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CH95-Stoma Care and Management Policy

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Stoma Care and Management Policy

1. Purpose

This policy outlines {{org_field_name}}’s commitment to ensuring the safe and effective management of stomas for the people we support. The policy aligns with CQC regulations, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and best practices in stoma care as recommended by the National Institute for Health and Care Excellence (NICE). It ensures that stoma care is provided in a way that promotes dignity, independence, and person-centred care.

2. Scope

This policy applies to all healthcare professionals, nursing staff, care assistants, and any other team members at {{org_field_name}} who are involved in providing care for individuals with a stoma. It covers the assessment, daily management, monitoring, emergency procedures, and ongoing support required for effective stoma care.

3. Principles of Stoma Care

4. Stoma Types and Considerations

There are different types of stomas that staff may encounter. Each requires specific care:

5. Stoma Assessment and Initial Care

Every person who has a stoma must have their individual stoma care needs assessed when they begin using the service and whenever there is a significant change in their condition, stoma, appliance, health needs or ability to manage their own care.

The assessment must be completed by a member of staff who has the appropriate knowledge, skills and competence for the aspect of care being assessed. Where assessment, diagnosis, treatment or adjustment of a clinical stoma management plan is required, appropriate advice must be obtained from a registered healthcare professional such as the person’s GP, registered nurse, specialist stoma nurse or other relevant clinician.

The assessment must include, where applicable:

A personalised stoma care plan and associated risk assessment must be developed from the assessment.

The care plan must clearly identify:

Staff must follow the current care plan and must not independently introduce a new appliance, treatment, medicine, topical preparation or clinical intervention outside their competence.

Changes in the person’s stoma, output, surrounding skin, overall condition or ability to self-manage must be documented and escalated in accordance with the person’s care plan and clinical need.

The person must be involved in assessment and care planning as far as possible. Where appropriate and with the person’s consent, their representative, family members and relevant healthcare professionals must also be involved.

5.1 Consent, Mental Capacity and Best Interests

Stoma care must only be provided with the valid consent of the person wherever they have capacity to make the relevant decision.

Staff must explain the proposed stoma care in a manner that the person can understand and must respect the person’s right to make decisions about their care, including the right to refuse care, unless there is a lawful basis for acting otherwise.

Consent must be obtained before providing stoma care and must be regarded as an ongoing process rather than a one-off decision. Staff must remain alert to verbal and non-verbal indications that the person no longer agrees to the care being provided.

Where there is reason to doubt a person’s capacity to make a particular decision about their stoma care, a decision-specific assessment of capacity must be undertaken in accordance with the Mental Capacity Act 2005.

A person must not be assumed to lack capacity merely because they make a decision that staff, relatives or healthcare professionals consider unwise.

Where a person lacks capacity to make the relevant decision:

A relative or friend must not give consent on behalf of an adult solely because of their relationship with the person. Staff must establish whether the individual has lawful authority, for example a valid and applicable Health and Welfare Lasting Power of Attorney or Court of Protection appointment.

Where a person refuses stoma care and has capacity to make that decision, staff must respect the refusal, explain any reasonably foreseeable risks, document the refusal and take appropriate action to obtain clinical advice where refusal creates a significant risk to the person’s health or wellbeing.

6. Daily Stoma Care Procedures

Stoma care must be delivered according to the person’s individual care plan, current clinical instructions, infection prevention and control procedures and the staff member’s assessed competence.

Before commencing care, staff must:

Disposable gloves must be worn where there is a risk of contact with stoma output, urine, faeces, bodily fluids, non-intact skin or contaminated items. An appropriate disposable apron must be worn where contamination of clothing is reasonably foreseeable.

Gloves do not replace hand hygiene. Staff must perform hand hygiene before putting on gloves and after removing them and must change gloves if they become contaminated or when moving from a contaminated task to a clean task.

Emptying the appliance

The appliance must be emptied at a frequency appropriate to the person’s individual needs and care plan and before its weight or contents create an avoidable risk of leakage, detachment or discomfort.

Staff must observe the output and report significant changes from the person’s normal pattern, including unexpected changes in amount, colour, consistency, smell or the presence of blood, in accordance with the escalation requirements in this policy.

Changing the appliance

The appliance must be changed at the frequency specified in the person’s care plan, manufacturer’s instructions or clinical instructions, and sooner when clinically necessary because of leakage, loss of adhesion, contamination or another identified problem.

Staff must not routinely change the appliance more frequently than clinically required where this could damage the surrounding skin.

Cleaning and drying

The stoma and surrounding skin must be cleaned using the method specified in the person’s care plan or by the relevant healthcare professional.

Unless otherwise clinically directed, the surrounding skin should be gently cleaned using warm water and dried thoroughly without rubbing.

Products containing substances that could irritate the skin or interfere with appliance adhesion must not be used unless they form part of the person’s documented stoma care plan or have been advised by an appropriate healthcare professional.

Skin and stoma observations

During care, staff must observe the stoma and surrounding skin for changes including:

Concerns must be recorded and escalated according to their severity and the person’s care plan.

Appliance fit and equipment

Staff must use the appliance and products specified in the person’s current care plan.

Where an appliance repeatedly leaks, causes pain, damages the surrounding skin or no longer appears to fit correctly, staff must not repeatedly improvise modifications. Advice must be obtained from an appropriate registered healthcare professional or specialist stoma service.

Any reusable equipment used for stoma care must be maintained and cleaned in accordance with infection prevention and control requirements and the manufacturer’s instructions.

Used disposable products and personal protective equipment must be disposed of safely in accordance with the service’s infection prevention and control and waste-management arrangements.

After care, staff must ensure that the person is comfortable, the appliance is secure, the area is left clean, waste has been disposed of safely, hand hygiene has been completed and the required record has been made.

7. Medicines and the Stoma

Medicines must be managed in accordance with the person’s medication record, the organisation’s Medication Management and Administration Policy, the prescriber’s directions and the person’s individual care plan.

A medicine must not be administered directly into or through a stoma unless this route of administration has been specifically prescribed or authorised by an appropriate prescriber and there are clear written instructions for its administration.

Staff must not assume that a liquid medicine is suitable for administration through a stoma.

Staff must not:

unless this has been specifically confirmed as safe and appropriate for that individual medicine by an authorised prescriber or pharmacist and the instructions have been documented.

Only staff who are trained, assessed as competent and authorised to administer the medicine by the required route may do so.

Where a person has an ileostomy or other condition that may affect medicine absorption, staff must be alert to concerns such as:

Such concerns must be documented and referred promptly to the person’s prescriber or pharmacist. Staff must not independently alter the medicine, dose, formulation, timing or route.

All medicine administration, omission, refusal and medicine-related concerns must be recorded in accordance with the Medication Management and Administration Policy.

8. Prevention, Recognition and Management of Stoma Complications

Staff must know the person’s documented normal stoma appearance, normal output and individual risk factors and must promptly recognise and respond to changes.

Staff must not diagnose or independently treat stoma complications beyond actions that are clearly included in the person’s current care plan and are within their assessed competence.

Peristomal skin damage

Redness, soreness, broken skin, ulceration or persistent irritation must be documented and acted upon.

Staff must check for obvious causes such as leakage or poor appliance adhesion but must not independently commence medicated creams, powders or other treatments unless these have been prescribed or form part of the person’s documented clinical plan.

Persistent, worsening or significant skin damage must be referred to an appropriate registered healthcare professional or specialist stoma service.

Leakage

Leakage must be dealt with promptly to protect the person’s dignity, comfort and skin integrity.

The appliance may be replaced by a competent member of staff in accordance with the person’s care plan.

Repeated leakage, a change in stoma size or shape, loss of appliance fit or associated skin damage must be escalated for clinical review.

Parastomal hernia

A new or increasing bulge, pain, difficulty fitting the appliance or change in output must be reported and referred for appropriate clinical assessment.

A support garment or belt must not be commenced solely on the initiative of care staff. It must be used where it has been individually assessed as appropriate and instructions for its use are documented.

Suspected obstruction or blockage

A significant reduction or cessation of the person’s usual stoma output, particularly when accompanied by abdominal pain, cramping, abdominal swelling or distension, nausea, vomiting or deterioration in the person’s condition, must be treated as a potential clinical complication.

Staff must:

Staff must not use abdominal or stoma massage as a routine treatment for suspected obstruction.

Staff must not give food, additional fluids, laxatives or other treatments specifically to treat a suspected obstruction unless this is consistent with the person’s current individual clinical instructions or directed by an appropriate healthcare professional.

Infection

Increasing redness, warmth, swelling, pain, purulent discharge, fever or systemic deterioration must be documented and escalated promptly to an appropriate healthcare professional.

Staff must follow the service’s Infection Prevention and Control Policy.

Bleeding

Minor superficial spotting associated with gentle cleaning may occur in some people. However, bleeding that is persistent, more than the person’s documented normal presentation, coming from inside the stoma, associated with significant pain or deterioration, or otherwise clinically concerning must be escalated promptly.

Heavy or uncontrolled bleeding, bleeding accompanied by collapse, faintness or signs of significant blood loss must be treated as a medical emergency and emergency medical assistance must be requested.

Prolapse, retraction or significant change in stoma appearance

A new prolapse, retraction or significant change in the colour, size, shape or function of the stoma must receive appropriate clinical assessment.

A stoma that becomes unusually dark, dusky, purple, grey or black, particularly where this is a new change, requires urgent clinical assessment.

Staff must not attempt to manually reduce a prolapsed stoma unless this is part of an explicit individual clinical plan and the member of staff has been appropriately trained and assessed as competent to carry out the intervention.

9. Promoting Independence and Supporting the People We Support

10. Training, Authorisation and Staff Competence

The Registered Manager must ensure that any member of staff who provides or assists with stoma care has the knowledge, skills, training and competence required for the particular tasks they undertake.

Staff must not provide stoma care independently until they have:

Staff must work only within the scope of their role, training, competence and authorisation.

A member of staff who is uncertain about a procedure, appliance, change in the person’s condition or clinical instruction must stop and seek appropriate advice rather than undertake a task for which they are not competent.

Competence must be reviewed whenever necessary to ensure continuing safe practice, including where:

Where stoma care involves a delegated healthcare task, the service must ensure that the delegation is appropriate, that clear instructions have been provided and that the member of staff accepting the delegated task has been trained and assessed as competent to undertake it.

Training and competency records must be maintained and be available for monitoring and audit.

11. Record-Keeping, Incidents and Notifications

Records relating to stoma care must be accurate, complete, legible, secure and contemporaneous.

Following stoma care, staff must record information relevant to the person’s individual needs and care plan. This must include, where applicable:

Records must clearly distinguish factual observations from professional advice received and from decisions made by staff.

The person’s stoma care plan and associated risk assessments must be reviewed and updated when their needs change and at the intervals required by the service’s care-planning arrangements.

Where a stoma-related event constitutes an accident, error, omission, near miss, injury or other safety incident, it must be reported through the service’s incident-reporting procedure and reviewed in accordance with the organisation’s governance arrangements.

The Registered Manager must ensure that incidents are investigated appropriately, actions are taken to reduce recurrence and learning is shared with relevant staff.

Where an incident meets the statutory criteria for notification to the Care Quality Commission, the Registered Person must ensure that the required statutory notification is submitted without delay and using the method required by CQC.

Where an event constitutes a notifiable safety incident under Regulation 20, the statutory Duty of Candour requirements must be followed, including openness with the person or their relevant representative, the required notification, an apology and an appropriate written record.

Not every episode of routine appliance leakage requires statutory notification to CQC. The Registered Manager must determine external reporting requirements according to the nature and consequences of the incident and the applicable statutory notification criteria.

12. Involvement of the Person, Representatives and Family Members

The person must be involved as far as possible in decisions about their stoma care, treatment, appliance choices and support arrangements.

Staff must provide information in a way that the person can understand and must make reasonable adjustments where these are required to enable effective communication and involvement.

The person must be supported to maintain or develop independence in stoma care where this is consistent with their wishes, abilities and safety.

Family members, friends or other representatives may be involved in discussions, education or care planning where:

Information about a person’s health, stoma or care must not be disclosed to family members or others solely because they are relatives or friends.

Staff must respect confidentiality and share only information that they are authorised or lawfully required to share.

Where a family member or representative assists with stoma care, the care plan must clearly identify:

The registered provider remains responsible for ensuring that regulated care provided by the service is safe and meets the person’s assessed needs.

Where specialist advice is required, appropriate referral or access to the person’s GP, registered nurse, specialist stoma nurse, pharmacist or other relevant healthcare professional must be facilitated.

13. Emergency and Urgent Escalation Procedures

Staff must follow the person’s individual emergency and escalation plan and must act promptly where a change in the person’s stoma or general condition may indicate a serious complication.

Emergency medical assistance must be requested immediately where the person has symptoms indicating an immediate or potentially life-threatening emergency, including:

Staff must call 999 where emergency medical assistance is required.

Suspected obstruction or absent output

A new or significant reduction or absence of output must be assessed in the context of the person’s normal pattern.

Where absent or significantly reduced output is accompanied by pain, cramping, swelling or distension, nausea, vomiting or deterioration, staff must obtain urgent clinical advice.

Severe pain, persistent vomiting, marked distension, collapse or rapid deterioration requires emergency assessment.

Staff must not routinely massage the abdomen or stoma or attempt to manually relieve a suspected obstruction.

Significant bleeding

Persistent or significant bleeding must receive prompt clinical assessment.

Heavy, uncontrolled bleeding or bleeding associated with deterioration, faintness or collapse requires emergency medical assistance.

Prolapsed or retracted stoma

A new or significantly worsening prolapsed or retracted stoma must be referred promptly for clinical assessment.

Emergency assessment must be obtained where the person has severe pain, obstruction symptoms, uncontrolled bleeding, significant deterioration or concerning changes in the colour or viability of the stoma.

Staff must not attempt manual reduction unless this forms part of a specific clinical plan and they have been trained, assessed as competent and authorised to perform it.

Severe skin damage or suspected infection

Severe, rapidly worsening or extensively broken peristomal skin, significant swelling, purulent discharge or signs of systemic infection must be referred promptly to an appropriate healthcare professional.

Where the person’s condition indicates sepsis or another medical emergency, emergency medical assistance must be requested immediately.

Following urgent or emergency escalation

Staff must:

14. Related Policies

15. Policy Review

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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