{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Stoma Care and Management Policy

1. Purpose

At {{org_field_name}}, we are committed to delivering safe, person-centred, and dignified stoma care for individuals requiring a colostomy, ileostomy, or urostomy. This policy ensures that all aspects of stoma care, hygiene, infection control, risk management, and staff training align with CQC regulations, NICE guidelines, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the Mental Capacity Act 2005.

Our goal is to maintain skin integrity, prevent infections, and promote independence while ensuring individuals receiving support feel comfortable and confident in managing their stoma care.

2. Scope

This policy applies to all staff, including permanent, temporary, agency, and volunteer workers who provide support to individuals with a stoma in our Supported Living service. It covers daily stoma care, emptying and changing of stoma appliances, identifying complications, infection prevention, and emergency response procedures.

3. Related Policies

• SL12 – Safe Care and Treatment Policy
• SL07 – Person-Centred Care Policy
• SL21 – Medication Management and Administration Policy
• SL16 – Infection Prevention and Control Policy
• SL08 – Dignity and Respect Policy
• SL34 – Confidentiality and Data Protection (GDPR) Policy
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy

4. Understanding Stoma Care

A stoma is a surgically created opening in the abdomen that allows waste to exit the body. Types of stomas include:

• Colostomy – An opening from the large intestine to divert faeces.
• Ileostomy – An opening from the small intestine to divert liquid stool.
• Urostomy – A urinary diversion that allows urine to bypass the bladder.

Each type requires individualised care to ensure the stoma remains healthy and the person is supported appropriately.

5. Stoma Care and Management

5.1 Person-Centred Stoma Care Plans

• Every individual who requires support with stoma care must have an up-to-date, personalised stoma care plan and associated risk assessment appropriate to the level of support provided by {{org_field_name}}.
• The individual must be involved as fully as possible in the assessment, planning, delivery and review of their stoma care. Their preferences, usual routines, desired level of independence, privacy, dignity, communication needs and any reasonable adjustments must be recorded and respected.
• Stoma care must only be provided with the individual’s valid consent. Consent must be treated as an ongoing process and staff must remain alert to any withdrawal of consent during care.
• Where there is reason to doubt an individual’s capacity to make a particular decision about their stoma care, capacity must be assessed in relation to that specific decision and at the time the decision is required, in accordance with the Mental Capacity Act 2005.
• Where an individual lacks capacity to make the relevant decision, staff must follow the Mental Capacity Act 2005 and any applicable lawful decision made on the individual’s behalf. Any best-interests decision must be properly made, recorded and involve appropriate consultation. Family members must not be treated as having authority to consent on the individual’s behalf unless they have the relevant lawful authority, such as a valid and applicable health and welfare Lasting Power of Attorney or court-appointed authority.
• The care plan and risk assessment must be developed and reviewed with the individual and, where appropriate and lawful, relevant healthcare professionals and others involved in their care.
• The care plan must include, where relevant:
  • the type of stoma and relevant clinical history;
  • the individual’s usual stoma appearance, function and normal pattern and consistency of output;
  • the level of support required and tasks the individual can undertake independently;
  • the individual’s preferred stoma appliances and supporting products;
  • instructions for emptying and changing the appliance;
  • skin and peristomal skin care requirements;
  • known allergies, sensitivities or contraindications;
  • dietary and hydration requirements and any individual clinical advice;
  • any known risk of dehydration or high-output stoma;
  • signs and symptoms of complications specific to the individual;
  • clear escalation instructions, including who staff must contact and when urgent or emergency medical assistance is required;
  • current contact details for the individual’s stoma care service, GP or other relevant healthcare professionals;
  • any reasonable adjustments or communication requirements;
  • arrangements for obtaining and maintaining an adequate supply of prescribed stoma appliances and products; and
  • the agreed review date.
• The stoma care plan and risk assessment must be reviewed whenever there is a significant change in the individual’s stoma, skin condition, output, health, treatment, appliance, support needs or relevant professional advice, and at the planned review interval.
• Staff must follow the current care plan, risk assessment and any individual instructions provided by an appropriately qualified healthcare professional. Staff must not undertake stoma care tasks for which they have not been trained and assessed as competent.

5.2 Daily Stoma Care Routine

• Before providing stoma care, staff must check the individual’s current care plan and risk assessment and ensure that they are trained and competent to undertake the required task.
• Staff must explain the intended care in a way the individual can understand and obtain or confirm the individual’s consent before commencing care. Where the individual lacks capacity for the relevant decision, staff must follow the documented lawful decision-making arrangements in accordance with the Mental Capacity Act 2005.
• Staff must perform hand hygiene before and after stoma care and use personal protective equipment appropriate to the assessed risk of exposure to blood, body fluids, faeces, urine or contaminated materials.
• Privacy and dignity must be maintained throughout stoma care.
• The stoma and surrounding skin must be observed during care. Staff must note any change from the individual’s normal appearance or function, including:
  • unusual redness or soreness;
  • broken or excoriated skin;
  • swelling;
  • unexpected bleeding;
  • unusual colour change;
  • prolapse or retraction;
  • leakage;
  • reduced, absent or significantly increased output; or
  • signs that may indicate infection, obstruction or dehydration.
• The skin around the stoma must be cleaned and dried in accordance with the individual’s care plan and instructions from the relevant stoma care professional. Products not identified within the person’s care plan or recommended by an appropriate healthcare professional must not be introduced by staff without appropriate advice.
• The stoma appliance must be applied and managed in accordance with the individual’s care plan, the instructions applicable to the prescribed product and any instructions provided by the individual’s stoma care professional.
• Any significant abnormality, deterioration or change must be acted upon promptly in accordance with the individual’s escalation plan and section 7 of this policy.
• Used appliances, PPE and contaminated materials must be disposed of safely in accordance with the organisation’s infection prevention and control and waste-disposal procedures.
• The care provided, observations made and any concerns, actions or escalation must be recorded accurately and contemporaneously.

5.3 Emptying and Changing Stoma Appliances

• Stoma appliances must be emptied or changed in accordance with the individual’s current stoma care plan, the instructions for the prescribed appliance and any advice provided by the individual’s stoma care professional.
• Staff must not use a fixed rule about how full an appliance must become before it is emptied or changed. The timing must reflect the type of stoma, type of appliance, amount and consistency of output, the individual’s usual routine and the need to prevent leakage, excessive weight on the appliance and damage to the surrounding skin.
• Drainable appliances must be emptied at appropriate intervals in accordance with the individual’s care plan and before they become excessively full.
• Closed appliances must be changed at the frequency identified in the individual’s care plan and according to the requirements of the prescribed product.
• If an appliance is leaking, it must be changed promptly and the surrounding skin inspected, cleaned and dried appropriately.
• Repeated leakage, difficulty achieving an effective seal, changes in body shape or stoma size, or recurrent skin problems must be reported to the appropriate healthcare professional or stoma care service for review.
• Staff must encourage and support individuals to manage as much of their own stoma care as they wish and are safely able to undertake.
• All staff assistance with stoma care, relevant observations, abnormalities and escalation must be recorded accurately and contemporaneously.

6. Infection Prevention and Skin Integrity

6.1 Preventing Infections

• Follow strict hand hygiene and PPE protocols before and after stoma care.
• Ensure stoma appliances are stored hygienically and changed as per guidelines.
• Clean and dry the skin gently to avoid irritation.
• Report any unusual odours, discolouration, or signs of infection immediately.

6.2 Skin Care and Preventing Irritation

• Staff must inspect the peristomal skin during stoma care and compare its condition with the individual’s normal skin condition and care plan.
• Peristomal skin must be kept clean and appropriately dry, using the methods and products identified in the individual’s care plan or advised by an appropriate stoma care professional.
• Harsh soaps, perfumed products or other products that may interfere with appliance adhesion or cause irritation must not be used unless specifically recommended for the individual by an appropriate healthcare professional.
• Staff must ensure that the appliance is fitted in accordance with the individual’s care plan and product instructions. Staff must not independently alter the fit, opening, positioning or prescribed stoma products outside their competence.
• Persistent redness, soreness, broken skin, ulceration, recurrent leakage, bleeding, pain, rash or another significant change in peristomal skin must be reported promptly in accordance with the individual’s care plan and referred to the appropriate healthcare professional where required.
• Any prescribed or recommended skin barrier or protective product must be used in accordance with the individual’s care plan and relevant instructions.

7. Identifying and Managing Stoma Complications

7.1 Recognising Stoma Complications

Staff providing stoma care must know the individual’s normal stoma appearance, function and output and must recognise significant changes. Staff must act within their competence and follow the individual’s care plan and escalation instructions.

Potential complications include:

• Leakage – recurrent or significant leakage may indicate problems with appliance fit, stoma size, skin condition, body shape or stoma output. Repeated leakage must be escalated for appropriate review.
• Peristomal skin damage – persistent redness, soreness, broken skin, ulceration, rash, weeping or pain requires assessment and must not simply be treated by introducing new stoma products without appropriate advice.
• Bleeding – minor superficial bleeding can occur when the stoma is cleaned or touched. Bleeding that is persistent, more than expected, difficult to stop, coming from inside the stoma, associated with blood in the appliance, or accompanied by deterioration must be escalated promptly. Significant bleeding requires urgent medical assessment.
• Stoma colour change – a significant change from the person’s normal healthy stoma colour, particularly a stoma that becomes very dark, purple or black, requires urgent medical assessment because it may indicate impaired blood supply.
• Prolapse – a stoma protruding significantly further than normal must be reported and assessed in accordance with the individual’s care plan. Urgent medical advice is required where the prolapse is painful, associated with reduced or absent output, ulceration or significant colour change.
• Retraction – a stoma that retracts to or below skin level can cause leakage and skin damage and must be referred for appropriate clinical review.
• Parastomal hernia or unexplained swelling – new or increasing swelling around the stoma must be reported. Pain, nausea, vomiting or reduced or absent output requires urgent assessment.
• Possible obstruction – reduced or absent output, abdominal cramps or pain, abdominal or stoma swelling, nausea or vomiting may indicate bowel obstruction and must be treated as potentially serious.
• High-output stoma or dehydration – a significant increase in watery output, particularly from an ileostomy, or symptoms of dehydration must be escalated promptly in accordance with the individual’s clinical plan.

Staff must not diagnose or independently treat a suspected complication beyond actions expressly contained in the individual’s current care plan or instructions from an appropriate healthcare professional.

7.2 Responding to Stoma Emergencies

Staff must follow the individual’s current stoma care plan and emergency escalation instructions. Staff must not diagnose a stoma complication or give clinical treatment outside their training, competence or documented instructions from an appropriate healthcare professional.

• Suspected bowel obstruction
  • Reduced or absent stoma output associated with abdominal pain or cramping, abdominal or stoma swelling, nausea or vomiting must be treated as a possible obstruction.
  • Staff must seek urgent clinical advice in accordance with the individual’s care plan and must not wait for a fixed 24-hour period before escalating.
  • For an individual with an ileostomy, a stoma that has not been active for more than 12 hours requires urgent medical advice, and earlier escalation is required where severe cramps, nausea, vomiting, significant abdominal pain, swelling or deterioration is present.
  • For an individual with a colostomy, staff must consider the individual’s normal bowel and stoma pattern. Output stopping for significantly longer than is normal for that individual, particularly with discomfort, abdominal pain, nausea, vomiting or swelling, requires urgent medical advice.
  • Staff must not routinely stop all food and fluids. Any temporary alteration to food or fluid intake must follow the individual’s clinical care plan or advice obtained from an appropriate healthcare professional.
• Significant bleeding
  • Significant, persistent or unexplained bleeding, blood coming from inside the stoma, or a large amount of blood in the appliance requires urgent medical assessment.
  • Emergency assistance must be sought where bleeding is severe, the individual is deteriorating, collapses, becomes unusually pale or confused, or shows other signs of serious illness.
• Change in stoma colour or blood supply
  • A stoma that becomes very dark, purple or black, particularly where accompanied by pain, swelling or reduced function, requires urgent medical assessment.
• Prolapse, swelling or hernia with concerning symptoms
  • A prolapsed stoma or swelling around the stoma associated with severe pain, vomiting, significant colour change or reduced or absent output requires urgent medical advice.
  • Staff must not attempt procedures to reduce a prolapsed stoma unless this is expressly included in the individual’s clinical care plan and the member of staff has been specifically trained and assessed as competent to undertake the procedure.
• High output or dehydration
  • A significant increase in watery stoma output or signs of dehydration, including unusual thirst, dry mouth, dizziness, weakness, reduced urine output or deterioration, must be escalated promptly in accordance with the person’s care plan.
  • Where severe dehydration, collapse, significant confusion or rapid deterioration is present, emergency medical assistance must be obtained.
• Leakage
  • A leaking appliance should normally be changed promptly where this can be done safely.
  • The skin must be assessed and cared for in accordance with the individual’s care plan.
  • Repeated leakage must be referred for appropriate review rather than repeatedly changing products without clinical advice.
• Emergency response
  • Staff must call 999 where there is an immediate threat to life or serious deterioration.
  • Where urgent medical advice is required but the situation is not immediately life-threatening, staff must follow the individual’s escalation plan and contact the appropriate stoma service, GP, NHS 111 or other healthcare professional as appropriate.
  • All observations, advice sought, action taken, people contacted and outcomes must be recorded contemporaneously.

8. Supporting Individuals with Stoma Care

• Encourage self-management and independence where possible.
• Provide psychosocial support for individuals struggling with stoma-related concerns.
• Offer privacy and dignity when assisting with stoma care.
• Ensure individuals have access to stoma nurses or support groups if needed.

9. Staff Training and Competency

• Only staff who have received appropriate training and have been assessed as competent for the specific stoma care tasks they are required to perform may undertake those tasks without supervision.
• Training and competency requirements must reflect:
  • the individual’s assessed needs;
  • the type of stoma;
  • the stoma appliances and products used;
  • the complexity of the care required;
  • the individual staff member’s role, previous training and experience; and
  • any instructions or delegation arrangements provided by an appropriate healthcare professional.
• Training for staff who provide stoma care must include, as applicable:
  • the individual’s person-centred stoma care plan;
  • safe emptying and changing of the individual’s stoma appliance;
  • peristomal skin care;
  • hand hygiene, personal protective equipment and infection prevention and control;
  • maintaining privacy, dignity, choice and independence;
  • consent and the Mental Capacity Act 2005;
  • recognising changes in stoma appearance and output;
  • recognising potential complications, including obstruction, significant bleeding, prolapse, retraction, skin damage, high output and dehydration;
  • the limits of the member of staff’s role and competence;
  • the individual’s escalation and emergency procedures; and
  • accurate record keeping and reporting.
• Staff who have not yet demonstrated the required competence must be appropriately supervised and must not undertake stoma care independently.
• Competency must be assessed by a person who has the appropriate knowledge, skills and competence to make the assessment.
• Training and competency records must identify the stoma care activities for which the member of staff has been assessed as competent.
• Competence must be reviewed at appropriate intervals and whenever there is:
  • a significant change in the individual’s stoma or care needs;
  • a change of appliance or procedure requiring different skills;
  • revised professional advice;
  • an incident, error or concern about practice;
  • an identified gap in knowledge or performance; or
  • another reason to doubt that competence is being maintained.
• Refresher training or reassessment must be provided whenever required to maintain safe practice.
• Staff must work only within the limits of their training and demonstrated competence and must seek advice where a task or clinical situation falls outside those limits.
• The registered manager or delegated competent person must ensure that staff training, supervision and competency records are current and available for audit.

10. Record-Keeping and Documentation

Staff must maintain an accurate, complete, legible, contemporaneous and up-to-date record of stoma care and relevant decisions concerning the individual’s care.

Records must include, where applicable:

• stoma care provided and the level of assistance required;
• relevant observations of the stoma and surrounding skin;
• any significant change in the amount, frequency or consistency of stoma output;
• leakage or appliance problems;
• pain, bleeding, swelling, skin damage or other abnormalities;
• signs or symptoms of dehydration, obstruction, infection or another possible complication;
• consent relating to care and any withdrawal of consent;
• relevant mental capacity assessments or best-interests decisions, where applicable, with cross-reference to the appropriate formal record;
• any care refused or not completed and the action taken;
• concerns identified and action taken in response;
• escalation to the registered manager, stoma care professional, GP, NHS 111, emergency services or another healthcare professional;
• advice received from healthcare professionals and any resulting changes to the person’s care plan;
• incidents involving stoma care or equipment;
• changes to the person’s care plan or risk assessment; and
• the outcome of any action or escalation, where known.

Records must be completed without undue delay following the care or event to which they relate.

Significant changes, new professional instructions or changes to the individual’s support requirements must be communicated promptly to relevant staff and incorporated into the individual’s care plan and risk assessment.

Records must be stored securely and accessed, shared, amended, retained and disposed of in accordance with applicable data protection legislation, confidentiality requirements and {{org_field_name}}’s relevant policies.

11. Monitoring and Continuous Improvement

• {{org_field_name}} will operate effective systems to assess, monitor and improve the quality and safety of stoma care provided by the service.
• Audits of stoma care practice, care plans, risk assessments, records, staff training and competency will be undertaken at a frequency determined by risk, service need, incidents, identified concerns and the organisation’s governance arrangements.
• Identified risks, shortfalls or unsafe practice must result in proportionate corrective action, with responsibility and timescales identified and completion monitored.
• Feedback from individuals receiving support and, where appropriate and lawful, relevant healthcare professionals and others involved in their care will be considered as part of quality monitoring.
• Incidents, errors, near misses, complaints and safeguarding concerns relating to stoma care must be reviewed appropriately. Lessons identified must be used to improve care plans, risk assessments, staff training, competency, procedures or wider practice where required.
• Significant or recurring concerns must be escalated through {{org_field_name}}’s governance arrangements.

12. Policy Review

This policy will be reviewed annually or sooner if required due to:

• Updates in NICE or CQC guidelines.
• Changes in best practice for stoma management.
• Feedback from staff, individuals receiving support, or healthcare professionals.

---

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.