Colorectal clinical nurse specialists play a key role in offering patients and their families information, support, guidance and counselling.
Stoma reviews are an essential part of the role of a clinical nurse specialist to ensure appropriate and cost effective use of products.
As a result of auditing stoma prescribing practices and the effect on both patients and health economy, GP’s invested money in the colorectal service to fund a clinical nurse specialist to review stoma patients in 17 GP surgeries (Williams, I Gastrointestinal Nursing Sept 2013 Vol 11, Issue 7, 36-44)
The reviews focussed on determining if GP’s were repeat prescribing for individual patients in an appropriate manner, the patients received the most appropriate products and the correct monthly amounts were administered. Although the work aimed to identify the cost benefits associated with a review and rationalisation of patient prescriptions, ensuring timely and expert follow up was a key quality driver.
In total 429 patients were reviewed in 17 surgeries and there were significant cost savings demonstrated in some of the reviews.
The annual stoma costs for the surgeries prior to reviews was £531,694.86 and there was total potential annual savings of £115,125.10.
There were benefits to both the patient and health economy.
- Patients benefit from being reviewed as physical and psychological problems can be addressed
- The Health Board is a large rural area with limited public transport in many areas and utilising clinical rooms which are available in GP surgeries to hold clinics is an efficient use of resources
- The work encourages good working relationships across the primary and secondary sector and money saved can be reinvested into the colorectal service to allow nurses to review patients annually to provide ongoing quality healthcare and provision of services close to patients’ homes.
A stoma care formulary was introduced to support the work and this will be used as a template to be used on an all Wales basis to help achieve a consistent approach whilst delivering services.
This work demonstrates how colorectal clinical nurse specialists can improve the quality of patient experience while saving money for the Health Board. Reviewing patients can potentially prevent them having to see a GP resulting in cost savings re GP appointments. Giving specialized timely advice can also help prevent unnecessary hospital admissions and consultant appointments.
At a time when clinical nurse specialist roles are coming under scrutiny in the search for cost savings this initiative raises the profile of the nurse specialist and demonstrates that clinical nurse specialist review and advice for patients is a quality initiative.
Iris Williams, Colorectal Clinical Nurse Specialist, Hywel Dda Health Board