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Registration Number: {{org_field_registration_no}}

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Stoma Care and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, dignified, and effective stoma care for service users who have undergone a colostomy, ileostomy, or urostomy. This policy outlines best practices in stoma care, infection prevention, dignity, and holistic support, in compliance with Care Inspectorate Wales (CIW) regulations, national healthcare guidelines, and safeguarding principles.

Our objectives are to:

• Ensure service users receive personalised and professional stoma care.
• Prevent stoma-related complications, including infections and skin irritation.
• Support service users in managing their stoma independently where possible.
• Provide staff with training on best practices in stoma care and hygiene.
• Maintain a dignified, person-centred approach that promotes the well-being of service users.

2. Scope

This policy applies to:

• Service users with a stoma, including colostomy, ileostomy, and urostomy.
• Family members and carers, providing support in stoma management.
• All employees, including care workers, managers, and administrative staff.
• The Registered Manager and Responsible Individual, responsible for compliance.
• Healthcare professionals, including district nurses and stoma care specialists.

3. Legal and Regulatory Framework

This policy aligns with and will be implemented in accordance with:

• Regulation and Inspection of Social Care (Wales) Act 2016.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended) and the Welsh Government Statutory Guidance for providers of care home and domiciliary support services (last updated 27 March 2024).
• Social Services and Well-being (Wales) Act 2014 (including duties relating to well-being, safeguarding and voice/control).
• Mental Capacity Act 2005 and associated Code of Practice, including Deprivation of Liberty Safeguards (DoLS) where applicable, ensuring lawful authority for any restrictions used in delivering care.
• Health and Safety at Work etc. Act 1974 and relevant health and safety regulations and guidance, including safe handling and disposal of clinical waste.
• Data Protection Act 2018 and UK GDPR (confidentiality, lawful sharing, secure records management).
• Equality Act 2010 (reasonable adjustments; non-discrimination) and a rights-based approach consistent with statutory guidance expectations.
• All-Wales Guidelines for Delegation (Social Care Wales / HEIW) where stoma care tasks are delegated by NHS professionals.
• Relevant national evidence-based guidance (e.g., NICE / NHS guidance) relating to stoma care, infection prevention and skin integrity.

3.1 Consent, Capacity, Best Interests and Least Restrictive Practice

Stoma care is intimate personal care and may involve contact with sensitive body areas. Staff must obtain the individual’s valid consent before providing stoma care on each visit, unless care is being provided in an emergency where immediate action is required to prevent harm.

Where there is reason to doubt an individual’s capacity to consent to stoma care arrangements, a decision-specific mental capacity assessment must be considered and recorded in line with the Mental Capacity Act 2005. If the person lacks capacity, any care provided must be in the person’s best interests, using the least restrictive option and involving the person as far as possible, as well as their representative/advocate where appropriate.

Staff must not apply any form of restriction (for example, preventing a person from moving away, holding them in place, or completing care against their expressed wishes) unless there is lawful authority, it is proportionate, and it is consistent with statutory guidance. Any concerns that the person may be deprived of their liberty in connection with care arrangements must be escalated to the Registered Manager for action in line with MCA/DoLS requirements.

3.2 Delegated Healthcare Activities (Clinical Task Delegation)

Some aspects of stoma care (for example, managing complex stomas, peristomal skin complications, wound concerns, or clinically directed product regimes) may constitute delegated healthcare activities. Where an NHS professional (e.g., District Nurse / Stoma Nurse Specialist) delegates any aspect of stoma care to {{org_field_name}} staff:

• Delegation must follow the All-Wales Guidelines for Delegation and be person-specific and task-specific.
• A named delegating clinician must confirm the task, boundaries, risks, and escalation criteria in writing (care plan / delegation record).
• Staff must not undertake delegated stoma tasks until they have completed training and competency assessment for that specific task and individual, with documented sign-off.
• Competency must be reviewed at agreed intervals and immediately following any change in the individual’s condition, products, or regimen.
• If the delegated task falls outside competence or the individual’s presentation changes, staff must stop, make the person safe, and escalate immediately in line with the care plan and this policy.

4. Understanding Stoma Types and Care Needs

4.1 Types of Stomas

A stoma is an artificial opening created surgically to allow waste (faeces or urine) to exit the body. The three main types are:

• Colostomy – An opening from the large intestine (colon), with faeces usually being semi-formed.
• Ileostomy – An opening from the small intestine, with liquid to semi-liquid stool output.
• Urostomy – A urinary diversion, where urine is passed into a stoma bag instead of the bladder.

4.2 Common Stoma-Related Challenges

Service users with stomas may experience:

• Skin irritation and infections around the stoma site.
• Stoma leakage and odour issues.
• Psychological and emotional distress due to lifestyle adjustments.
• Difficulties in managing the stoma independently, particularly for elderly or disabled individuals.

How we manage this efficiently:

• Each service user has a personalised stoma care plan, developed in collaboration with healthcare professionals.
• Care workers receive hands-on training from stoma care nurses to provide effective support.
• Regular stoma assessments ensure early detection of issues and timely intervention.

5. Personalised Stoma Care Plans

Each service user requiring stoma care will have an individualised care plan, developed in consultation with stoma nurses, GPs, and the service user themselves.

5.1 Contents of a Stoma Care Plan

A comprehensive stoma care plan will include:

• The type of stoma and its expected output.
• Preferred stoma products (bags, adhesive rings, barrier wipes, etc.).
• Specific hygiene and cleaning procedures.
• Signs of infection or complications to monitor.
• Instructions for changing the stoma appliance and disposal procedures.
• Emergency contacts, including stoma nurses and GP details.
• The person’s consent preferences for stoma care (including privacy/dignity preferences) and how consent will be checked on each visit.
• Any communication needs and reasonable adjustments required (e.g., hearing/visual impairment, cognitive impairment, preferred language, use of interpreter/advocacy).
• Any mental capacity considerations, best interests decisions, and who should be involved/consulted where relevant.
• Whether any part of stoma care is a delegated healthcare activity, including the name/role of the delegating clinician, date of delegation, and the competency sign-off record for each staff member.
• Clear escalation triggers and contacts (e.g., output changes, bleeding, colour change, persistent leakage, skin breakdown, signs of infection, suspected blockage) and the required response times.
• The recording requirements for each visit (what was observed, what products were used, stoma appearance, skin condition, output, actions taken, advice given, and any escalations).

How we manage this efficiently:

• Care plans are reviewed regularly to ensure they reflect any changes in the service user’s needs.
• A designated key worker is assigned to oversee stoma care for each individual.

6. Hygiene and Infection Control in Stoma Care

6.1 Hand Hygiene and Personal Protective Equipment (PPE)

• Staff must wash hands thoroughly before and after providing stoma care.
• Gloves and aprons must be worn during all stoma-related tasks.
• PPE must be disposed of properly in clinical waste bins.

6.2 Cleaning and Changing Stoma Bags

• The skin around the stoma should be cleaned with warm water and a soft cloth – avoid soap with fragrances.
• Used stoma bags must be disposed of in accordance with local council waste regulations.
• A new stoma appliance must be applied securely to prevent leaks.

6.3 Preventing Skin Irritation and Infections

• Barrier creams or sprays may be used to protect the skin around the stoma.
• Ensure the correct size of the stoma appliance is used to avoid leaks.
• Service users should be monitored for signs of infection, such as redness, swelling, or unusual discharge.

How we manage this efficiently:

• Regular skin checks are documented in care notes.
• Care staff are trained to recognise early signs of infection and escalate concerns promptly.

6.4 Clinical Waste, Spillages and Equipment Decontamination

• Stoma waste must be managed as directed in the care plan and in line with local arrangements for clinical waste where applicable. Staff must never leave used appliances or contaminated materials in the person’s home without safe containment and agreement of disposal method.
• Any spillage of bodily fluids must be managed immediately using approved cleaning products and PPE, and in line with infection prevention procedures.
• Any reusable equipment used for stoma care (where applicable) must be cleaned and decontaminated after each use in accordance with manufacturer instructions and infection prevention guidance.
• Staff must report and record any infection control concerns (e.g., repeated leakage, skin infection, household hygiene barriers) and escalate to the manager for review and risk control.

7. Supporting Service Users in Stoma Management

7.1 Encouraging Independence

Where possible, service users should be encouraged to:

• Participate in their stoma care routine, promoting dignity and autonomy.
• Learn self-care techniques, with guidance from healthcare professionals.
• Express preferences regarding stoma care and products.

7.2 Psychological and Emotional Support

• Acknowledge and address emotional difficulties associated with living with a stoma.
• Offer counselling or peer support referrals where necessary.
• Ensure a compassionate and reassuring approach to stoma care.

How we manage this efficiently:

• Staff are trained in dignity and person-centred approaches to stoma care.
• Service users are supported to adapt to lifestyle changes with confidence.

8. Emergency Procedures and Managing Stoma Complications

8.1 Recognising Stoma Complications

Care workers must be alert for:

• Stoma blockages (abdominal pain, reduced output).
• Skin breakdown or excessive irritation around the stoma.
• Excessive bleeding or unusual stoma colour (pale, blue, or dark red).

8.2 Responding to Stoma-Related Emergencies

• Encourage hydration and gentle abdominal massage if a blockage is suspected.
• Report concerns to a GP or stoma nurse immediately.
• If a service user experiences severe pain, call 999 for emergency medical support.

How we manage this efficiently:

• Emergency protocols are outlined in each service user’s care plan.
• Staff receive scenario-based training on handling stoma complications.

8.3 Recording, Records Retention and Information Governance

Staff must make a clear, accurate record for every stoma-care visit, including: observations (stoma colour/appearance, peristomal skin condition), output (where relevant), products used/changed, the individual’s response, consent obtained (or why not), and any advice/escalation action taken.

All records must be accurate, contemporaneous, and stored securely in line with the service’s records policy, UK GDPR / Data Protection Act 2018, and the requirements of the Regulated Services (Wales) Regulations 2017 (records available to the individual and regulator as required).

Any suspected breach of confidentiality or loss of personal information must be reported immediately in line with the organisation’s information governance and incident reporting procedures.

8.4 Incident Reporting, Safeguarding Concerns and Regulatory Notifications

Any stoma-related incident that results in (or could result in) harm must be reported in line with the organisation’s incident procedure and escalated to the Registered Manager without delay. This includes (but is not limited to): suspected blockage with significant symptoms, uncontrolled bleeding, signs of sepsis, severe skin breakdown, repeated appliance failure causing skin injury, or refusal of essential care creating significant risk.

Where there is any concern of abuse, neglect or improper treatment, staff must follow safeguarding procedures immediately and in line with local safeguarding arrangements.

The Registered Manager/Responsible Individual will consider whether the incident meets the Regulations 2017 Schedule 3 notification requirements and ensure any required notifications are made to the relevant bodies within required timescales.

9. Staff Training and Competency in Stoma Care

9.1 Mandatory Training Includes:

• Recognising different types of stomas and their care requirements.
• Correct techniques for changing and securing stoma appliances.
• Infection control measures in stoma care.
• Supporting service users with dignity and respect.
• Consent, privacy and dignity in intimate personal care, including responding to refusal and distress.
• Mental Capacity Act 2005 / DoLS awareness relevant to care delivery, and escalation routes where capacity is in question.
• Delegated healthcare activities (All-Wales Delegation principles), including task boundaries and escalation.
• Record keeping and information governance requirements for stoma care documentation.

9.2 Competency Assessments

• All staff providing stoma care must complete practical competency assessments.

Competency sign-off must be individual-specific where required, particularly where care is complex or clinically delegated, and must include documented observation of practice. Competency must be reassessed following any significant change in the individual’s condition, stoma type, products, or care regimen, or following any incident/near miss.

• Refresher training is provided annually or sooner if required.

How we manage this efficiently:

• A designated stoma care trainer oversees staff competency assessments.
• Regular audits ensure adherence to best practices.

10. Related Policies

This policy aligns with:

• Infection Prevention and Control Policy (DCW22)​.
• Personal Care and Dignity Policy (DCW07)​.
• Medication Management Policy (DCW21)​.

11. Policy Review

This policy will be reviewed annually or sooner if required due to legislative changes, business needs, or CIW updates. The Registered Manager and Responsible Individual are responsible for ensuring compliance.

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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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