PrescQIPP

Stoma Appliance Reviews (2018)

South Worcestershire, Redditch and Bromsgrove and Wyre Forest CCGs

Introduction

It is estimated that over 130,000 people in the UK have a stoma (1) and it has been reported that up to 85% of these patients have an issue with their current solution (2). There are a number of common problems including skin irritation, blockage, leakage, difficulty with attaching and removing the appliances and sore skin. Most of these can often be resolved with appropriate advice from a trained healthcare professional.

It is estimated that over two thirds of ostomates in the UK are experiencing sore skin and attempt to resolve the issue without support. This may be in part due to a lack of awareness of issues related to their stoma, and/or a fragmented service available to patients who seek support. It is recognised that GPs who provide prescriptions for stoma products do not have the skills to be able to determine on-going clinical appropriateness of prescribed items or help patients resolve common issues. This in turn leads to increased healthcare costs due to increased product use, product wastage and potentially unnecessary referrals.

This project, in partnership with Coloplast, seeks to improve patient awareness by facilitating support services to provide stoma patients with specialist care. It also aims to reduce prescribing costs by reducing over ordering and waste through intensive initial review and annual follow ups, allowing the specialist nurse to discontinue unnecessary items following discussion with the patient and in a timely manner.

References:

  1. Burch J. (2011) Management of stoma complications. Nursing Times; 107: 45, 17-20
  2. Coloplast. (2015) Data on File: Data from ostomy checks performed March – June 2015 (approx. 5,000 patients)

How was the project established? / How is it currently being established?

One GP practice in Worcestershire set up a clinic to review their stoma patients with a stoma nurse from Coloplast undertaking Appliance Use Reviews. This work demonstrated savings on inappropriate or duplicate stoma products being prescribed but also identified patients who had unaddressed issues with their stoma. Based on this the CCGs established a joint working agreement with Coloplast to set up community clinics to review all stoma patients across the county during 16-17.

Who are the main beneficiaries of the project? How would they benefit?

Benefits to the Patients:

The service has provided patients with access to appropriate support which has not previously been available. It has addressed issues with their stoma some of which significantly impacted on their daily lives. Patients also have access to educational support on the appropriate usage of their stoma solution and are informed on current frequency of stoma usage to ensure that ostomy products are being ordered appropriately.

Benefits to the NHS:

Reduction in prescribing of inappropriate or excessive amounts of stoma products resulting in a reduction in spend on stoma products. In addition there is an assurance that patients are having a regular review of their condition.

The spend/item for Worcestershire has reduced by 3.7% from 15-16 (before the service started) to 17-18. England increased by 0.5% in the same time period.

What were the main outcomes and / or achievements of the project?

As of December 2017 38 GP practices had taken part in this service across Worcestershire. Key findings based on 285 patient reviews showed that:

  • 49% of these patients had not seen a nurse about their stoma in over two years
  • 23% of these patients reported sore skin
  • 22% of these patients reported that their stoma leaked
  • 20% of the prescribing costs for these patients within this category was on accessories, often used to solve clinical issues but in most cases not having a positive impact.
  • 178 products were stopped when found to be inappropriate to needs or just being wasted
  • The average saving per patient per year across the 285 patients seen in clinic was £336
  • This service also avoided 64 Stoma Care Nurse appointments and 61 GP appointments
  • 100% of the patients reported being very satisfied with the Coloplast Nursing Service.
    This service is ongoing across the county and to date over 300 patients have been reviewed.

Patient testimonials:

Mrs T, a 61 year old lady presented at the Stoma clinic with a Urostomy. She had suffered with incontinence post child birth and had undergone urostomy surgery to manage the condition. Mrs T had a large undulating abdomen with “valley” in midline and the Urostomy was situated on the valley slope. She was using a pouch which she was changing up to 6 times a day and reported significant leakage, particularly on a night. The patient had reported that “every night she had leaks that meant she was practically swimming from her bed”. Mrs T was changed to a convex pouch which meant that she only had to change it every 3 to 5 days and experienced improved sleep through the night. This meant she could use 15 pouches per month instead of 180 pouches which is the quantity she had been ordering previously. Previous pouches 180 per month at a cost of £959.22 per month. New convex pouch 15 per month at a cost £105.54. Potential savings: £853.68 per month; £10,244.16 per year. Mrs T was “over joyed to sleep through the night after so many years”.

Mrs S came to clinic - could not remember the last time she had seen a stoma nurse but thought it was about three years ago when she had her surgery in London. Having moved into the area she never made contact with the stoma care team until the invite to clinic. She was using a closed flat pouch however she was experiencing pancaking and leakage. This meant that she was presently using 8 pouches a day. After her review Mrs S was provided with a closed light convex pouch. This meant Mrs S could use 2 pouches per day. 240 pouches cost £710.00 reduced to 60 pouches per month. Overall cost saving £643.80 per month; £7,725.60 per year.