Peristeen Plus transanal irrigation system for managing bowel dysfunction

Project management

This technology can be best adopted using a project management approach. NICE has produced the into practice guide, which sets out the most common steps taken when putting evidence-based guidance into practice.

Care pathway mapping

Individual organisations need to consider the point at which to implement the guidance, and any changes to the current pathway that may be needed. Firstly, identify current practice. This should be what usually happens and not what ideally would happen.

Once current practice has been established, asking the questions in assessment of readiness will help in understanding where the technology will fit in the care pathway and what changes to the pathway are needed.

Patient selection

Peristeen is not suitable for all people needing bowel dysfunction management and appropriate patient selection is important for successful treatment and effective use of resources. Input from members of the multidisciplinary team can be used to assess a person's suitability for transanal irrigation and in partnership with the person to choose which device is most appropriate. Patient selection is informed by a combination of factors including:

Use local documentation including proformas to ensure that the agreed process is followed for selecting and training patients.

Patient training, information and support

Having noted the considerable dropout rate when people were using Peristeen in clinical studies, the medical technologies advisory committee recommended that it is most effective when offered with specialist training and structured patient support. Contributors said support should be tailored and that people need information, training, support and encouragement both before and while using Peristeen to promote long-term use. Contributors suggested the following considerations:

Healthcare professional education and training

The success of Peristeen depends on the expertise, skills and competence of healthcare professionals responsible for selecting people and providing initial and ongoing support.

Training needs will depend on current knowledge, skills and role in relation to Peristeen. For example, staff who start treatment with Peristeen (such as nurses and physiotherapists with a special interest in continence) may work in a different service to those responsible for the long-term support and monitoring of people who are stable.

Those responsible for training people in using Peristeen should be signed off as trained and competent following an approved course. Training should cover anatomy and physiology, colorectal surgery, gastrointestinal disorders and a specific focus on transanal irrigation.

The manufacturer of Peristeen provides tailored training and refresher sessions as needed from their registered nurse advisors, who will also support joint patient visits if required.

Business case

The NICE guidance states that the cost modelling for Peristeen is uncertain, but it is likely that it provides additional clinical benefits without costing more than standard bowel care. The NICE resource impact statement states that any additional costs as a result of implementing Peristeen are likely to be offset by a reduction in adverse events.

Producing a business case should be a priority for the implementation team. Local arrangements for developing and approving business plans will vary, and each organisation is likely to have its own process in place. Submitting the business case to the local area prescribing committees will be particularly important if seeking agreements with primary care to support the long-term prescribing and monitoring of people who are stable.

Commissioning and prescribing

If there are no formal agreements about who takes responsibility for the ongoing prescribing of Peristeen once the person is stable, there is a risk that funding may not be available.

A number of approaches could be used to support a formalised funding agreement that allows coordinated funding and provision of transanal irrigation services:

Ensure that plans are in place to maintain the cost-effective use of transanal irrigation systems once established in practice. This could include reminders for clinical staff to ensure the correct type and quantity (taking into account the person's routine) are prescribed and developing a system to flag up people who are using the products too frequently so that they can be followed up.

Measuring success

It is important to record a baseline assessment and take measurements during and after implementation to show the cost and clinical benefits of adopting Peristeen.

Contributors to this resource suggested that before implementation, the team should plan who will be responsible for collating and managing this data.

Developing local documentation

The following are examples of tools developed by NHS services using Peristeen, which can be used for developing local documentation. They have been shared by contributors; they were not produced for or commissioned by NICE.