfred Sauer Uribag URIbag 11 Manfred Sauer Uribag (female) URIbagF 11 NaCl 50mls for mechanical flush only FB Peristeen anal irrigation 1 control unit, 2 rectal catheters, 1 water bag, 1 strap set, 1 toilet bag Peristeen anal irrigation 1 control unit, 2 small rectal catheters, 1 water bag, 1 strap set, 1 toilet bag Peristeen anal irrigation 1 set of straps Peristeen anal irrigation 10 rectal catheters Peristeen anal irrigation 10 small rectal catheters Peristeen anal irrigation 15 rectal catheters, 1 water bag Peristeen anal irrigation 15 small rectal catheters, 1 water bag Peristeen anal irrigation 2 tubes and blue connectors Peristeen Anal Plug Large Peristeen Anal Plug Small ProSys (Clini Supplies) Bed bag stand 7 ProSys Non Sterile Night drainage bag 2 Litre PSU2 6 Prosys Vesica Clinic Pack Catheterisation procedure pack VESCP-01 4 Qufora toilet system monthly set QTM 11 Qufora toilet system starter set QTS 11 Rochester Freedom Transfix 100% clear silicone sheath style 1 standard length (9cm) 41mm TF Rochester Freedom Transfix 100% clear silicone sheath style 1 standard length (9cm) 36mm TF Rochester Freedom Transfix 100% clear silicone sheath style 2 shorter length 32mm TF Rochester Freedom Transfix 100% clear silicone sheath style 2 shorter length 41mm TF Rochester Freedom Transfix 100% clear silicone sheath style 3 standard length with extra wide adhesive 41mm TF Rochester Freedom Transfix 100% clear silicone sheath style 1 standard length (9cm) 25mm TF Rochester Freedom Transfix 100% clear silicone sheath style 2 shorter length 25mm TF Rochester Freedom Transfix 100% clear silicone sheath style 2 shorter length 29mm TF Rochester Freedom Transfix 100% clear silicone sheath style 2 shorter length 36mm TF Rochester Freedom Transfix 100% clear silicone sheath style 3 standard length with extra wide adhesive 25mm TF Rochester Freedom Transfix 100% clear silicone sheath style 3 standard length with extra wide adhesive 29mm TF Rochester Freedom Transfix 100% clear silicone sheath style 3 standard length with extra wide adhesive 32mm TF

16 Rochester Freedom Transfix 100% clear silicone sheath style 3 standard length with extra wide adhesive 36mm TF Rochester Freedom Transfix 100% clear silicone sheath style 1 standard length (9cm) 32mm TF Rochester Freedom Transfix 100% clear silicone sheath style 1 standard length (9cm) 29mm TF Rochester ReleaseNF Standard length indwelling catheter Rusch Belly Bag 1000ml (short outlet tube) B Rusch Belly Bag 1000ml (short outlet tube) B1000P 7 Rusch Belly bag with extra long (60cm) outlet tube B1000CT 7 Rusch Brilliant Aquaflate female catheter DA Rusch Brilliant Aquaflate male catheter DA Rusch Brilliant Silflate female catheter DG Rusch Brilliant Silflate male catheter DG Rusch Sympacath Aquaflate female catheter DH Rusch Sympacath Aquaflate male catheter DH Simpla (Coloplast) Bed bag stand 7 Simpla Catheter leg bag straps Simpla Catheter Valve Simpla G Strap (Abdominal strap) Simpla G strap (leg Strap) Simpla S5 Night bag Simpla Trident 2 Long tube 500ml leg bag Simpla Trident 2 Short tube 350ml leg bag Simpla Trident 2 Short tube 500ml leg bag Simpla Trident T1 Long tube 500ml leg bag Simpla Trident T1 Short tube 350ml leg bag Simpla Trident T1 Short tube 500ml leg bag Solution R Citric acid 6% Twin 2 x 30mls Sterile water for injection 10mls 7 Suby G Citric acid 3.23% Twin 2 x 30mls

17 Continence Formulary Questionnaire We would welcome your feedback. Please complete this questionnaire after you have been using the formulary for at least 3 months and return to the address below. Please circle your area of practice: community / hospital Profession, e.g. nurse How often (on average) have you referred to the formulary since receiving it? Never used it Once Once a month Once every 2 weeks Once a week 2-3 times a week Daily Do you find the formulary choice adequate? Yes / No If no, please state why Has the formulary influenced your prescribing or practice? Yes / No Which section(s) do you find most useful and why? List any products / sections you would like to be included in future editions: Thank you for your time Please return to: Hilary Chiffins Lead Specialist Continence Nurse Sussex Community NHS Trust B14 Hove Polyclinic Nevill Avenue Hove BN3 7HY 16