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Stoma Care Support Policy

Aims of Policy

This policy is intended to set out the values, principles and policies underpinning {{org_field_name}}’s approach to providing care and support for people who use services who have a stoma.

Principles of Stoma Care

A stoma is formed from part of the bowel or part of the urinary tract which is brought through an opening in the front of the abdomen called an ostomy. The stoma allows faeces or urine to exit and be collected in a specially designed bag on the outside of the body.

There are various different types of ostomy. For instance:

• a colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall
• in an ileostomy, the bottom of the small intestine (ileum) is attached to the stoma
• in an urostomy, the tubes that carry urine to the bladder are attached to the stoma bypassing the bladder.

A healthy stoma will be red and moist and may protrude above the surface of the skin slightly.

People will need a stoma to be formed where they have a problem with part of their bowel or with their bladder that prevents them passing faeces or urine normally. For instance, they may have had surgery for bowel cancer or have a severe inflammatory bowel disease. A urinary stoma may be needed where someone has had surgery for a condition such as bladder or prostate cancer. A stoma is usually permanent but some people need a temporary stoma operation where doctors want to allow the rest of their bowel to heal after surgery.

A stoma allows the person to pass urine or faeces and live a normal life. Bags can be worn under normal clothes. Some people require a special diet.

Routine daily care involves:

• emptying the stoma bag when full
• changing a bag for a new one and disposing of it.

Most people will develop a routine for changing or emptying their bags. Stoma bags can be emptied down the toilet. The empty bag should be rinsed and wrapped in a waste bag before being disposed of. In most local authority areas, stoma bags used by people in their own homes are classified as “offensive” or “hygiene” waste but can be disposed in normal household waste provided they are wrapped thoroughly first. In other areas, a home collection service will collect the waste.

Skin can become irritated around the stoma because of the adhesive used to stick the bag in place. In some cases, irritation can also be caused if the contents of a bag contact the skin. Many people who have a stoma apply a barrier cream or gel to protect their skin.

Most people are self-caring and are able to manage their stoma independently with support from their GP and their stoma nurse and occasional outpatient’s appointments. However, some people require additional support for day-to-day care.

Some people with a stoma can become anxious and depressed. It can also affect their body image or quality of life.

Care that will typically be required includes:

• help with emptying or changing a bag
• help with disposing of the bag contents and with disposing of the bag
• help with keeping the skin around the stoma clean
• general support.

Medical or specialist care of a stoma is outside of the scope of this policy and is not supported by {{org_field_name}}.

Policy Content

In {{org_field_name}}:

• all people who use services will have an individualised person-centred care plan based upon a full needs assessment; where a person has stoma care needs these should be fully discussed and any care or support that is required should be agreed and recorded
• the plan will constitute an agreement with the person and their carers; plans will be person focused and fully negotiated at every stage; the plan should include input from carers and family, as appropriate, and from specialist agencies involved in the care of the person where necessary, including specialist stoma care teams and GPs
• during the assessment, and throughout the delivery of care, people will be approached as equal and expert partners in their care; every effort will be made to ensure effective communication and ensure the person’s understanding; where a person lacks capacity, a best interests’ assessment will be completed in compliance with the Mental Capacity Act 2005
• care plans for people who have a stoma and require social care support will specify exactly what help is required; appropriately trained, skilled and competent home care support staff will then be allocated; where the plan includes help with the disposal of stoma bags, care managers should check for compliance with local authority waste arrangements
• care plans will be reviewed on an annual basis or more frequently if a person’s condition changes
• home care staff will be trained to provide support for people who require assistance with their stoma as part of their personal care; training will include how to change a bag, how to dispose of a bag and its contents, care of the stoma, etc; it will also include an awareness of complications, etc; training will be accessed through local stoma care services wherever possible, including local Stoma Care Nurse Specialists
• the approach taken by care staff and managers should be one of empowering people who use services who have a stoma, where possible, to be as self-caring and as independent as possible, self-managing their condition and thus maintaining and enhancing their dignity and privacy; as part of this self-empowerment, people will be encouraged to talk to staff about any concerns or worries they may have
• all people who use services who have a stoma should be supported to attend reviews with their healthcare providers, with specialist stoma teams and with their GP; care staff and managers will work closely with an individual’s carers and healthcare team, including their Stoma Care Nurse Specialist
• care plans should include common problems and what staff should do if they are encountered; care staff should report the problems and support the person to access appropriate specialist care as required; issues that may cause concern include:

a) bleeding from the stoma or around the stoma
b) painful or prolonged soreness around the stoma
c) output problems, ie diarrhoea or constipation
d) dehydration, for instance, where a person has an ileostomy and does not drink enough water

• medical or specialist care of a stoma is not supported by {{org_field_name}} and should not be attempted by care staff. Any unmet needs, complications with a stoma or requests for care that are outside of the scope of this policy or outside of the competencies of a care worker should be discussed with a line manager/supervisor and referred to the relevant GP or healthcare staff involved.

Training

All care staff should read and understand this policy. Basic stoma care training will be covered in the service’s induction programme for new care staff. Where a care worker is involved in actively providing stoma care they will be provided with specialist training in any specific procedures to be used. This will include supervised practice and verification of competencies.

To be competent in the different aspects of stoma care, selected staff will be given relevant training and refresher courses as appropriate and as identified in individual appraisal and learning plans.

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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: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

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