Sheffield s Integrated Continence Service (SICS)

Transcription

1 Sheffield s Integrated Continence Service (SICS) Version: 1.0 Date at ET/PEC: Date ratified at Board: Name and dept of originator/author: Name of responsible committee/individual and title: Date issued: Review date: June 2011 Target audience: Continence Service Shirley Budd Penny Brooks-Cordon All professionals and support workers managing patients using continence appliances This policy/service has been reviewed in accordance with Equalities Legislation on race, disability, age, gender, sexual orientation and gender identity, faith and belief. Chairman Tony Pedder Chief Executive Jan Sobieraj NHS Sheffield is the Sheffield Primary Care Trust 1

2 Contents Introduction Prescribing guidelines Supplier Options Catheters: Foley Lubricating gel Catheters: Nelaton Suggested Catheters for Intermittent Self Catheterisation: reusable Single use hydrophilic intermittent catheters Single Use pre-soaked Catheters Catheter Valves Sterile Urine Drainage Bags- Leg Bags Urine Drainage Night Bags to Attach to Leg Bag- 2 Litre Urine Drainage Night Bags to Attach Directly to Catheter- 2 Litre Clinisupplies Belly Bag Catheter Drainage Suspensory Systems Urinary Drainage Sheaths Appliance management of faecal leakage Anal plugs Faecal Collector Bowel Irrigation Prescription Urinals Catheter Maintenance Solutions Bladder washout sodium chloride solution 2

3 Introduction Objectives of formulary: The goal is to simplify prescribing of continence prescription appliance products across Sheffield PCT. This will involve good quality, effective products. Choices have been balanced gauging effectiveness and value for money. The formulary of products has been selected balancing patient requirements, commonly used products and the Sheffield PCT Medicines Management Team premise that 80% of patients in the community will find the products chosen quite satisfactory for their needs. This is a guideline, therefore patient and carer s clinical needs may be accommodated if the suggested products are not satisfactory. Prescribers and other professionals need to be aware of alternative options for when the baseline formulary is found to not be appropriate. The products have been chosen based on experience and collaboration between the Medicines Management Team, the Continence Advisory Service, The Care Homes Team and Community Nurses. The formulary will match evidence base and information documented within Sheffield s Catheter Guidelines which are currently in draft form. Prescribing Guidelines When prescribing ensure details are accurate and include: Manufacturer and Brand, Drug Tariff Order Codes Correct size and length Type, Quantity; see comment box on charts to identify ordering volumes. Aim to provide products to last a month. Gender, for when prescribing catheters as accuracy of the length is essential. Making choices for patients and their carers should involve a holistic assessment taking into consideration physical, psychological, social, and religious or faith beliefs and sexuality. Therefore this needs to be a collaborative process based on informed consent, dignity, respect and patient s clinical needs. This is inclusive of infection control guidelines. The assessment should include a continence assessment of bladder and bowel function using Sheffield s Continence Care Pathway to promote a decision regarding a provisional diagnosis. This will facilitate a holistic approach; prevent unnecessary difficulties for the patient and promote a trusting relationship between the patient and professional. The assessment will include: Medical history such as allergies, medication and long term conditions Social activities Cognition Ability to perform activities of daily living 3

4 Self care abilities. Patients and carers needs are likely to change over time and therefore a regular reassessment of products will be required. Regulation of Prescription Appliances Prescriptions of continence appliances are classified as medical devices and are regulated by the Medical Devices Agency (MDA) The MDA should be informed of any faulty products following the PCT policy for medical devices. Adverse incidents may be reported using the yellow card forms that may be found in the back of the British National Formulary (BNF) or may be downloaded from the MHRA website: or reported at Supplier Options Most patients and GP Practices will use the local chemist. The local pharmacist is likely to provide a confidential delivery service and may already be involved with the patient or carer by providing and possibly delivering prescription medications. It is the patient s choice where they take their prescriptions. There are also Dispensing Appliance Contractors (DACs) that provide a specialist confidential delivery service. They will often provide a delivery prior to requesting a prescription. The GP practice is under no legal obligation to provide a retrospective prescription to an appliance contractor. 4

5 Catheters: Indwelling (Foley) Suggested Short Term Foley Catheter Product name Drug Tariff Order Codes Time can be left insitu Teleflex PTFE (coated latex) coated Aquaflate 10ml balloon Standard/male length DP3101 Sizes Ch Female length DP2101 Sizes 12-24Ch days Dispensed with syringe for balloon deflation & syringe with 10mls sterile Cost per catheter 2.10 Suggested Catheters for Long Term Use Product name Teleflex Medical Rüsch Brilliant Aquaflate All-silicone Coloplast Folysil open tip silicone catheter Drug Tariff Order Codes Standard/male length DA DA Sizes Female DA DA Sizes Standard/male length AA74-10ml balloon 12-18Ch Time can be left insitu Average use 3 to 12 weeks Average use 3 to 12 weeks Adjust last 2 numbers of codes for correct code to size Dispensed with empty syringe for balloon deflation and sterile water filled syringe for balloon inflation. The tip tapers to facilitate insertion and removal but may be an issue with problematic encrustation Prescribe for urethral and suprapubic catheterisation Prescribe where there is a problem with bypassing (consider anticholinergic medication) & encrustation. Open tip may promote improved drainage. Due to potential cuffing of balloon on deflation remove by 8 weeks for suprapubic use. Prescribe for urethral and suprapubic catheterisation Cost per catheter

6 Suprapubic Catheter Product name Drug Tariff Order Codes Time can be left insitu Long length Average use is L.IN.C Medical ml balloon 12Ch 3 to 12 weeks Suprapubic catheter ml balloon 14Ch with open tip ml balloon 16Ch ml balloon 18Ch ml balloon 20Ch ml balloon 22Ch ml balloon 24Ch Suprapubic use only Prescribe where there is a problem with bypassing (consider anticholinergic medication) & encrustation. Open tip promotes improved drainage. Easy to remove due to integral balloon deflating flat Cost per catheter Lubricant gels to aid comfortable catheter insertion Product name Instillagel 6mls for female catheterisation 11mls for male catheterisation Cathejell Mono 8.5 gms for female catheterisation 12.5 gms. for male catheterisation Licensed Use Sterile single use Sterile single use For urethral catheterisation. To be used prior to catheterisation for adequate activation of anaesthetic. Wait for at least 4 minutes. To be used prior to suprapubic catheter change or urethral where there has been trauma to the urethra and Lidocaine would be contraindicated. There is no Lidocaine. This is relevant due to the risk of absorption of Lidocaine through broken skin or traumatised mucosal linings directly into systemic blood stream. If this occurs risks include respiratory and cardiac impairment. Cost per piece

7 Suggested Catheters for Intermittent Self Catheterisation Single use hydrophilic catheters Product Name Drug Tariff Order Codes Licensed number of uses C S Bullen Ltd Standard/male length Single use only Hi-Slip Hydrophilic HS.SM4008- HS. SM4022 Coating will not Catheter reactivate Female length HS. SF2008-HS.SF2016 Coloplast Easicath Male 5348= 8Ch, 4350= 10Ch 5352= 12Ch, 5354= 14Ch 5356= 16Ch, 5358= 18Ch 5360= 20Ch, 5362= 22Ch Female 5368= 8Ch, 5370= 10Ch 5372= 12Ch, 5374= 14Ch 5376= 16Ch Single use only Coating will not reactivate Dispensed in packs of 30 Size of catheter highlighted in code e.g. 12Ch= Soak in cold water for 30 seconds to activate coating Dispensed in packs of 25 Soak in cold water for 30 seconds to activate coating Price per catheter 98p

8 Single Use Catheters. Either pre-hydrated or containing a sterile water sachet Product Name Drug Tariff Order Codes Licensed number of uses C S Bullen Ltd Hi-Slip Plus Hydrophilic Catheter with water sachet Rochester Medical HydroSil Silicone Hydrophilic Catheter with integral water pack Coloplast Speedicath Compact Standard/male length HS. PM4008, HS. PM4024 Female length HS. PF2008, HS. PF2016 Standard/male length HydroSil discreet female length Female 28580= 10Ch 28582= 12Ch 28584= 14Ch Single use only Single use only Single use only Size of catheter highlighted in code Hydrated by bursting water sachet Wait 30 seconds for hydration process Dispensed in pack of 30 Size of catheter highlighted in code Hydrated by bursting water sachet Wait 30 seconds for hydration process Dispensed in pack of 30 Lipstick size product Pre-hydrated Dispensed in pack of 30 Price per catheter Indications for prescribing: to promote dignity and reduce risk of urinary infections in public and home facilities. 8

9 Sterile Urine Drainage Bags- Leg Bags Product Name Drug Tariff Order Codes Licensed use Price per 10 bags L.IN.C Medical 350ml direct inlet tube, T-tap LM350SD-T 350ml 10cm inlet tube, T-tap LM350MD-T 350ml Direct inlet tube swivel tap LM350SD-S 350ML 10Ccm swivel tap LM350MD-S 500ml direct inlet tube, T-tap LM500SD-T 500ml 10cm inlet tube, T tap LM500MD-T 500ml 30cm inlet tube, T tap LM500LD-T 500ml Direct inlet tube, swivel tap LM500SD-S 500ml 10cm inlet tube, swivel tap LM500MD-S 5-7days per bag Issued in packs of ml= ml= CliniSupplies Ltd ProSys 350ml 10cm inlet tube P350S 350ml 30cm inlet tube P350L 500ml 10cm inlet tube P500S 500ml 30cm inlet tube P500L 5-7 days per bag Issued in packs of 10 At the moment barrel/t tap only Tap maybe stiff so assess dexterity Manfred Sauer UK Ltd Discreet Thigh Bag 450ml direct inlet 70.04S 5-7 days per bag Pack includes non-latex sterile gloves Issued in packs of 10 Swivel tap Diagonal direct inlet tube suitable for suprapubic catheter connection ml straight direct inlet 70.06S 5-7 days per bag Discreet. A good option for people who want to wear skirts or shorts 9

10 Product Name Drug Tariff Order Codes Teleflex Medical Belly Bag Licensed use Price per bag Teleflex Medical (Rusch) Belly Bag including belt B1000P 28 days Sterile drainable 1 litre bag. Suitable for suprapubic or urethral. Promotes dignity, mobility and quality of life by having the bag worn at the abdominal area. Fastening around the waist by means of a woven belt with a quick release buckle. Suitable for male or female use 24 hours per day. It is designed to be used with foley or suprapubic catheter Eliminates the problem of catheter expulsion and leg bruising. May reduce vacuum problem/suction of eyelets into bladder wall. Twist action tap 2 in a pack Sample port includes belt Catheter Valves Requires bladder function assessment and holistic assessment of patient to ensure safe and accurate use. Product name Bard Limited Flip-Flo catheter valve Drug Tariff Order Codes Licensed use Cost per valve BFF5 5-7 days 5 per pack Helps to maintain bladder function. 10

11 Urine Drainage Night Bags to Attach to Leg Bag- 2 Litre Product Name Drug Tariff Order Codes Licensed Use Price per bag L.IN.C Medical Ltd LM2LNS Single use Care homes should only use single use night drainage bags 2.10 for 10 bags Clinisupplies Ltd ProSys Non-sterile 2 litre night bag with single use drainable tap PSU2 Single use 3.10 for 10 bags 2 Litre Urine Drainage Night Bags to Attach Directly to Catheter or to the leg drainage bag. Product Name Simpla S5 Lever tap Drug Tariff Order Codes Licensed use 5-7 days Sterile drainable 2 litre night bag to attach to catheter. Use clinical judgement to discern if a reusable night bag is appropriate in a patient s private residence. Price per bag for 10 bags ProSys T-tap P days As above Contains pair of sterile non-latex gloves Tap may be stiff so assess dexterity for 10 bags 11

12 Product Name Coloplast Ltd Simpla G-Strap Short: 40cm Adult: 50cm Abdominal: 90cm Drug Tariff Order Codes Catheter Draining Suspensory Systems Licensed use Price per pack For supporting catheter or drainage bag 5 per pack Prevents traction on urine drainage systems To help prevent trauma to the urethra/penis Coloplast Ltd Aquasleeve Small (leg circum cms) Standards (leg circum cms) Medium (leg circum cms) For supporting any drainage bag Can accommodate any manufacturer leg drainage bag 4 per pack Accurate measurement of the leg essential. If sleeve too tight, it will graze the skin and too loose, will not be supportive. Correct size provides excellent support, helps to avoid blistering from ordinary catheter bag straps Large (leg circum cms) X-large (leg circum 65 cms plus)

13 Urinary Drainage Sheaths Product Name Rochester Medical Limited Clear advantage with aloe silicone sheath Standard length Style 1: 24mm 28mm 32mm 36mm 40mm Pop-on Style 2: 24mm 28mm 32mm 36mm 40mm Style 3 Wide band: 24mm 28mm 32mm 36mm 40mm Drug Tariff Order Codes Licensed use For 24 hours 30 per box Appropriate training required for correct measurement, fitting and patient education. Just a few failures with a sheath can be discouraging resulting in rejection of the system. Always assess patient for penile retraction to assess for appropriate sheath. Incorrectly fitting products may cause skin damage, infection, leakage, pressure sores. Good adhesive qualities, the aloe helps to protect the skin. Pop-on sheath may be used on a mildly retracting penis. Price per box

14 Urinary Drainage Sheaths Product Name Manfred Sauer UK Limited P-SURE Latex free self adhesive sheath Drug Tariff Order Codes Licensed use 24 hours Box of 30 Specialist sheath with anti-urine blow back feature. Price per box Paediatric 18 mm Small 20 mm 22 mm 24 mm Good fitting instructions Telephone continence service regarding advice about fitting Medium 26 mm 28 mm 30 mm Large 32 mm 35 mm 37 mm X-large 40 mm

15 Product Name Clinimed Limited BioDerm sheath Circular Drug Tariff Order Codes Licensed use Price per box 20006/starter (box 5) 20006/10 (box 10) For approximately 3 days. Specialist sheath, particularly for a retracted penis. The hydrocolloid adhesive is applied to the glans of the penis and the foreskin rolled back over the glans. It is left in place up to 3 days Oval 20026/starter (box 5) 20026/10 (box 10) For support with sheath fitting contact: Karen Kemp, Nurse Advisor Script-easy: Mobile: /free phone Or Sean Casey, Nurse Advisor Fittleworths: Mobile: or free phone Product Name Manfred Sauer UK Limited Non-sterile, leg bag 600ml 45cm adjustable tube swing tap Coloplast Limited Conveen Security + leg bag non-sterile 50cm tube Non-sterile sheath drainage leg bags Drug Tariff Licensed use Price per bag Order Codes 5-7 days 10 in a pack Adjustable tube is adj soft and flexible days 10 in a pack Adjustable corrugated tube

16 Appliance management of faecal leakage Anal Plugs Product name Coloplast Limited Peristeen Anal Plug Small: 37mm Large: 45mm Drug Tariff Order Codes Licensed Use May be left in place for up to 12 hours 20 per pack Useful for mucus leakage or small to moderate leakage of liquid faeces. Should not be used for cases of diarrhoea or constipation. Cost per pack of Faecal Collector Product name Hollister Limited Hollister Faecal Collector Drug Tariff Order Codes Licensed Use 24 hours or longer 10 per box For bed bound patients Cost per box 500 mls 1 litre

17 Product name Coloplast Limited Peristeen Bowel Irrigation Kit: System includes: 1 control unit, 2 rectal catheters, 1 water bag, 2 straps. Drug Tariff Order Codes Anal Irrigation System Licensed Use Cost per item System works 90 times. Change every 6 months if irrigating alternate days Indications: neurogenic bowel: e.g. spinal cord injury, spina bifida, multiple sclerosis Chronic constipation and chronic faecal incontinence DVD plus instruction leaflet available from manufacturer Accessory unit 15 rectal catheters, 1 water bag Order 1 box per month when irrigating alternate days. Rectal catheters are single use, water bag 15 uses For professional support contact the continence advisory service or Paula Mills: health care professional. Paula will help with professional advice and joint visits. Mobile: , Trent Direct:

18 Prescription Urinals Product name Beambridge Medical Prescription Urinals Bridge Saddle Urinal Bridge Urinal Drug Tariff Order Codes Licensed Use On use going Standard Infection Control precautions. Private Homes in comparison to Care Homes. Cost per piece Bridge Urinal with tap 6-18T Male Draining Jug 6-50 Male Draining Jug with tap 6-50T Beambridge Standard Funnel 6-35M Manfred Sauer Discreet Uribag 18

19 Catheter Maintenance Solutions Product name Bard Limited Drug Tariff Order Codes Licensed Use Single use See catheter guidelines Cost per piece OptiFlo G 3.23% citric acid 50 mls 100 mls CSG50 CSG OptiFlo R 6% citric acid 50 mls 100 mls CSR50 CSR100 Product name Drug Tariff Order Codes OptiFlo S 0.9% saline CSS50 CSS100 Licensed Use Single use Bladder Washout Solution For bladder irrigation only. May help reduce catheter blockage from blood clots or mucus 3.20 Cost per piece 19