How can a primary‑care clinician obtain and prescribe ostomy supplies (e.g., pouch, skin barrier, wafer) for a patient with a colostomy or ileostomy?

Obtaining Ostomy Supplies in Primary Care

Primary care clinicians should prescribe ostomy supplies (pouches, skin barriers, wafers) through durable medical equipment (DME) suppliers or medical equipment companies, with the patient's insurance typically covering these items as medically necessary equipment.

Prescription Process

Direct Prescription to DME Suppliers

• Write a prescription specifying the exact ostomy supplies needed, including pouching system type, skin barrier/wafer specifications, and quantity based on expected usage frequency 1.
• Colostomy appliances typically require changing every 6-7 days, while ileostomy wafers need replacement approximately every 4 days on average 1.
• Each ostomy supply item is available through the patient's medical equipment supplier and can be ordered with a standard prescription 1.

Essential Supply Components to Prescribe

• Pouching system (one-piece or two-piece system) 2
• Skin barriers/wafers (flat or convex depending on stoma characteristics) 1
• Accessory items such as ostomy belts, paste, or barrier rings for patients with leakage issues 1
• Convex appliances, ostomy belts, paste, or barrier rings are specifically indicated when patients have flush stomas, obesity, or skin creases predisposing to leakage 1

Determining Supply Quantities

Colostomy Patients

• Prescribe supplies for appliance changes every 6-7 days (approximately 4-5 complete systems per month) 1
• Output is typically formed stool once daily, making management easier 1

Ileostomy Patients

• Prescribe supplies for wafer changes every 4 days (approximately 7-8 wafers per month) 1
• Pouches require emptying 3-4 times daily due to liquid effluent, but the wafer/barrier remains in place 1, 3

Critical Considerations for Supply Selection

Patient-Specific Factors Affecting Supply Choice

• Obesity, skin creases, or flush stomas require convex appliances rather than flat barriers to prevent leakage 1
• Loop ostomies are more prone to leakage than end ostomies and may require additional barrier rings or paste 1
• Liquid effluent (ileostomy or diarrhea with colostomy) necessitates more frequent pouch emptying and potentially specialized high-output pouching systems 1

Insurance and Coverage

• Ostomy supplies are considered medically necessary durable medical equipment and are typically covered by insurance when prescribed appropriately 4
• Document the medical necessity (type of ostomy, indication, and specific supply needs) to facilitate insurance approval 4

Common Pitfalls to Avoid

• Failing to account for individual stoma characteristics when prescribing generic supplies—flush stomas, obesity, and skin creases all require specialized convex systems rather than standard flat barriers 1
• Under-prescribing quantities based on theoretical change frequencies rather than accounting for leakage episodes, skin complications requiring more frequent changes, or patient learning curve 1
• Not providing adequate variety initially—patients may need to trial different barrier types, pouch styles, and accessory products before finding optimal fit 4
• Repetitive leakage causes significant skin excoriation, pain, and considerable added expense leading to financial hardship 1

When to Refer for Specialized Fitting

• Refer to wound ostomy continence (WOC) nurse or enterostomal therapist for complex cases including recurrent leakage, peristomal skin complications, or difficulty with pouching 1, 5
• Preoperative stoma site marking by a stomatherapist and proper fitting prevent many complications 1, 5
• Adequate stomal care improves clinical outcomes and reduces hospitalizations 1