Nurse Justification Letter

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Confirmation

Patient details
*TItle
*First name	*Last Name
*Date of Birth	*Email
*Phone number	Does the patient require GapFill?YesNo
*Todays Date	*Nurse
*Primary Diagnosis	*Letter Type: Bowel, Bladder or Bowel & Bladder
*Primary Diagnosis patient description
*Patient Description	NDIS Goal

Risks	Continence Goals
Please tick applicable risks Urinary tract infection- leading to poor health outcomes Hospitalisation related to UTI Social isolation related to poor health outcomes Damage to upper renal tracts related to ineffective management of bladder dysfunction Inability to access reasonable and necessary continence products due to lack of funding Incontinence associated dermatitis and skin breakdown leading to wounds Chronic constipation and impaction related to poor management of neurogenic bowel Hospitalisation related faecal impaction Deterioration in health and wellbeing related to poor management of neurogenic bladder and bowel Poor self-esteem and reduced dignity related to faecal odour Reduced employment opportunity related to ineffective neurogenic bladder & bowel management	Please choose type, enter value, and tick applicable goalsAchieve regular and predictable bowel emptying at a socially acceptable time and place Use a minimum of physical and pharmacological interventions to completely empty the bowel within an acceptable timeframe Avoid bowel accidents, constipation, and other complications Maintain compliance with bowel management Reduce fear and anxiety related to ineffective neurogenic bowel management when accessing the community Funding to be sufficient for John Appleseed to exercise choice and control when selecting continence products Maintain dignity and encourage independence with regards to bowel management
Other	Other

Costing Table Please complete each item as a new line in each section	Luja Male Market Claim
List Coloplast products required (include code and annual quantity)	Please select relevant market claims below
	Core ClaimResidual urine is a risk factor for getting UTI’s. Micro-hole Zone Technology is designed to reduce the risk of UTIs Residual urine is a risk factor for getting UTI’s. Luja’s Micro-hole Zone Technology is designed to ensure complete bladder emptying to reduce the risk of UTIs The Micro-Hole Zone defines a new emptying technique in a free flow. Luja sets a new standard for bladder emptying With the Micro-hole Zone Technology, the flow only stops when the bladder is completely empty. Residual urine at 1st flow stop with Luja is on average 5mL Micro-hole Zone Technology ensures an uninterrupted and free urine flow Residual urine, an important UTI risk factor, is minimized with Luja HCPs are less worried that their patients are at risk of getting UTIs due to incomplete bladder emptying. Reduced suction of the bladder wall tissue to protect against microtrauma compared to conventional eyelet catheters With Luja there is significantly reduced mucosal suction compared to conventional eyelet catheters "Reduced suction of the bladder wall tissue to protect against microtrauma compared to conventional eyelet catheters" Simple procedure with one position compared to conventional eyelet catheters Disclaimer: Fewer steps due to no repositioning SCI users find it easy to learn how to use Luja
Flex Set Market Claim	Peristeen Plus Market Claim
Core ClaimFlexible and round tip for easy insertion/guidance through the bends and curves/barriers of the male urethra Flexible tip and soft catheter to gently insert/navigate both normal and difficult male anamoes. (At least) 84% of users agree that SpeediCath Flex feels gentle due to the flexible tip and the soft catheter. (At least) 90% of HCPs agree that SpeediCath Flex is a gentle catheter due to the flexible tip and soft catheter. Easy to insert for users with reduced hand dexterity Using the sleeve prevents transfer of bacteria to the catheter / Sleeve protects against bacteria from users' hands, pants, etc. Due to its no-touch protective sleeve, it is easy to handle and aim the catheter at the urethral opening Easy to handle for users with reduced hand dexterity Mess-free / Clean (catheterisation) "The majority of HCPs recommend SpeediCath® Flex Set 80%* of HCPs would recommend SpeediCath® Flex Set for the majority or for all of their patients needing a solution with a urine bag." The packaging is easy to open / Easy-Pack(aging) Easy to use/easy to handle* "77% of HCPs agree or completely agree that the product makes acceptance of IC easier.* OR (At least) 70% of HCPs agree or completely agree that the product makes acceptance of IC easier. OR HCPs agree or completely agree that the product makes acceptance of IC easier. " "77% of users agree or completely agree that SpeediCath® Flex Set fits into their daily life.* OR (At least) 69% of users agree or completely agree that SpeediCath® Flex Set fits into their daily life. OR Users agree or completely agree that SpeediCath® Flex Set fits into their daily life. " "82% of users agree or completely agree that SpeediCath® Flex Set gives them a feeling of control.* OR (At least) 76% of users agree or completely agree that SpeediCath® Flex Set gives them a feeling of control. OR Users agree or completely agree that SpeediCath® Flex Set gives them a feeling of control. " Catheterize anywhere anytime / when- and wherever "Easy to catheterise in bed /wheelchair 60%* of HCPs agree or completely agree that the product is easy for their patients to use in bed." The product has a modern consumer design for maximum discretion Non-medical design that blends into other daily objects Compact and practical "Only one product to carry / bring with you to cover the entire catheterization process. The product is an integrated solution with catheter and bag. Also since the product can be repackaged into the pouch after use, no need to bring additional bags for discreet disposal of the product" Easy to catheterise in bed /wheelchair* 60% of HCPs agree or completely agree that the product is easy for their patients to use in bed.* "Easy to catheterise in sitting position* 67% of users find it easy or very easy to use SpeediCath® Flex Set when catheterizing in a sitting position." Reduced risk of urethral damage compared to uncoated catheters Smooth and uniform hydrophilic coating without dry spots for reduced friction at insertion and withdrawal Reduced risk of urinary tract infection compared to uncoated catheters Polished eyelets to reduce the risk of urethral damage Polished eyelets to reduce patient discomfort compared to non- polished eyelets Reduced risk of urinary tract infection compared to uncoated catheters* Reduced risk of urethral damage* with triple action coating technology	Core ClaimMajority of users agree that Peristeen Plus Cone allows them to control when and where they empty their bowels* Majority of users agree that Peristeen Plus Cone reduces the total time spent on managing their bowels* Peristeen Plus Cone is the only transanal irrigation cone device with efficacy documented ina randomised control trial

Bladder Management Please provide further information	Bowel Management Please provide further information


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Headline

Patient details

Risks

Continence Goals

Costing Table

Luja Male Market Claim

List Coloplast products required (include code and annual quantity)

Please select relevant market claims below

Flex Set Market Claim

Peristeen Plus Market Claim

Bladder Management

Bowel Management

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