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Registration Number: {{org_field_registration_no}}

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Stoma Care and Management Policy

(In Compliance with CIW Regulations in Wales)

1. Purpose

The purpose of this policy is to ensure that residents at {{org_field_name}} who have a stoma receive safe, dignified, and person-centred care that promotes their health, independence, and well-being. Our approach is fully aligned with Care Inspectorate Wales (CIW) regulations, ensuring high standards of care while respecting the privacy, dignity, and choices of residents.

This policy aims to:

• Ensure best practice in stoma care and management.
• Promote resident dignity and independence in managing their stoma where possible.
• Minimise risks of infection, leakage, skin irritation, and discomfort.
• Provide comprehensive staff training to ensure competency in stoma care.
• Maintain clear documentation of stoma care routines and resident preferences.
• Ensure collaboration with healthcare professionals, including stoma care nurses and GPs.

2. Scope

This policy applies to:

• Residents who require stoma care, ensuring their needs are met in a dignified and professional manner.
• Care staff who provide direct or indirect support in stoma management.
• Nursing staff and external healthcare professionals, ensuring collaborative care planning.
• Relatives and advocates, who are involved in decision-making where appropriate.
• Record-keeping and regulatory compliance, ensuring the care provided meets CIW inspection standards.

3. Related Policies

This policy is closely aligned with the following:

• Infection Prevention and Control Policy (CHW17).
• Safe Care and Treatment Policy (CHW11).
• Dignity and Respect Policy (CHW08).
• Person-Centred Care Policy (CHW07).
• Medication Management and Administration Policy (CHW21).

4. Types of Stomas and Individualised Care Plans

A stoma is a surgically created opening on the abdomen to divert the flow of waste from the body. There are three main types of stomas:

1. Colostomy – Diverts the large intestine to the abdominal surface.
2. Ileostomy – Diverts the small intestine to the abdominal surface.
3. Urostomy – Diverts urine from the bladder through a stoma.

Individualised Care Plans:
Each resident requiring stoma care will have a tailored care plan that includes:

• Type of stoma and reason for its formation.
• Preferred routine for emptying and changing the stoma appliance.
• Skin care and protection to prevent irritation or infection.
• Dietary requirements and fluid intake monitoring.
• Psychological and emotional support needs.
• Frequency of stoma assessments by nursing staff or healthcare professionals.

5. Daily Stoma Care Routine

5.1. Emptying the Stoma Bag

• Stoma bags should be emptied as required, typically when they are one-third full.
• Residents who can manage their own stoma should be encouraged and supported to do so independently.
• Staff assisting with stoma care must wear gloves and aprons to prevent infection.
• Hand hygiene must be performed before and after the procedure.

5.2. Changing the Stoma Appliance

• A full appliance change should be carried out according to the resident’s individual needs, typically every 1-3 days or sooner if leakage occurs.
• Steps for a safe appliance change:
  1. Prepare supplies (adhesive remover, new appliance, wipes, barrier cream if required).
  2. Remove the old appliance gently, using an adhesive remover if necessary.
  3. Cleanse the skin with warm water, avoiding harsh soaps or alcohol-based products.
  4. Assess the stoma and surrounding skin, checking for redness, irritation, or swelling.
  5. Apply barrier cream if required and allow to dry.
  6. Fit the new appliance securely to avoid leakage.

5.3. Skin Integrity and Prevention of Irritation

• Skin should be assessed at every bag change for signs of redness, irritation, or ulceration.
• Barrier products should be used if the skin is vulnerable.
• If persistent irritation occurs, a stoma care nurse should be consulted immediately.

5.4. Hydration and Dietary Management

• Colostomy: Residents should maintain a high-fibre diet to prevent constipation.
• Ileostomy: Residents may require additional fluids and electrolytes due to increased output.
• Urostomy: Residents should increase fluid intake to reduce the risk of urinary tract infections (UTIs).
• Any dietary adjustments will be documented in the care plan and reviewed regularly.

6. Training and Competency of Staff

• All staff assisting with stoma care must complete stoma care training.
• Training covers:
  • Infection prevention and hand hygiene.
  • Correct appliance changing procedures.
  • Recognising complications (e.g., infection, blockage, leakage).
  • Supporting residents’ independence in stoma management.
• Competency assessments will be conducted annually and during induction training for new staff.

7. Managing Complications

7.1. Stoma Blockages

Symptoms:

• Reduced or no output, cramping, nausea, bloating.
• Residents should drink warm fluids, massage the abdomen, and move around if possible.
• If symptoms persist for more than 6 hours, seek urgent medical attention.

7.2. Skin Irritation and Leakage

• Check for ill-fitting appliances or allergic reactions.
• Use protective barrier products to prevent further irritation.
• Seek advice from a stoma care specialist if issues persist.

7.3. Signs of Infection

• Increased pain, redness, swelling, or unusual discharge around the stoma.
• Raised temperature or flu-like symptoms.
• Immediate referral to a GP or district nurse is required.

8. Psychological and Emotional Well-being

• Residents may experience emotional distress, body image concerns, or anxiety related to their stoma.
• Staff should provide reassurance, emotional support, and signposting to counselling services if required.
• Where appropriate, peer support groups or external organisations such as Colostomy UK can be recommended.

9. Compliance and Monitoring

• Stoma care audits will be conducted every three months to ensure best practice is maintained.
• CIW inspectors will review care plans, training records, and competency assessments during inspections.
• Any concerns identified during audits will be addressed immediately through staff training or policy updates.

10. Policy Review

This policy will be reviewed annually or sooner if:

• Legislative or regulatory changes occur.
• Best practice guidelines evolve.
• Incident reports suggest improvements are needed.

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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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