WORCESTERSHIRE AREA PRESCRIBING COMMITTEE Guidelines for Prescribing Stoma Appliances and Accessories in General Practice

Transcription

1 Wrcestershire Area Prescribing Cmmittee July 2016 WORCESTERSHIRE AREA PRESCRIBING COMMITTEE Guidelines fr Prescribing Stma Appliances and Accessries in General Practice Intrductin This guideline prvides advice t GP practices n the issue f prescriptins fr items that are supplied t stma patients, t prmte clinically apprpriate use, reduce waste, imprve cmmunicatin and reduce ver-rdering. The guidance utlines the respnsibilities f the stma specialist, GP practice, dispensing cntractr [dispensing appliance cntractr (DAC), cmmunity pharmacy r dispensing dctr] and the patient/ carers r relatives and is designed t be used by all prescribers (medical and nn-medical), GP practices, and specialist nurses. The guidance prvides advice n mnitring and review f stma appliance and accessry use t ensure best practice. The healthcare prfessinal (HCP) wh prescribes these prducts legally assumes clinical respnsibility fr the treatment and the cnsequences f its use. General A list f all stma appliances available n FP10 can be fund in the Drug Tariff, Part IXC. This can be accessed nline at Stma appliances shuld always be prescribed by brand and nt generically; this generally takes the frmat f the manufacturer s name, a descriptin f the prduct and the manufacturer s cde. If the manufacturer s cde fr the item descriptin is entered, the EMIS Web system will select the specific prduct which saves scrlling thrugh a lng list. Quantities shuld always be specified. Use f the term OP (Original Pack) shuld be avided. If the patient is trialling a new prduct, a small quantity shuld be prescribed t avid waste althugh riginal packs cannt be split. Patients requiring incntinence r stma appliances can have these dispensed either by a dispensing appliance cntractr (DAC), a pharmacy cntractr r a dispensing dctr. Respnsibilities f the Dispensing Appliance r Pharmacy Cntractr The dispensing appliance cntractr r pharmacy cntractr is required t ensure that apprpriate advice is given t patients abut any appliance prvided t them in rder t enable them t utilise, stre and dispse f appliances apprpriately. The dispensing appliance cntractr/pharmacist must als prvide apprpriate advice t patients n the imprtance f nly requesting n repeat thse items which they actually need t ensure that unnecessary supplies are nt made. Dispensing cntractrs must als supply a reasnable quantity f wipes and dispsal bags with stmy prducts free f charge, which d nt need t be added t the prescriptin. (A marker has been placed in the Drug Tariff next t thse categries t indicate with which items wipes and dispsal bags must be supplied). Date apprved by APC: July 2016 Expiry date: July 2019 Page 1

2 Wrcestershire Area Prescribing Cmmittee July 2016 Appliances shuld nt be supplied t a patient withut a signed prescriptin. Emergency supplies must nt be made unless a request is specifically initiated by the prescriber and as the prescriptin is prvided within 72 hurs. Respnsibilities f the Stma Specialist Select and initiate the mst apprpriate prduct fr treatment/management withut pressure frm any spnsring cmpany ensuring that patients have cmplete freedm f chice. Stma appliance prescribing chices shuld be made based n individual patient needs. Prescribing quantities shuld be based n individual patient need and take int cnsideratin recmmended quantities fr prescribing. Refer t attachment 1, Prescribing guidelines fr stma appliances accessries. Only stma prducts listed in part IXC f the Drug Tariff shuld be initiated. Ensure that patient has an established treatment plan that they fully understand. Cmmunicate prmptly with the GP regarding: Prduct initiatin (including prduct cdes). Expected mnthly usage. Expected duratin f treatment; r, if lng term, date f next review. Specialist nurse name and cntact details in case there are any queries regarding the appliance use by the patient. Mnitr respnse t treatment, r advise GP f mnitring requirements. If changes are made t the patient s prescriptin, advise bth GP and dispensing cntractr (where apprpriate) f any mdificatins. Ensure clear arrangements fr back-up, advice, and supprt including review at least annually fr lng-term stma patients. Respnsibilities f the Practice T check that patients have been referred t the Cmmunity Stma Care Service and if nt cmplete the referral. All requests fr prescriptins shuld be initiated by the patient. The preferred rute is direct t the GP practice, t enable a rbust audit trail. Prescriptins shuld nly be issued at the request f the patient/patient s carer r relevant healthcare prfessinal. Requests fr prescriptins shuld nly be accepted frm a stma specialist nurse, hspital ward staff r district nurse if a prir agreement has been made with the GP. Initiate system fr supply, and then cntinue prescribing, adjusting prescriptins fr prducts(s) as advised by the specialist. Check quantities requested against infrmatin in Attachment 1 Prescribing Guidelines fr Stma Appliances Accessries. These prvide suggested prescribing quantities and prescriptin directins and ntes t assist the prescriber. Be aware f the nrmal usage rate by the patient and that any irregularities are flagged t the GP and reviewed with the patient/carer. Refer t the flw charts 1 and 2 at the end f this dcument t identify veruse f stma appliances and accessries and the actin t take in such cases. (Flw chart 1: Overuse f stma prducts flw chart. Flw chart 2: Overuse f stma accessry prducts flw chart). Be aware f the situatins that may require referral t a stma care specialist: Rutine ver rdering f stma supplies. Lng term use three mnths f skin prtective prducts (wipes / films / paste / pwders). Date apprved by APC: July 2016 Expiry date: July 2019 Page 2

3 Wrcestershire Area Prescribing Cmmittee July 2016 Current use f pressure plates r shields patient may benefit frm the use f newer prducts with built in cnvexity. Old style reusable bags. Current use f adhesive rings, discs pads r plasters newer prducts may be mre apprpriate. Current use f prducts that are t be discntinued. Patients that are experiencing leakage. Patients experiencing dietary prblems. Patients that have develped hernias. Patients having management difficulties, e.g. elderly. At patient s request. Patients having psychlgical difficulties adapting t their stma. Be aware f advice in Attachment 2 Medicines use in Stma Management. Prducts/quantities shuld nt be altered withut cnsulting the patient/carer. Issue prescriptins fr stma appliances n a separate frm frm ther patient medicatin t avid prblems if a patient uses a DAC rather than a pharmacy cntractr. Recrd DAC r pharmacy cntractr details in the patient s medical recrds. GP practices shuld nt issue retrspective prescriptins if requested by the Dispensing Appliance Cntractr (DAC). The dispensing cntractr must receive the prescriptin PRIOR t the delivery f items. If the dispensing cntractr delivers item(s) prir t receiving a prescriptin, it risks nt btaining a prescriptin t cver the supply. In such cases, the GP is entitled t refuse t supply a prescriptin. The nly exceptin t this might be the first prescriptin fllwing discharge t ensure the patient has a supply f prducts at hme. In these circumstances supply is initiated by the Acute Trust specialist team. Print / issue the prescriptin fr the patient/carer (r send t cntractr) within the agreed turnarund time and by the agreed methd f dispatch. Dcument any cmmunicatin frm the dispensing cntractr and specialist in the patient s clinical recrd. Reprt t and seek advice frm the specialist n any aspect f patient care that is f cncern and may affect treatment. Stp r adjust treatment/management n the advice f the specialist r immediately if an urgent need t stp treatment arises. Cpies f appliance use reviews (AURs) shuld be reviewed by an apprpriate persn in the practice and stred in the patient s medical recrds. Ensure clear cmmunicatin with patient regarding the rdering prcess agreed between the practice and the cntractr, e.g. regarding the interval prir t delivery when the regular prescriptin request shuld be submitted. Typically, patients with stma request mnthly prescriptins. If requests are mre frequent, advice shuld be sught frm the specialist nurse. It is strngly recmmended that the practice has its wn agreed prtcl fr hw it deals with dispensing cntractrs. Appliance use reviews (AURs) Appliance use reviews (AURs) frm part f the advanced services that can be carried ut by cmmunity pharmacists r specialist nurses and are an effective way f assessing and crrecting any prblems with appliances. They are similar in cncept t Medicines Use Reviews (MURS) but directed at use f appliances. Date apprved by APC: July 2016 Expiry date: July 2019 Page 3

4 Wrcestershire Area Prescribing Cmmittee July 2016 AURs are intended t imprve the patient s knwledge and use f the appliance they are prescribed. A recrd f each AUR must be cmpleted and frwarded t the appliances supplier, the patient s GP and any ther healthcare prfessinal, including any NHS nurse prviding care fr that patient. Each recrd must dcument any advice given t the patient r any interventin made. Attachments Attachment 1: Prescribing Guidelines fr Stma Appliances and Accessries. Attachment 2: Medicines Use in Stma Management. Flw chart 1: Overuse f Stma Prducts. Flw chart 2: Overuse f Stma Accessry Prducts. Acknwledgement These guidelines are based n dcuments prduced by PrescQIPP: Date apprved by APC: July 2016 Expiry date: July 2019 Page 4

5 Wrcestershire Area Prescribing Cmmittee May 18 Attachment 1. Prescribing guidelines fr stma appliances and accessries Appliance Usual mnthly quantity Prescriptin directins Ntes Clstmy bags (ne piece systems) General ntes bags Remve and discard after use. Bags are nt drainable Usual use: 1-3 bags per day. Flushable bags nly t be used n advice f bwel/stma nurse bags + 15 flanges Bag remve and discard after use. The flange (base plate fr 2 piece systems) is nt usually Clstmy bags (tw piece systems) Flange change every 2-3 days. changed at every bag change. Items rdered separately. Irrigatin (gravity 1 kit/year T wash ut clstmy The use f irrigatin pumps such as Irypump is nt supprted systems) in Wrcestershire (see general ntes belw) Irrigatin sleeves 30/mnth Use nce every 1-2 days Self-adhesive dispsable sleeves Stma caps 30 Fr use n mucus fistulae r This may be in additin t riginal stma bag clstmy if irrigating Ilestmy bags bags Drain as required thrughut the day. Bags are drainable (ne piece systems) Use a new bag every 1-3 days. Ilestmy bags bags + 15 flanges Bag change every 1-3 days The flange (base plate fr 2 piece systems) is nt usually (tw piece systems) Flange change every 2-3 days changed at every bag change. Items rdered separately. Urstmy bags (ne piece systems) Urstmy bags (tw piece systems) Night drainage bags fr urstmy patients bags Drain as required thrughut the day. Generally replace bag every 2 days bags + 15 flanges Bag change every 2 days Flange change every 2-3 days 4 bags (1 bx f 10 bags Use a new bag every 7 days. every 2-3 mnths) Bags are drainable The flange (base plate fr 2 piece systems) is nt usually changed at every bag change. Items rdered separately Bags are drainable If quantities rdered exceed thse listed withut gd reasn (e.g. number f bags in times f diarrhea), refer t stma specialist. Stma underwear is nt necessary and shuld nt be prescribed, unless a patient develps a parastmal hernia and has been advised t wear supprt underwear r a belt by a stma care nurse specialist wh will advise n prduct chice. The use f irrigatin pumps such as Irypump fr stma irrigatin is nt supprted in Wrcestershire. Patients shuld be referred t a stma care nurse specialist fr advice abut an alternative gravity based irrigatin system. Refer t patient s Appliance Use Review (AUR) fr stma nurse specialist advice. Refer t stma nurse specialist if further advice needed r n AUR in last 12 mnths. Attachment 1 updated and apprved by APC May 18

6 Wrcestershire Area Prescribing Cmmittee May 18 Prescribing guidelines fr stma accessries Accessry Usual quantity Prescriptin directins Ntes Flange extenders (fr ne and tw-piece systems) Belts (fr cnvex puches) 3 packs per mnth Change every time bag is changed. May require 2-3 fr each bag change. 3 per year 1 t wear, 1 in the wash, 1 fr spare Supprt belts 3 per year 1 t wear, 1 in the wash, 1 fr spare Adhesive remvers 1-3 cans (depending n Use each time stma bag frequency f bag is changed changes) Dedrants Lubricating dedrant gels Skin fillers Skin prtectives (wipes, films, pastes and pwders) Nt rutinely required. Husehld air freshener is sufficient in mst cases. Nt rutinely required. A few drps f baby il r live il can be used as an alternative. If required 1-2 bttles per mnth. Fllw directins f bwel / stma nurse Fllw directins f bwel/ stma nurse Use as needed when changing stma bag Put ne squirt in t stma bag befre use Change each time bag is changed Apply when bag is changed as directed Often required fr extra security if the patient has a hernia r skin creases as it increases adhesive area. If used as there is leakage arund the stma - refer fr a review. Washable and re-usable. Only if deemed clinically required by stma care nurse specialist (needs t be reviewed n an annual basis). Sprays are mre cst effective than wipes. Nn-sting, silicne based prducts are recmmended. Pelican - use as adhesive remver and dedrant. Shuld nt be required. If crrectly fitted, n dur shuld be apparent except when bag is emptied r changed. Husehld air freshener is sufficient in mst cases. If dur present at times ther than changing r emptying refer fr review. Only recmmended if patients have difficulty with pancaking. Bttles are mre cst effective than sachets. A few drps f baby il r live il can be used as an alternative. Filler pastes/ washers are used t fill creases r dips in the skin t ensure a seal. Alchl cntaining prducts may sting. SHORT TERM USE ONLY (acute prescriptin): may be used n skin that is brken, sre r weepy t prmte healing. If used fr >3 mnths, refer. Barrier creams are NOT recmmended as they reduce adhesiveness f bags/flanges. Useful fr Crhn s disease patients, useful fr lse watery utput. 1-2 sachets/strips t be used each time appliance is emptied Thickeners fr ilestmy 2 bxes/tubs per mnth Use ne with every new bag Acute sprts shield 1-2/year Are nt rutinely necessary but may be prescribed fr sprting activities if recmmended by a stma nurse specialist Attachment 1 updated and apprved by APC May 18

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