This page will bring together all the PrescQIPP continence and stoma resources as well as showcase good practice examples of projects focusing continence and stoma. Each set of resources contains tools that can be adapted for local use before implementation.
Continence and Stoma: An Introduction
Continence and stoma is an area of care that affects a large number of service users, and also provides a significant cost pressure to the National Health Service due to high levels of inappropriate prescribing and waste, with often patchy monitoring and review processes. Ensuring that patients are prescribed appropriate appliances and accessories can greatly improve their quality of life. Increasing accessibility to expert clinical support and advice reduces dangerous and costly complications, for example catheter-associated urinary tract infections (CAUTIs) and pressure ulcers. Hospital admissions can be reduced as can care home admissions precipitated by incontinence or stoma issues.
This webkit supersedes the previously published PrescQIPP continence and stoma toolkit. We intend to build up the resources with lots of shared good practice of what members are doing locally in their areas. If you would like to submit a resource to be shared on this webkit- please see the Innovation hub on how to do this.
Continence and Stoma Virtual Professional Group
Chaired by Saj Khatri, this group is a chance for subscribers to connect with colleagues and discuss experiences, challenges and strategies.
Complete the form below to register for the group.
You can find out more about how we are helping subscribers to collaborate during our Year of Community.
Continence and Stoma Webinar
The old toolkit was launched via a webinar that featured Stuart Lakin (Head of Medicines Management, Rotherham CCG) and Joanne Mangnall (Continence Advisor/Clinical Lead Continence Service, The Rotherham NHS Foundation Trust), who shared their excellent work in re-designing the continence service in Rotherham.
Effective Commissioning of Continence Care Webinar
In September 2013, we did a webinar about commissioning of a continence service and was given by Liz Bonner, the lead nurse of the Bladder and Bowel Service at Whittington. She presented on the challenges commissioners face in trying to provide an effective continence service as well as some advice on how they can be tackled. In particular, she discussed the very useful guide, ‘Cost-effective Commissioning for Continence Care’, which can be downloaded from the following link: http://www.appgcontinence.org.uk/pdfs/CommissioningGuideWEB.pdf
2016 Innovation Award Winner - Nottinghamshire Appliance Management Service (NAMS)
Stoma appliance products represent a proportion of the GP prescribing budget about which GPs have little knowledge, with prescribing heavily influenced by manufacturers and suppliers of the products. There wasconsiderable growth in both the number of items and cost of stoma appliances in Nottinghamshire compared to other geographical areas and the prescribing budget as a whole.
Development of this service was intended to provide easy to access, immediate clinical support for patients in primary care with a stoma,combined with reducing waste in prescribing of stoma appliances. Stoma Nurse Specialists have the responsibility of undertaking the prescribing for all patients, which will improve patient care by ensuring that the patient receives the most appropriate appliance.
The initial proposal was worked up with input from local patient groups, specialist stoma nurses within the local trusts and by scoping similar models in other areas.
All 6 CCGs (Nottinghamshire City CCG, Mansfield and Ashfield CCG, Newark and Sherwood CCG, Nottingham North East CCG, Nottingham West CCG and Rushcliffe CCG) approved the service specification and the contract was offered out for tender to both NHS and private providers. Following a rigorous review the contract was awarded to a private organisation with very strict KPIs ensuring that provision of the service does not influence the choice of product or dispenser.
The commissioners worked together with the newly developed Nottinghamshire Appliance Management Service (NAMS) in the initial set up phase to ensure:
- Thorough communication to all stakeholders and patients
- Development of relationships with the stakeholders
- Accurate and secure transfer of patient data onto the clinical system at NAMS
- Development of clear pathways for patients transferring between secondary and primary care.
The vast majority of patients requiring stoma appliances in Nottinghamshire have had their prescription management transferred to the NAMS team. More information available here.
Continence and Stoma Landscape Review
In 2016, PrescQIPP conducted a landscape review on continence and stoma services which covered things such as how services were commissioned locally, number of specialist trained staff supporting local services, prescriptions and dispensing and local formularies. 49 commissioners participated in the landscape review. The final report discusses the responses received to the questions and also looks at prescribing data where appropriate to identify any trends.
The stoma bulletin provides advice on appropriate stoma prescribing. Support resources include guidance on appropriate quantities to prescribe, template patients letters and a letter to DAC.
Stoma (resource folder)
Service Redesign Board Report - Rotherham CCG
Stuart Lakin, Head of Medicines Management in NHS Rotherham, has kindly shared the board paper he produced for the re-design of the stoma service in Rotherham.
Please acknowledge Rotherham CCG in any use of the paper.
Prescribing Stoma Appliances - Wiltshire CCG
Stoma Guidelines – Worcester APC
Stoma Product Formulary Guide - West Kent CCG
Review of Stoma Ancillaries Report - Herefordshire CCG
Stoma Formulary - Herefordshire CCG
The continence bulletin and support materials advises on appropriate prescribing for continence and includes supporting resources to help review prescribing.
Formulary and Implementation Tools - NHS Coastal West Sussex
Continence Product Prescribing Guideline - Chiltern and Aylesbury Vale CCG
Continence Formulary – Wales
Continence Service Review – Wyre Forest
Continence Service Redesign Business Cases - Nene and Corby CCGs
Continence Formulary - Herefordshire CCG
Catheter Associated Urinary Tract Infections (CAUTI’s)
CAUTIs occur when germs (usually bacteria) enter the urinary tract through the urinary catheter and cause infection. CAUTIs have been associated with increased morbidity, mortality, healthcare costs, and length of stay. The risk of CAUTI can be reduced by ensuring that catheters are used only when needed and removed as soon as possible; that catheters are placed using proper aseptic technique; and that the closed sterile drainage system is maintained. This section of the webkit shares projects that have been done around managing and preventing CAUTIs.