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Ipswich and East Suffolk Clinical Commissioning GroupWest Suffolk Clinical Commissioning GroupSimple Switches and Appliances Quick Win GuideThis document has been developed to assist practices with appliance reviews and simple switches. It willensure cost effective prescribing in line with CCG formularies whilst improving patient care throughassessment. These switches have been chosen carefully and can be implemented by the practice.CCG formularies can be found using the following links:Ipswich and East /CCGFormularies/Appliances.aspxWest -and-stoma/Exclusions for all switches:Patients under the age of 18, patients receiving palliative care or where a specific product has beenchosen by a clinic/specialist in exceptional circumstances.Please contact the team for support and guidance:East Suffolk: iesccg.medsmanagement@nhs.netWest Suffolk: wsccg.medsmanteam@nhs.netContents1) Appliance Switch Process2) Barrier Cream and Quick Wins3) Continence Appliances Summary Sheet and Quick Wins4) Stoma Appliances Summary and Quick Wins5) Suffolk Skin Care - Quick Switch Tool6) Wound Care Summary and Quick WinsAppendicesAppendix 1: Generic Switch – patient letterAppendix 2: Stoma Service Review – patient letterDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Appliances Switch ProcessReview practice data and identify high spend Appliance categoryPerform search on Appliance Quick Win category to identify which patients areappropriate for switchingAccess each patient record on the search report and review the medication list – MostAppliances (excluding those for wound care) can be located and placed on a repeat template. Wherethey are not visible, check acute templates to confirm product has been recently prescribed.Refer to relevant Appliance Quick Win chart to match products and switch to recommendedformulary productCheck patient allergy status - if patient has a sensitivity to the product exclude patient from productswitchPlace new product on repeat template (excluding wound care products unless agreed bymedicines management team)Inform patient of changes in normal way according to practice procedure (see Appendix forgeneric patient letter template that can be used if required)Update Dispensing Appliance Contractor/Pharmacy of change made – This helps to ensurethe next prescription request is correct and stops incorrect products being sent outDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Tips - they may have more than one quick win on their list, save time by switching other QuickWin products at the same time! Additional products do not always show in the reportBarrier CreamsBarrier creams should ideally be reviewed fortnightly and stepped down to more appropriate longterm treatment.Key pointsIt is best practice to ONLY use ointments short term and these are for severely broken skin.The step up and step down technique should be applied where possible. Please obtain skin integrityand encourage review. See chart below.For guidance on tub use in care homes please see formulary.Switch from:Severe skin DamageProshieldMild to Moderate Skin DamageCavilon cream, Medi honey or ProshieldPrevention (intact skin)Cavilon cream, Medi Honey or ProshieldSwitch to: Medi Derma Pro Medi Derma S or Medi Derma S Pump Spray Conotrane or Medi Derma S in care homes.Simple Switch ‘Like for Like’ where skin integrity is unknownOriginal ProductOintmentsProshield 115gCleansersProshield Spray Cleanser235mlCreamsLBF Barrier Cream 90gCavilon Barrier Cream 90gMedihoney Barrier Cream28gCavilon Barrier Cream 28gFilmsCavilon Film FoamApplicator 1mlCavilon Film FoamApplicator 3mlBrava Barrier Film Spray50mlLBF Barrier Film WipesCavilon Barrier Film WipesDT Price( )Alternative ProductDT Price( )Saving9.94Medi Derma-Pro 115g8.5014.5%6.61Medi Derma-Pro Spray Cleanser250ml5.9510%7.556.554.89Medi Derma-S Cream 90gMedi Derma-S Cream 90gMedi Derma-S Cream 28g5.955.952.9821%9%40%3.32Medi Derma-S Cream 28g2.9810%4.09Medi Derma-S Barrier Film FoamApplicator 1mlMedi Derma-S Barrier Film FoamApplicator 3mlMedi Derma-S Barrier Film Spray50mlMedi Derma-S Barrier Film WipesMedi Derma-S Barrier Film 226.0823.76Developed by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Continence Appliances When prescribing continence products (catheters, catheter drainage bags and accessories) themost cost-effective formulary choice should be used first, taking into consideration patient needse.g. bag capacity and tubing length.Simple, cost effective switches can be made to catheter drainage bags, valves, catheters and otheraccessories without affecting the patient’s treatment.Considerations when switching catheter bags: Match bag size i.e. 500ml to 500ml. Match tube length i.e. short tube (10cm) to short tube (10cm) and long tube (30cm) to long tube(30cm). If there is not an exact match, pick the nearest available length. Review all patients that are currently using adjustable tubes as there is an increased infection riskto the patient. Remove these where possible. All formulary bags come with washable bag straps and should not be prescribed separately. Ensure quantity of bags provided is in line with recommendations on the formulary.Day BagsNight Bags Single Use (disposable)Night Bags- Drainable (5-7 day use)CathetersCatheter valves10 bags (1 box) every 2 months30 bags (3 boxes of 10) every month10 bags (1 box) every other month1 every 4-12 weeks1 box of 5 every monthThe following table provides a guide to switching commonly prescribed catheter bags, catheters andaccessories. It is not exhaustive and any queries regarding switches should be directed theAppliance Nurses within the CCG. This gives you examples of switches.The CCG’s second line option Is Clinisupplies Prosys and these are an alternative to LINC, should theneed arise. Please do not re-issue previous brands.Key PathwaysSheath pathwayFor patient reviews please contact Suffolk CCC on 03001232425 Bladder and Bowel Service. All patients arethen activated on the system to ensure monitoring. For Nursing homes ONLY please contact Traci FranksDirect. Traci.frank1@nhs.net. The patient will need to provide consent. Please see formulary.Intermittent catheter pathwayPatients in most cases should not be emptying their bladder more than 5/6 times a day, increased usage cancause trauma or risk of infection. If a patient has increased their usage then a fluid balance chart isrecommended for completion, please see the formulary for an example of this.If a patient or dispensing contractor (DAC) are requesting more than 150 per catheters per month, pleaseliaise with the patient to review how many times a day they are emptying their bladder. Adjust theprescription accordingly. If more than 5 times a day and there’s no clear clinical need the GP will need toreview and complete a fluid balance chart. Please see formulary.Bladder washout pathwayPlease see link for useful information on increased usage or requests for bladder washout preparation (i.e.OptiFlo and PDF.pdfDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Check that a prescription for the Appliance is still required i.e. is patient still catheterised? If catheterhas been removed, catheter bags and accessories will need to be taken off repeat.Select T Tap or lever Tap when completing switches. Either are appropriate but slide Taps are lesslikely to be knocked by the patient causing leaking. Keep tube length the same where possible.DAY BAGSSwitch From:Bard Uriplan 350ml direct inlet tube D3SSimpla Profile 350ml 6cm tube 21563Bard Spirit leg bags 350ml 10cm tubeDSLB350SBard Uriplan 350ml 30cm inlet tube D2LSimpla Profile 350ml 25cm tube 21564Switch to: Linc Flo 350ml direct inlet tube LM350SD-TProsys do not have direct inlet tubes (6cm) Prosys Sterile Leg Bags with slide action tap.P350SProsys Sterile Leg Bags with slide action tap.Containing 1 pair of non-latex gloves and softelasticated cotton Velcro straps per box of 10P350LLINC do not have 30cm tube 350ml Bard Spirit 350ml 30cm tube DSLB350LBard Uriplan 500ml Direct inlet D5SColoplast Simpla Profile 500ml 6cm tube21573Bard Uriplan 500ml 10cm Tube D5MSpirit 500ml 10cm tube DSLB500SBard Uriplan 500ml 30cm tube D5LSimpla Profile 500ml 25cm Tube 21574Simpla Profile 750ml Direct Inlet 21593Bard Uriplan 750ml Direct Inlet D7SBard Uriplan 750ml Short tube D7MBard Uriplan 750ml Long Tube 30cm D7LSimpla Profile 750ml 25cm Tube 21594 LINC Flo Leg Bag 500ml Direct Inlet. LM500SD-TProsys do not have direct inlet tubes (6cm) Prosys Sterile Leg Bags 500ml 10cm tube P500S Prosys Leg bag 500ml 30cm inlet tube P500L Linc Flo 750ml direct inlet tube LM750SD-TProsys do not have direct inlet tubes (6cm) Prosys leg bag 750ml 10cm inlet tube P750S Prosys leg bag 750ml 30cm inlet tube P750LSINGLE USE NIGHT BAGS: These are more clinically suited in Care Homes due to infection controlSwitch From:Switch to:Bard Uriplan One MT single use slidedrainage tap 90cm inlet Lever Tap D1MTProsys Non-sterile 2 litre night bag with single use drainable tap Code PSU2Coloplast Simpla Profile drainable nightdrainage bag Lever Tap 21578 2LDRAINABLE NIGHT BAGS - 5 TO 7 DAY USESwitch From:Switch to:Coloplast drainable night drainage bag T-Tap21365 2L (Coloplast ltd)Prosys Sterile 2 litre night bag with 90cm inletSimpla Profile drainable night drainage bagtube, non-return valve, sample port connector, Lever Tap 21578 2L (Coloplast ltd)lever outlet tap and pair of non-latex glovesCode P2000-LTUriplan drainable night drainage bag LeverTap D813131 2L (Bard)CATHETER VALVESSwitch From:Switch to:Flip-Flo Cath Valve Lever Tap BFF5 BardCliniSupplies Ltd Prosys Catheter Valve CODE PCV3942Coloplast Cath Valve Lever Tap CV3808Developed by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
CATHETERSAll catheter Trays are NOT permitted for prescribing. They cost between 17- 20 and have a 10dispensing fee on prescription. The disposable items inside are NOT required and should be supplied bythe care provider e.g. nursing home, district nurse. Please dispense individual catheters ONLY andLidocaine (Cathejel or LINC Gel)Switch From:Switch to:1) Rüsch Sympacath AquaFlate Hydrogel CoatedBard Biocath Comprehensive Care FoleyLatex with sterile water filled syringe Male 10ml Tray all sizes MALE Sizes 12ch-22chBalloon Sizes: 12ch – 22ch Code: DH310112DH3101222) Cathejell 12.5g CJL 125011) Rüsch Sympacath AquaFlate Hydrogel CoatedBard Biocath Comprehensive Care Foleywith Latex sterile water filled syringe FemaleTray all sizes FEMALE Sizes 12ch-16ch Sizes: 12ch - 16ch 10ml Balloon Code: DH210112DH2101222) Cathejell 12.5g CJL 12501When switching catheters please replace with ‘Like for Like’. Gauge and length must match, forexample 12ch to 12ch or 14ch to 14ch .Female to female and male to male.Some Females will use MALE catheters or standard length but Men MUST NOT use a female lengthcatheterLatex standard cathetersBard Biocath Aquamatic Hydrogel CoatedRüsch Sympacath AquaFlate Hydrogel Coated Latex#Pre-filled with sterile water MALEwith sterile water filled syringe Male Sizes: 12ch – 22ch 10ml BalloonBard Biocath Hydrogel Coated MALECode: DH310112- DH310122Bard Biocath Aquamatic Hydrogel Coated#Pre-filled with sterile water FEMALEBard Biocath Hydrogel Coated FEMALE Rüsch Sympacath AquaFlate Hydrogel Coated withLatex sterile water filled syringe FemaleSizes: 12ch – 16ch10ml BalloonCode: DH210112- DH210122SiliconeMaleBard Lubri-Sil Aquafil Hydrogel Coated Silicone withpre-filled syringe of sterile water MaleD175812-22EBard Lubri-Sil Hydrogel Coated Silicone MaleD176816-22EBard All Silicone (Male/Standard) (D1658)Coloplast Ltd Folysil All Silicone Catheter Male AA71Folysil X-Tra with pre-filled syringe for balloon MaleAA8A12-AA8A22FemaleBard All Silicone Female D1661Folysil X-Tra with pre-filled syringe female AA8B12AA8B18Bard Lubri-Sil Aquafil Hydrogel Coated Silicone withpre-filled syringe of sterile water Female D17611216EColoplast Ltd Folysil All Silicone Catheter Female AA75Rüsch Brillant AquaFlate All-Silicone withsterile water filled syringe for ballooninflation and empty syringe for balloon deflation Male. DA310112 - DA310124Sizes 12-22ch10ml balloonRüsch Brillant AquaFlate All-Silicone withsterile water filled syringe for ballooninflation and empty syringe for balloon deflation FemaleDA210112 - DA210124Sizes 12-22ch10ml balloonDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
STOMA ACCESSORIESBarrier wipes for stoma patients should not be used long term. Patients on these should be reviewedby their stoma nurse approx. every 6 months. Stoma accessories can be very high cost and can beswitched simply for cost effective alternatives on the CCG Stoma formulary as non-exhaustiveexamples outlined below. For full range of products see SystmOne searches.Barrier wipes3m Health Care Cavilon No Sting Barrier FilmStoma Wipe Do not switch if this has been recommendedby the Stoma NurseCliniMed LBF Ster No Sting Barrier Film Wipes x30Coloplast Brava Skin Barrier Wipe ConvaTec ConvaTec Silesse Sting Free Skin Barrier WipesGreat Bear GB SOFT SKIN No Sting Barrier StoCare Barrier Wipes STC 250 (30 wipes)WipesMedicareplus Medi Derma-S Non-Sting Medic Barrier Film WipesPelican Protect Plus Non-Sting Barrier Film WipesProSys Independence No Sting Barrier Film Sach WipesSalts Barrier Film Wipes PPS1 Trio Elisse Sting Free Skin Barrier Wipes Barrier Film SpraysAll barrier film sprays Cavilon Barrier Film Pump Spray (28ml)For example. Brava skin barrier spray 50mlDeodorant spraysDeodorant sprays are not clinically necessaryand should NOT be on a prescription STOP – Not clinically necessaryFor example. Opus NaturCare Breeze Deod A/SpyAdhesive Remover SpraysC D Medical Peel Easy Adh Remover Spy 50ml CliniMed Appeel Advance No Sting Medic Adh Remover A/Spy 50mlCliniMed Appeel No Sting Medical Adh Remover A/Spy 50mlColoplast Brava Adh Remover Spy 50ml Dansac Non Sting Adh Remover A/Spy 50ml Lift Plus 360 adhesive remover spray 50mlHollister Adapt No-Sting Medical Adh Code 5506Remover A/Spy 50mlHollister Adapt No-Sting Medical Adh Remover A/Spy 76gOakmed EasyLease No-Sting Adh Remover Spy 50mlOpus Lift Plus Adh Remover A/Spy 50ml Pelican Release Non-Sting Adh Remover Spy 50mlDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
ProSys Independence Adh Remover Aero50mlRhodes StoCare Remove Medic Adh RemoverSpy 50mlSalts Adh Remover Spy 50mlTrio Elite Sting Free Adh Remover Spy 50mlOpus Lift Plus Citrus Medical Adh RemoverSpyRespond Remove Adh Remover Spy AppleRespond Remove Adh Remover Spy BlkberryRespond Remove Adh Remover Spy MintAdhesive Remover WipesC D Medical Peel Easy No Sting Adh RemoverWipesCliniMed Appeel No Sting Medical AdhRemover WipesColoplast Brava Adh Remover WipesConvaTec ConvaCare Adh Remover WipesConvaTec ConvaTec Niltac Sting Free MedicAdh Remover WipesDansac Non Sting Adh Remover SachGreat Bear GB Soft Skin No Sting Medical AdhRemover WipesHollister Universal Remover WipesOpus Lift Medical Adh Remover Soln Sach 2mlOpus Lift Plus Citrus Medical Adh RemoverSachOpus Lift Plus Medical Adh Remover SachWipePelican Release Non-Sting Adh Remover SachWipeProSys Independence No Sting Adh RemoverSach WipesCleansersCleansing products are not clinically necessaryFor example. Brava cleansing wipes Lift Plus Citrus 360 adhesive remover spray50ml StoCare Non-sting Medical AdhesiveRemover Wipes STC 200 (30 wipes) STOP products and advise patient to contactStoma Nurse if necessaryStoma ReviewsPatients can access a Stoma review via the Stoma Nurses at any point – Please see Appendix 2 forexample letter which the practice can send to patient.Developed by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Ipswich and East Suffolk Clinical Commissioning GroupWest Suffolk Clinical Commissioning GroupSuffolk Skin Care- Quick Switch ToolThis guide is intended for use when an emollient or barrier cream needs switching to a more cost effective andapproved alternative. The alternatives indicated are within the same product group on the GP formulary and shouldprovide the same treatment as the original product requested.Product CategoryAveeno Cream Colloidal oatmeal 1%500mlSimilar Products Epimax Oatmeal Cream 500ml Epimax Original Cream 500g Epimax Isomol Gel 500g Medi Derma-S Barrier Cream 90g Medi Derma-Pro skin protectant ointment 115gAqueous cream 500gCetaben Cream 500gAproDerm Emollient Cream 500gDiprobase Cream 500gZerobase Cream 500gE45 Cream 500gZerocream Cream 500gUltrabase Cream 500gEpiderm Cream 500gOilatum Cream 500gOilatum Junior Cream 500gDoublebase Gel 500gDoublebase Dayleve Gel 500gHypoBase Gel 500gMyriBase Gel 500gZerodouble Gel 500gCavilon Barrier cream 92gMedihoney Barrier cream 50gProsheild Ointment 115gPropsheild Foam Spray 235mlMedi Derma-Pro foam and spray incontinence cleanser 250mlOintment switch for patients in own home: for guidance on tub use in care homes please see formularyCetaben Ointment 450gEpiderm Ointment 500g Epimax ointment 450gDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Dressings Switch ChartDressings should NOT be placed on repeat unless confirmed by Medicines Management Team or TissueViability Nurse. See below basic dressings that can be safely switched at time of request.GP Practice FormularyPopular non-formulary dressingsProduct TypeOcclusive FilmProduct NameMepitel FilmMeporeAdhesive AbsorbentLow absorbencyPrimaporeOpsite Post Op Approved Products Mepore Film Cosmopor E Mepore Film Pad (waterproof)Opsite PlusAllevyn GentleBiatainBordered and Nonbordered Silicone FoamModerate absorbencyLyofoam Max(non-bordered)Mepilex /Mepilex Comfort Kliniderm Foam Silicone(bordered ornon-bordered)Biatain Silicone (borderedor non-bordered)Urgotul AbsorbBorderedFoam SacrumKliniderm Foam SacrumMepilex Sacrum Allevyn HeelFoam HeelBordered and non-borderedAbsorbent PadModerate absorbencySuperabsorbentHigh absorbency Biatain Silicone Heel(Bordered only) Zetuvit E (non-sterile)Mepilex HeelPremierPadMesorbCutimed SorbionSachet / SanaBiatain Silicone SacrumKliniderm Foam SiliconeHeel(Bordered or nonbordered-match torequested product)Zetuvit (sterile) bsorbentMextraSuperabsorbent Activon Tulle MediHoney TulleAlgivon MediHoney ApinateActivon Tube 25g MediHoney Antibacterial Wound Gel 10gAlginateKaltostat Melgisorb PlusHydrofiberAquacel / Durafiber ExufiberHydrogelIntrasite Gel Activheal Hydrogel TubesStockinetteComfifast TubifastManuka HoneyDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Appendix 1Patient Letter template- genericPractice LetterheadAddressTel:Fax:Private and confidential Patient Name Patient Address Today's date NHS no NHS number Dear «PatientName»Important information about your repeat prescriptionIn line with best clinical practice and local guidelines we regularly review the medicines and appliances weprescribe to check that we are using the most effective choices. Your GP Practice has reviewed your currenttreatment and has made the following changes to your prescription.From:To:Whilst the name of the new product is different, it will continue to treat your condition in the same way.(insert previous product here) is not recommended on the CCG formulary.The NHS considers this a more effective treatment regime. Please continue to use any products you haveat home before requesting your new supply.You should not experience any side effects from this change. Should you have any other queries about thismedication change please contact PALS on 08003896819 or Email PALS@Suffolk.nhs.ukYours SincerelyDeveloped by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
Appendix 2Patient Letter Template – Request Stoma ReviewPractice LetterheadAddressTel:Fax:Private and confidential Patient Name Patient Address Today's date NHS no NHS number Dear «PatientName»Stoma Review IndicatedIt can be a worrying time when trying to access the support you need when living with a stoma. You may needmedical help to access advice on skin health and products, or have a question relating to your condition.At {insert name of GP Practice} in partnership with Suffolk Community Stoma Services, we can support you withaccessing a community stoma nurse specialist.How to access Stoma supportYou can call the surgery on {insert surgery telephone number} and the receptionist will ask for your contact detailsand the community stoma nurse will call you back to answer any questions you may have.Alternatively, you can contact the stoma nurse directly:Ipswich & East Suffolk GP Federation - Community Stoma Nurses:Debbie Cooper and Claire BurkeT: 03001232425Ipswich Hospital Stoma Nurses:Sharon Stopher, Sally Power and Laura PyneT: 01473 703301West Suffolk Stoma Nurses:Katie LloydT: 01284 712697As well as discussing the health of your stoma and skin, the nurse will answer any questions you may have aroundlifestyle, exercise, diet and products available.If you have experienced any stoma or skin related problems during this time, we would urge you to contact us or thecommunity stoma nurse directly.Yours Sincerely{Insert name of GP Prescribing Lead, Practice Manager or Community Stoma Nurse on behalf of GP practice}Developed by IESCCG & WSCCG Medicines Management Teams. Version 3.0. Approved by SNEE APC. Review date: May 2023
LBF Barrier Film Wipes 26.08 Medi Derma-S Barrier Film Wipes 19.40 26% Cavilon Barrier Film Wipes 23.76 Medi Derma-S Barrier Film Wipes 19.40 18% Tips - they may have more than one quick win on their list, save time by switching other Quick Win products at the same time! Additional products do not always show in the report . Developed by IESCCG & WSCCG Medicines Management Teams. Version 3.0 .
