Cambridgeshire and Peterborough Integrated Care System sought to improve the continued care of their Stoma patients and increase formulary adherence From the initial 6 practice reviews concentrating on formulary switches and reducing over ordering of bags.
349 patient reviews were performed, resulting in 82 being referred for advice often due to overprescribing of items. 23 of those required a specialist clinical review due to problems with their stoma.
The analysis of the data from the pilot established that greater cost savings were recuperated from the high-cost items where patients had been over ordering Stoma products such as bags and Belts, than the associated stoma accessories which tended to be lower in cost. Experience showed that this was where the greatest need for a clinical review was.
We sought to devise a model of clinical stoma reviews by specialist Stoma nurses with the least impact on hospital stoma nurses and Practice staff. As Appliance contractors were currently performing Annual use reviews (AURs). The possibility was explored of working with Community Stoma nurses within the locality to provide targeted AURs for patients with the greatest need. The amended model of targeted AURs in 2 practices highlighted areas relating to patient safety.
Out of the 58 patients reviewed 27 had not been seen by a stoma nurse in 2 years and an additional 10 had not been seen in over a year. From the reviews 61 patients needed some sort of intervention by the stoma nurse, which picked up associated clinical issues around the patients' stomas such as leakage, pancaking, ballooning and hernia issues. Which would have resulted in an additional referral to a specialist hospital stoma nurse, if the original model had been followed. Alongside this, cost savings were released of an average cost per patient annually of £102 exc. potential clinical nurse review costs.
This model of reviews ensured patients received a clinical review and were able to discuss concerns with a specialist stoma nurse. The nurse could discuss any overprescribing of bags etc and the reasons for this. As well as explain and agree formulary switches with the patients ensuring future adherence to the formulary choices.
The reviews did not incur any additional costs as the AUR payment covered this. And the impact on practices was minimal only requiring admin support to update patients repeat templates and clinic space. To support formulary adherence following the stoma reviews the Medicines optimisation team developed a stoma switch toolkit which included all the required documents to support with ongoing stoma switches to formulary choices.
