The NHS in Liverpool wants to improve care for adults and children using stoma products in the city. Before we make any changes we’d like to hear from people using stoma products, families, carers and support organisations.
A stoma is an opening on your abdomen that can be connected to either your digestive or urinary system. There are three main types: colostomy, ileostomy and urostomy. Stoma surgery is undertaken to treat a range of illnesses including cancer, diverticulitis and Crohn’s disease or following a trauma to the abdomen.
At the moment, once you are discharged from hospital your repeat prescriptions for stoma products are issued by your GP (family doctor). We’re proposing that in the future this is done by a specialist stoma products ordering service overseen by stoma nurses for patients in Liverpool. A trained advisor from the service would call you every month to ask what products you need and how you are feeling; you would also have the option to order online if you would prefer. If you are having any problems, you would be referred to a stoma nurse for more support. All prescriptions would be approved by a stoma nurse before they were issued. The new service would send prescriptions straight to your chosen pharmacy or delivery company (also known as a Dispensing Appliance Contractor or DAC) so that they could issue your products.
As well as taking your orders, the new service would offer patients a face to face review with a stoma nurse each year, either in a community clinic or at home. There would be an emergency contact number for outside of office hours, including bank holidays.
You would still choose which community pharmacy (local chemist) or delivery company dispenses and delivers your products. Your GP and stoma clinic would be advised of any changes to your prescription, so that everyone involved in your care is kept in the loop.
Children requiring stoma products would have a nominated parent, guardian or carer who will liaise with the service on their behalf.
A similar service to this was introduced in Liverpool for urology appliances (such as catheters) in 2017, and patient feedback has been very positive.
To make sure that patients get the right products, in the right quantity: There are lots of different stoma products and accessories available and new products are being introduced all the time. GPs generally have limited experience to be able to accurately prescribe type or quantity of product. Products can easily be incorrectly used or inappropriately prescribed. If products are used incorrectly the risk of infection, rashes, and leakage is increased.
To make sure that patients are reviewed so that changes are picked up: We have found that some patients, particularly those requiring stoma products long term, do not have regular reviews to make sure that prescribed products are still meeting their needs. Stomas can change over time so it is important that products are reviewed. A review can help avoid a number of issues, such as patients using products incorrectly, products not being updated or changed to meet new needs, and patients being prescribed inappropriate products. All these issues can affect quality of life and potentially result in infections, ill health and sometimes even admission to hospital.
To improve quality of life for stoma patients: Having the incorrect products – or using them incorrectly – can have an enormous effect on a person’s mental and social wellbeing. If a product isn’t working properly people might not want to leave the house or do activities that they would otherwise enjoy, this can lead to social isolation, poor quality of life and low self-esteem.
To reduce waste: Currently, costs for prescribing stoma products are rising but without an increase in quality of care for patients. We think this is because sometimes the wrong products – or amounts – are being ordered. Creating a dedicated ordering point for stoma prescriptions could reduce waste costs, while improving care for patients in the city.
NHS Liverpool Clinical Commissioning Group (CCG) is responsible for planning and buying most local health services, including hospital, community and GP services. We have developed proposals for the new stoma service with nurses who specialise in caring for stoma patients.
From Tuesday 30th July to Monday 23rd September 2019 you can share your views about this proposal. We will use the feedback we receive to make a final decision about the service – at the moment we expect that this decision will be made during autumn 2019. We would then start to make plans for who would provide the service, and when it would begin. We would get in touch with patients again before any changes happen.
We will use the information collected in this survey to inform plans and highlight any issues that we may not have thought about yet. The survey is anonymous so any information you share will be confidential.
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