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Keeping continence services within budget is no easy task

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Nursing Times Award winner Joanne Mangnall on why financial pressures on continence services are giving her nightmares

As the end of the financial year draws ever closer I find my dreams become more bizarre. The obsessive checking of financial reports and repetitive number crunching exercises become a number one priority as the end of March looms. A dislike of all things mathematical means my poor brain becomes overloaded with numbers; this translates into the strangest of dreams which typically have me at work trying to make sense of financial reports with only a really old abacus to help me!

This year we have been watching our budget with a little more interest than usual because we have redesigned services for patients who require prescribed continence equipment. On April 1st 2009 Stuart Lakin, our Head of Medicines Management, transferred prescribing responsibilities from GP’s to specialist nurses working in the continence service.

This means we have clinical responsibility for the patients now registered on our service, along with the financial responsibility of ensuring the budget does not overspend. A core component of our new service is ensuring regular reviews of the patients product needs are undertaken. These reviews allow us to adjust patients products requirements based on clinical need and identify any inappropriate product use.

Some inappropriate product use can be risky, for example we have identified a number of patients who have been changing catheter leg bags every day instead of the recommended once every five to seven days. This frequent breaking of the closed drainage system potentially increases a patient risk of developing a urine infection.

Financially, this can result in us spending in the region of £500 a year on products for patients that are not clinically indicated. Reviews have also identified risks which have resulted in us prescribing extra items such as catheter supporting devices to reduce the risk of urethral trauma. Obviously in these cases prescription costs have increased, however we have evidence to support our decision from the review.

We have, to date, managed the prescribing budget effectively. The Medicines Management team keep a keen eye on our prescribing practice and send us monthly prescribing data reports; these can be a challenge to those with a mathematical deficit but are understandable once a full explanation has been given!

We know the NHS has to find productivity and efficiency savings of between £15bn and £20bn over the next three years. As a service we feel we are contributing to these savings by making sure all continence products prescribed in our area are clinically indicated, appropriate for the patients needs and importantly being used correctly. As they say “Every little helps!”I

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