As the service team lead I noticed a clinical need for a care plan to help assist and manage patients with a high out put stomas or bowel fistulas. In the community these patients are frequently readmitted to hospital with little education to the patient of what warning signs to look out for. I attended a clinical workshop/ master class by Coloplast aimed at managing high out put stomas and off the back of this I developed a care plan for clinical nurse specialists and patients to use.