S4E7 Supporting Products Intro - Welcome to Stoma and Continence Conversations from Coloplast Professional. I'm Hannah, Ostomy Care Associate Education Manager at Coloplast. Working in specialist care, I know that stoma, bowel and bladder issues impact the lives of those you care for. This podcast is here to support your educational needs and help you in supporting your patients. You'll hear from fellow healthcare professionals and experts by experience discuss the latest hot topics in the world of stoma, continence care and specialist practice. This time… Supporting products are an essential aspect of stoma care. We're talking belts, we're talking seals, etc, etc, etc... They are not accessories. They are supporting products. Hannah - Hello, and this time I am once again joined by Paul as we discuss the use of supporting products within stoma care. So for many individuals living with the stoma, supporting products can be the difference between having a leakproof seal and being trapped in that vicious leakage cycle. So without further ado, as I said, I've got Paul here, so I'll bring in Paul. Hi Paul! Paul - How you doing Hannah? How you doing? Do you know what, I'm so excited about this podcast. I am, I love talking about supporting products. So if I do ramble, please make sure you stop me. Hannah - I'll reign you in, I'll reign you in! Paul - Thank you. Hannah - So supporting products, where do we start? Paul - I think that for me the key point is supporting products are an essential aspect of stoma care and they really are a vital weapon in stoma care nurses arsenal, when, like you said at the start, when we really, when we wanna ensure that the individuals we care for don't go into that vicious leakage cycle so we can maintain a decent quality of life and maintain that healthy parastomal skin. So they really are a vital aspect of stoma care. Hannah - So I'm gonna ask the question now. Is it supporting product or is it an accessory? Paul - They are not accessories, they are supporting products! Um, and a supporting product does. Exactly. I promise Hannah: I promise I wasn't trying to wind you up there! Paul - That's okay, that's okay. It's fine, it's fine, it's fine. Because you know, a supporting product does exactly that… It supports the chosen pouching system in maintaining positive fit to body and preventing, as I say, that leakage cycle. I always use for this kind of thing, this example of fuel in a car, bear with me… So you can have the best car in the world, okay? And it can be sitting on your drive. Now, would you class the fuel that you need to make that car go as an accessory? Or does whatever fuel you use, whether it's an electric car, whether it's a diesel, whether it's a petrol car, you need that fuel to make that car go. You can have the car just like you can have a pouch, but sometimes you need something to physically make that pouching system work. So just like fuel in the car. Fuel isn't an accessory. Fuel for a car is a necessity, not an accessory. Supporting products fill the same bracket. So supporting products can support the chosen pouching system in maintaining that positive fit to body and that leakproof seal. Hannah - So I obviously know that in your opinion, supporting products are really essential. And I think, you know, we can hear already that the way you're discussing about it, your opinions on them. But do you think there are any major issues with the use of supporting products? Paul - Yeah. Do you know what there is! There is, and there can be. And supporting products can be a double edged sword. So I agree 100% with the appropriate use of supporting products, but… The biggest issue with supporting products is the overuse of supporting products. And for me, that's one of the biggest issues and that's why sometimes supporting products have got a little bit of a bad name is because of their overuse. And, you know, roughly speaking, an ostomate in the UK is on approximately three supporting products. And don't forget, the actual scope for supporting products is quite big. So, you know, we are talking belts, we're talking seals, etc, etc, etc. And including that is adhesive remover spray as well. So, you know, it's, as I said, it's a double edged sword. Appropriate use of supporting products. Yes! Overuse of supporting products is, as I say, it's a no-no, and it can actually make a lot of situations worse by overusing supporting products. Hannah - So given your passion about supporting products and taking that into account. What are your thoughts on the main supporting products used? So we're talking seals, tapes, barriers, adhesive removers, deodorants, etc, even lubricants and potentially solidifying agents… Paul - As I said, you know, all supporting products have their place, but as I say, it's the inappropriate or the overuse of supporting products. So take, for instance, tapes, and I dunno about you, but I'm sure every single stoma nurse out there has seen tapes being used to patch a leaking pouch.. Hannah – Yes! Paul - It infuriates me to the Nth degree! When you know, tapes do not stop the leaks from occurring. You know, a leak will happen from the inside out. They don't happen from the outside in. So tapes are brilliant for, supporting that edge, increasing the size of the adhesive needed, going over those sometimes difficult contours, etc. Most of the time I actually take more people off tape than I put on tapes. Hannah - I was the same. Paul -Yeah, as I say, it's that inappropriate use. And I think that, as I said before, that's where the, you know, support products get their bad name from. It's the inappropriate use. So it's like with tape, do not patch please! And again, the amount of times and the amount of incident forms I've actually completed because of people patching stomas using tapes. Hannah - I can tell you a tale about that actually. I remember going onto the ward once on the morning, I was doing some stoma teaching with a patient and their stoma was on the right side. They'd obviously had a leak towards the inside edge, so towards their belly button. They actually had a little line of elastic tape going right the way across to the left side of their tummy, like a little map going across their tummy! Paul - Yeah, it beggars belief sometimes, doesn't it? It really, really does. But again, I, you know, I think, you know, as stoma care specialists, we almost have to take responsibility for those situations and say, you know, are we educating the ward staff enough? And, you know, we can do things like, facilitating, making sure that people have undertaken the foundation course in stoma care and that sort of thing. You know, utilising Link Nurses to try and get that appropriate use of some supporting products. Then it come down to things like seals, you know, any seal worth its salt is gonna have a pH buffer. It's gonna, you know, it's nothing new. It's been around for a long old time, which again, just helps maintain that healthy acidity of the skin. You know, you've got things like convex seals. You know, sometimes if you've got a really, really deep retracted stoma when even a deep convex doesn't reach the bottom, things like convex seals can be a really, really good thing to use. If you've got a really soft, like really spongy tummy, you know, again, things like convex seals – perfect! Again, I know you could use, you know, you could think about convexity, but again, depending on their body profile, you might try to wanna use a convex seal, you know. But seals are very good, when they're used properly. But if we go back to the consensus paper back in 2018, you know, it clearly states that, you know, we shouldn't build up convexity, you know, and a seal doesn't add convexity. So, and we shouldn't build up. So, you know, if you shouldn't start off with flat, flat and a seal soft, light, deep, if that individual needs light or they need a deep, just go to light and deep! You know, don't build them up. You know, if you've done your assessment, you've got that validated tool. There, used, brilliant, crack on! Barriers… yep barriers in their place, you know and their time, they're an amazing product, especially with urostomies. I always use a barrier with a urostomy cause of the potential for leakage with urostomies. Not so much with colostomies. And again, I've probably taken more people off barriers than I've actually initiated… Adhesive removers… Now again, adhesive removers. This can sometimes split a lot of stoma nurses. I am in favour of adhesive removers, but appropriate use of adhesive removers, and it's making sure that the individuals we care for are taught and trained appropriate and proper usage of adhesive remover. But saying that sometimes, people don't need an adhesive remover. You know, if they've got a really, really good pouch removal technique where they're taking the skin off the bag, not the bag off the skin and that sort of thing, they've got no other predominant factors, you know, then fine, yeah, potentially they don't need those adhesive removers. But it does reduce peel force, it does make the pouch changing process that little bit easier and nicer for the individual. So, yep, adhesive removers in their time when used appropriately and not overused – brilliant! Deodorants. Now, this is where I can sometimes say, you know, I probably fall on the side of no… But saying that when it comes to deodorants, you know, obviously we look after people in a holistic way, we've gotta think about their, you know, their emotional, psychological needs. But like I say, when it comes to deodorants, you know, I go to the experts, you know, Febreeze, and, you know, VIPoo is, you know, it's almost better than any product you can get from any stoma manufacturer really. Lubricants. Lubricants are really, really good if you do have that really, really kind of sticky output. But again, are they needed long term? Potentially not. Have you looked, have we looked at the cause for that really kind of sticky output? Are they drinking enough? Are they having enough soluble fibre? All of those sorts of things. So potentially in the short term, yes, lubricants. But, are they needed? And it's this constant reviewing of these supporting products, and are they still needed? And again, it's just like that continual assessment of the individual's base plate and their body profile. Same goes for solidifying agents. You know, it's this, it's self-explanatory. Sometimes I've had individuals who just need it at night because they can have a healthy output throughout the day, no matter what they do with their diet, it's a case of over as night goes on, their output comes more and more wet and, you know, they are experiencing leakage early hours in the middle of the night type thing. So, yeah, solidifying agents. So all of you know, they're the kind of the big ones that I kind of think about when it comes to supporting products. All of them have their place, but saying that all of them I have seen, and I'm sure I will continue to see their overuse. And you know, we really can't, we sometimes, unfortunately, we can be our own worst enemy, but you know, as I say, I 100% support the appropriate use of these supporting products that I have mentioned. Hannah - Absolutely, I think it is all about that appropriate use. And as you said, every supporting product does have its place when used correctly. Paul - Exactly. Hannah - And so finally, with the ever increasing number of formularies being created, what can stoma care nurses actually do to ensure that they continue to have access to those, as you said, rightly so, those are vital weapons in our arsenal. So that's when ensuring those individuals can still maintain that decent quality of life. Paul - Exactly. And I think that this is where, you know, being active and being proactive is essential. You know, fight your corner when it comes to formularies because at the end of the day, you aren't fighting your corner, you're fighting the corner of the people which you care for. So, if you do have a formulary in place, make sure your voice is heard when it comes to review. You are the expert in stoma care. Don't let people whitewash, don't let people step over you when it comes to formularies. And this is for formularies for supporting products when it comes to bags and plates and all pouching systems. You know, please, please, please be proactive. You know, fight your corner. Sometimes it takes a lot of nerves to have to kind of break that initial stand up and go, excuse me, hold on, I need to say something, that can take a lot of, for want of better words, guts. But we are there for our patients, we are their voice. And you know, as we've said, you know, we need to ensure that these individuals can continue to live the life that they want. And some of these individuals need certain supporting products and it is down to you as the CNS to fight that corner to make sure that if there is a formulary, if there is one, or there's gonna be one, that the appropriate products are on that formulary to best suit the needs of your patients. Hannah - Thanks Paul. As ever, some really great advice there. I think we can really see your passion when it comes to advocating the use of supporting products. So thank you once again for chatting with me. Paul - And as always, I say it, every single podcast there is more on supporting products on the Coloplast Professional website as well as all of our digital training and digital education. So if you haven't registered, the link is in the podcast description. So log on, have a little look, register so you can be sent educational updates as well. And thank you for inviting me back Hannah – Absolutely my pleasure. So thank you for listening, and we look forward to you joining us next time.. Outro - Stoma and Continence Conversations is brought to you by Coloplast Professional. To learn more, visit www.coloplastprofessional.co.uk .