DC95-Stoma Care and Management Policy

Registration Number: {{org_field_registration_no}}

Stoma Care and Management Policy

1. Purpose and Commitment

The purpose of this policy is to outline how {{org_field_name}} ensures safe, effective, and compassionate stoma care for service users. Stoma care involves managing an artificial opening in the body, often created during surgery to divert waste from the digestive or urinary system. This policy ensures that all staff provide high-quality, person-centred stoma care while maintaining the dignity, comfort, and independence of service users.

Our commitment is to deliver stoma care that aligns with the Health and Social Care Act 2008, NICE guidelines, and the Care Quality Commission (CQC) standards. We prioritise service user safety, promote independence, and support emotional well-being by ensuring that staff are trained, competent, and equipped to manage stoma care effectively.

2. Scope

This policy applies to all employees, including care staff, administrative staff, volunteers, and contractors involved in stoma care. It covers:

Daily stoma care and maintenance.
Monitoring for complications and responding appropriately.
Supporting service users’ physical and emotional well-being.
Effective communication with healthcare professionals and families.

The policy applies to all domiciliary care settings where service users require stoma care as part of their care plan.

3. Policy Statement

Our domiciliary care company is committed to providing safe, respectful, and efficient stoma care. We ensure that all care is delivered by trained and competent staff who adhere to best practices. Our approach includes:

Providing comprehensive staff training.
Developing personalised care plans for each service user.
Conducting regular risk assessments and monitoring for complications.
Promoting service users’ dignity, independence, and quality of life.

3.1 Consent, Mental Capacity and Choice

Stoma care must only be provided with the consent of the service user or, where applicable, a person who is lawfully authorised to make the relevant decision on their behalf.

Consent must be treated as an ongoing process and must be sought or confirmed as appropriate before stoma care is undertaken. The service user must be given information about the proposed care in a way that they can understand and that meets their communication needs. A service user who has capacity to make the relevant decision has the right to refuse stoma care or to withdraw consent at any time. Staff must respect the person’s decision, explain any immediate risks where appropriate, record the refusal or withdrawal of consent and follow the care plan and escalation procedure where the refusal may place the person at risk.

Where there is reason to believe that a service user may lack capacity to make a particular decision about their stoma care, staff must follow the Mental Capacity Act 2005 and the associated Code of Practice. Capacity must be considered in relation to the specific decision at the time it needs to be made and must not be assumed to be absent solely because of a person’s diagnosis, disability, age, appearance or behaviour.

Where the service user lacks capacity to make the relevant decision, any decision or action taken on their behalf must be lawful, in their best interests and the least restrictive available option, in accordance with the Mental Capacity Act 2005. Any applicable attorney, deputy or other person with lawful decision-making authority must be involved where their authority covers the relevant decision.

Consent, refusal of consent, relevant capacity assessments, best-interests decisions and any involvement of a lawful representative must be recorded in accordance with the organisation’s consent, mental capacity and record-keeping procedures.

4. Understanding Stoma Care

4.1 What is a Stoma?

A stoma is a surgically created opening in the abdomen that allows waste to exit the body. Stomas are typically created for individuals with medical conditions affecting the digestive or urinary systems. There are three main types of stomas:

Colostomy: Created from the large intestine to divert stool.
Ileostomy: Created from the small intestine to divert stool.
Urostomy: Created to divert urine from the urinary system.

4.2 Importance of Stoma Care

Proper stoma care is essential to prevent complications such as infections, skin irritation, and leakage. Effective stoma management supports service users’ health, comfort, and confidence while promoting independence in daily activities.

5. Roles and Responsibilities

5.1 Care Staff Responsibilities

All staff who provide or assist with stoma care must:

Follow the service user’s current individual care plan, risk assessment and any instructions provided by the stoma care nurse or other appropriate healthcare professional.
Obtain or confirm the service user’s consent before providing care and respect any refusal or withdrawal of consent.
Only undertake stoma care tasks for which they have received appropriate training and have been assessed and recorded as competent.
Not undertake a stoma care task independently where they have not been assessed as competent, where the task falls outside their role or competence, or where the required care differs from the authorised care plan or instructions.
Follow any documented delegation arrangements where the activity has been delegated by a regulated healthcare professional.
Follow standard infection prevention and control precautions, including effective hand hygiene and the appropriate use of personal protective equipment.
Use stoma appliances, accessories and other products only in accordance with the service user’s care plan, manufacturer’s instructions and any relevant instructions from an appropriate healthcare professional.
Observe the stoma, surrounding skin and output, as required by the care plan, and identify changes or signs of deterioration.
Take appropriate action and escalate concerns promptly in accordance with the service user’s care plan and this policy.
Seek immediate advice from a senior member of staff or appropriate healthcare professional if they are uncertain about any aspect of the person’s stoma care or if the person’s needs have changed.
Record the care provided, relevant observations, concerns, action taken, escalation and advice received accurately and contemporaneously.
Maintain the service user’s privacy, dignity, comfort, independence and choice throughout all stoma care.

5.2 Manager Responsibilities

The Registered Manager or delegated responsible manager must ensure that:

Each service user’s stoma care needs are assessed and supported by an up-to-date person-centred care plan and proportionate risk assessment.
The care plan identifies the type of stoma, the assistance required, the usual appliance and accessories, relevant skin-care requirements, expected observations where appropriate, known risks, signs of deterioration and clear escalation arrangements.
Stoma care is allocated only to staff who have received appropriate training and whose competence for the tasks they are expected to undertake has been assessed and recorded.
Staff do not undertake stoma care independently until they have been assessed as competent for the activities concerned.
Competency is reviewed at appropriate intervals and whenever there is a change in the service user’s needs, equipment, procedure or delegated activity, or where there is reason to question a member of staff’s continuing competence.
Appropriate supervision, support and access to clinical advice are available to staff providing stoma care.
Where a stoma-related healthcare activity is delegated by a regulated healthcare professional, the delegation, responsibilities, required competence, supervision arrangements and escalation procedure are clearly documented.
There are sufficient appropriately trained and competent staff available to meet assessed stoma care needs, including reasonable contingency arrangements for planned and unplanned staff absence.
Incidents, errors, complications and concerns relating to stoma care are reviewed and appropriate action is taken to reduce recurrence.
Records relating to stoma care, competency, risk assessment, care planning, incidents and clinical advice are accurate, complete, contemporaneous and securely maintained.
Relevant changes in a service user’s stoma or health condition are referred to the appropriate healthcare professional and the care plan and risk assessment are reviewed where necessary.

5.3 Service User and Family Responsibilities

Service users and families are encouraged to:

Participate in care planning and decision-making.
Report any changes in the stoma site or health condition.
Follow hygiene practices and care instructions.

5.4 Delegated Healthcare Activities

Where any element of a service user’s stoma care is a healthcare activity that has been delegated to a care worker by a regulated healthcare professional, the activity must only be undertaken in accordance with a clear and documented delegation arrangement.

Before the delegated activity is undertaken, the organisation must ensure that:

The activity is appropriate for delegation to the care worker concerned.
The service user has consented to the proposed arrangement or, where they lack capacity to make the relevant decision, the Mental Capacity Act 2005 has been followed.
The delegated activity is clearly described in the service user’s care plan.
Relevant risks have been assessed and measures to mitigate those risks are documented.
The care worker has received training appropriate to the particular activity and has demonstrated the required competence.
The care worker’s competence has been assessed and recorded before they undertake the activity independently.
The responsibilities of the delegating healthcare professional, the organisation and the care worker are clear.
Appropriate supervision, review and clinical support arrangements are in place.
A clear escalation plan identifies who staff must contact if there is a concern, change in the person’s condition, equipment problem, unexpected outcome or uncertainty about undertaking the activity.

Staff must not alter a delegated procedure or undertake a delegated healthcare activity outside the limits of the documented delegation and their assessed competence. Where circumstances have changed or a staff member is unable to carry out the activity safely, the activity must be stopped where safe to do so and advice sought from the delegating healthcare professional or other appropriate healthcare service.

6. Stoma Site Care and Hygiene

6.1 Stoma Care

Stoma care must be provided in accordance with the service user’s individual care plan and any instructions from the stoma care nurse or other appropriate healthcare professional.

Before beginning care, staff must explain what they are going to do, obtain or confirm consent, protect the service user’s privacy and dignity and ensure that all necessary equipment is available.

Staff must:

Perform effective hand hygiene before preparing equipment and before and after providing stoma care.
Use personal protective equipment appropriate to the task and the assessed risk of exposure to blood, urine, faeces or other body fluids.
Prepare an appropriately clean working area and avoid contamination of clean equipment and supplies.
Gently remove the existing appliance using the method and any adhesive-removal product specified in the service user’s care plan.
Clean the stoma and surrounding skin using the method identified in the service user’s care plan. Unless the individual care plan or specialist advice states otherwise, routine cleaning should normally use clean warm water and suitable disposable or designated materials.
Dry the surrounding skin gently and thoroughly before applying the replacement appliance.
Observe the stoma and surrounding skin for changes including redness, soreness, skin breakdown, swelling, unusual bleeding, discharge, significant change in size or appearance, retraction, prolapse or other abnormalities.
Use barrier products, powders, seals, pastes, creams or other accessories only where these form part of the service user’s care plan, have been recommended by an appropriate healthcare professional or are otherwise authorised for that individual.
Fit the appliance in accordance with the service user’s assessed requirements and the manufacturer’s instructions.
Dispose of used appliances, personal protective equipment and other waste safely in accordance with the person’s care plan, local waste arrangements and the organisation’s infection prevention and control procedures.
Record relevant care, observations, concerns and action taken.

Staff must not improvise with unapproved products or alter the planned stoma-care procedure where this could compromise the service user’s safety. Where the stoma or surrounding skin has changed, the appliance no longer fits appropriately, repeated leakage occurs or staff are otherwise concerned, advice must be sought from the appropriate healthcare professional.

6.2 Infection Prevention and Control

Standard infection prevention and control precautions must be applied during stoma care.

Staff must:

Perform hand hygiene at the appropriate points before and after care.
Use gloves and any other personal protective equipment required by the task and risk assessment.
Change gloves between separate tasks where contamination could be transferred.
Avoid touching clean equipment with contaminated gloves or hands.
Use equipment and supplies in a manner that prevents avoidable contamination.
Ensure reusable equipment, where used, is cleaned and decontaminated in accordance with the manufacturer’s instructions and organisational procedures.
Dispose of waste and contaminated materials safely.
Follow the organisation’s current Infection Prevention and Control Policy and relevant public health guidance.

Routine stoma care in a person’s home requires an appropriately clean working environment and effective standard infection prevention and control precautions. Staff must not describe or treat the person’s home as a sterile clinical environment unless a specific clinical procedure expressly requires an aseptic or sterile technique and this has been directed by an appropriate healthcare professional.

7. Changing Stoma Appliances

7.1 Appliance Selection

Stoma appliances should be selected based on individual needs, including skin type, stoma shape, and lifestyle. Options include:

One-piece systems (combined bag and adhesive).
Two-piece systems (separate bag and adhesive base).
Drainable or closed-end pouches.

7.2 Changing Procedure

Staff changing a stoma appliance must follow the service user’s individual care plan, their training and assessed competence and any instructions supplied by the stoma care nurse or other appropriate healthcare professional.

The procedure must include the following:

Explain the procedure to the service user, obtain or confirm consent and maintain privacy and dignity.
Gather the equipment specified in the service user’s care plan and ensure that the correct replacement appliance and any authorised accessories are available.
Perform hand hygiene and apply appropriate personal protective equipment.
Prepare an appropriately clean working area.
If required, empty a drainable appliance before removal.
Remove the existing appliance gently, supporting the surrounding skin and using an authorised adhesive-removal product where this forms part of the person’s care plan.
Dispose of the used appliance appropriately.
Clean the stoma and surrounding skin using the method specified in the care plan and gently dry the surrounding skin thoroughly.
Observe the stoma and surrounding skin for redness, soreness, breakdown, unusual bleeding, swelling, discharge, changes in size or appearance, prolapse, retraction or other concerns.
Apply only those barrier products, powders, seals, pastes or other accessories that are specified in the person’s care plan, recommended by the stoma care nurse or other appropriate healthcare professional, or otherwise authorised for that individual.
Apply the correct replacement appliance in accordance with the person’s care plan and manufacturer’s instructions, ensuring an appropriate fit and secure seal without causing avoidable pressure or injury.
Ensure that any drainable outlet or closure is secured appropriately.
Make the service user comfortable, dispose of waste safely, remove personal protective equipment and perform hand hygiene.
Record the appliance change, relevant observations, any problems encountered, action taken and any advice or escalation required.

Staff must not independently introduce a new stoma product, cream or treatment for skin damage or other complications unless this is within their role and has been appropriately authorised. Where there is significant skin damage, repeated leakage, unusual bleeding, marked change in the stoma, pain or another concern, staff must follow the escalation plan and obtain appropriate clinical advice.

8. Monitoring and Managing Complications

8.1 Monitoring for Complications

Staff providing stoma care must monitor the service user in accordance with their care plan and remain alert to changes that may indicate a complication or deterioration.

Relevant concerns may include:

Persistent or worsening redness, soreness or skin breakdown around the stoma.
Repeated leakage or an appliance that no longer fits securely.
Signs of infection, including increasing redness, warmth, swelling, pain, discharge or systemic signs of illness.
Significant change in the size, colour, shape or appearance of the stoma.
A stoma protruding substantially further than usual, which may indicate prolapse.
A stoma becoming retracted or sinking below the normal level of the surrounding skin.
Reduced, absent or otherwise significantly altered output compared with what is normal for the individual.
Abdominal pain, distension, cramping, nausea or vomiting associated with reduced or absent output.
Unexpected high or watery output, particularly where this creates a risk of dehydration.
Signs of dehydration, including where relevant increased thirst, dry mouth, weakness, dizziness, reduced urine output, dark urine or other deterioration.
Unusual or significant bleeding from the stoma or blood within the output.
Persistent pain or swelling around the stoma.
Any other change identified in the individual’s care plan as requiring clinical review.

A small amount of contact bleeding may sometimes occur when a stoma is cleaned. Staff must nevertheless follow the person’s care plan and seek clinical advice if bleeding is more than expected, persists, recurs unusually or is associated with other symptoms.

8.2 Responding to Complications

Where a concern or complication is identified, staff must:

Assess the immediate situation within the limits of their role and competence.
Ensure the service user’s immediate safety and comfort.
Follow the person’s individual care plan, risk assessment and escalation instructions.
Report and escalate the concern promptly to the appropriate senior member of staff and healthcare professional according to the nature and urgency of the concern.
Seek advice from the person’s stoma care nurse, GP, community nursing service, NHS 111 or another appropriate healthcare service where clinical assessment is required.
Call 999 where the person has signs of a life-threatening emergency or serious acute deterioration.
Not attempt a procedure, treatment or alteration to the stoma-care regime that is outside their competence or has not been authorised.
Record the observations, symptoms, time of onset where known, action taken, persons contacted, advice received and the outcome.
Ensure that the care plan and risk assessment are reviewed following a significant change, complication or new clinical instruction.

Any recurring complication, repeated appliance failure, unexplained deterioration or repeated need for escalation must be brought to the attention of the Registered Manager and appropriate healthcare professional for review.

9. Supporting Service User Well-Being

9.1 Promoting Independence

We encourage service users to participate in their own stoma care, promoting independence and confidence. Staff provide education and support, ensuring service users feel empowered to manage their stoma safely.

9.2 Emotional Support

Living with a stoma can be challenging, both physically and emotionally. Our staff provide compassionate support by:

Listening to concerns without judgment.
Encouraging open communication about stoma-related challenges.
Referring service users to support groups and counselling services if needed.

10. Training and Competency

10.1 Training Requirements

Staff must receive training appropriate to the stoma-care tasks that they are expected to undertake.

Training must be appropriate to the staff member’s role and must cover, as relevant:

The different types of stoma relevant to people supported by the service.
Person-centred care, dignity, privacy, independence and communication.
Consent and the Mental Capacity Act 2005.
Infection prevention and control and the appropriate use of personal protective equipment.
The safe removal, cleaning and application procedures relevant to the appliances used by service users.
Safe use of stoma appliances, accessories and other equipment.
Recognition of common complications and signs of deterioration.
Monitoring and recording relevant observations.
Escalation procedures and action in an emergency.
Record-keeping and reporting requirements.
The boundaries of the care worker’s role.
Delegated healthcare arrangements, where applicable.

Training alone does not demonstrate competence. Staff must demonstrate that they can carry out the required stoma-care activities safely before they undertake those activities independently.

10.2 Competency Assessment and Review

A staff member must not undertake stoma care independently unless their competence for the relevant activities has been assessed and recorded.

Competency assessment must include practical assessment appropriate to the tasks the worker will carry out and must confirm that the worker can:

Follow the individual’s care plan correctly.
Apply appropriate infection prevention and control precautions.
Use the required equipment and products safely.
Carry out the procedure safely and respectfully.
Recognise relevant complications and deterioration.
Understand when they must stop and seek assistance.
Follow the correct escalation procedure.
Make accurate and contemporaneous records.

Where a healthcare professional has delegated a particular activity, any competency and reassessment requirements specified by the delegating professional must be followed.

Competence must be reviewed at appropriate intervals and additionally where:

The service user’s needs or stoma-care procedure change.
New equipment or products are introduced.
The staff member has not undertaken the activity for a period that could affect competence.
An incident, error, concern or poor practice indicates that reassessment is required.
The delegating healthcare professional requires reassessment.
The staff member identifies that they are no longer confident or competent to undertake the activity safely.

Where competence cannot be demonstrated, the staff member must not undertake the relevant activity independently until appropriate further training, supervision and successful reassessment have taken place.

11. Record-Keeping and Documentation

Records relating to stoma care must be accurate, complete, legible, contemporaneous and securely maintained in accordance with the organisation’s record-keeping and data protection procedures.

Staff must record, as relevant:

The stoma care provided and the date and time of the intervention.
Appliance changes and relevant equipment or products used.
Relevant observations of the stoma, surrounding skin and output where monitoring forms part of the care plan.
Any changes from the service user’s normal presentation.
The service user’s consent and any significant refusal or withdrawal of consent where relevant to the care provided.
Any inability to complete planned stoma care and the reason.
Any complication, deterioration, leakage, equipment failure or other concern.
Action taken in response to a concern.
Escalation to senior staff or healthcare professionals.
The name or role of the healthcare professional contacted, the advice received and any instructions given.
Emergency action taken, where applicable.
Relevant decisions made about the person’s care.
Any changes in instructions or care arrangements and whether the care plan or risk assessment requires review.
Any incident report completed in accordance with organisational procedures.

Records must be made as soon as reasonably practicable after care has been provided or an event has occurred and must not contain inaccurate, misleading or retrospective information presented as though it were contemporaneous.

Where a healthcare professional gives new or changed instructions about stoma care, these must be communicated appropriately and incorporated into the service user’s care plan before staff follow the revised procedure, except where immediate action is required to protect the person from harm.

Records must be stored securely and only accessed, shared or disclosed by authorised persons in accordance with applicable information governance and data protection requirements.

12. Communication and Collaboration

Effective communication ensures continuity of care. This includes:

Regular updates to healthcare providers, including GPs and stoma nurses.
Collaboration with dietitians and pharmacists if required.
Clear communication with service users and families.
Participating in multidisciplinary team meetings when needed.

13. Emergency Procedures

Staff must know and follow the service user’s individual emergency and escalation plan. The response to a stoma-related problem must be proportionate to the person’s symptoms and level of clinical risk.

Staff must call 999 where the service user has a life-threatening emergency or serious acute deterioration, including where appropriate:

Collapse, loss of consciousness or a significant reduction in responsiveness.
Severe breathing difficulty or other immediately life-threatening symptoms.
Severe or rapidly worsening abdominal pain associated with significant deterioration.
Severe or uncontrolled bleeding.
Signs of shock or other serious circulatory compromise.
Any other situation in which the staff member reasonably believes that there is an immediate threat to life.

For urgent stoma-related concerns that are not immediately life-threatening, staff must follow the person’s care plan and obtain appropriate clinical advice without avoidable delay. Depending on the circumstances, this may include contacting the stoma care nurse, GP, community nursing service, NHS 111 or another appropriate healthcare professional.

Urgent clinical advice must be sought where indicated by the person’s care plan or clinical presentation, including for:

Significantly reduced or absent stoma output associated with pain, swelling, nausea or vomiting.
Significant or persistent bleeding from the stoma or blood in the stoma output.
Severe or worsening abdominal pain.
Significant stoma swelling, prolapse or retraction associated with pain, altered output or other deterioration.
Signs of significant dehydration.
Persistent high or watery output where this creates a risk of dehydration.
Signs of significant infection or systemic illness.
Any marked or unexplained deterioration in the service user’s condition.

Appliance leakage or appliance failure must be addressed promptly to protect the person’s skin, dignity and comfort, but appliance leakage alone does not automatically require an emergency ambulance. Staff must assess the situation within their competence, follow the person’s care plan and seek appropriate clinical advice if leakage cannot be safely resolved, is recurrent, is associated with skin damage or is accompanied by other concerning symptoms.

Staff must not attempt to manually treat a suspected obstruction, reduce a prolapsed stoma or undertake any other clinical intervention outside their training, assessed competence and authorised care plan.

Following any urgent or emergency event, staff must:

Remain with the service user where it is safe and appropriate to do so.
Follow instructions provided by emergency or healthcare professionals.
Inform the appropriate manager or on-call person.
Record the symptoms observed, action taken, persons contacted, advice received and outcome.
Complete any required incident reporting.
Ensure that the person’s care plan and risk assessment are reviewed following the event where necessary.

14. Supply Management and Storage

14.1 Ordering Supplies

Stoma supplies should be ordered in advance to avoid shortages. Staff must:

Monitor stock levels regularly.
Ensure service users have sufficient supplies for daily care.
Record all supply orders and deliveries.

14.2 Safe Storage

Stoma supplies must be stored:

In a clean, dry environment.
Away from direct sunlight and moisture.
In original packaging, clearly labelled.

15. Compliance and Review

This policy is reviewed annually or following any significant incident. Compliance is monitored through:

Investigations following reported complications.

Regular audits of stoma care practices.

Staff feedback and incident reports.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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