DTHFT Wound Care Formulary

Transcription

1 DTHFT Wound Care Formulary September 206 Developed in collaboration with East Midlands Tissue Viability Group. Working together with NHS Supply Chain and wound care industry Trust wide formulary

2 Introduction In 203 the East Midlands Tissue Viability Group began a reassessment of the regional wound care formulary. Our aim was to agree a regional formulary which supports clinical and costeffective wound management for all patients within the East Midlands. In collaboration with NHS Supply Chain and our individual Procurement teams the products once evaluated were put into an e-auction and the wound care companies asked to bid. The winners of these bids are the products that have been put on the formulary. These products are comparable in their clinical effectiveness. The process Wound Management groups including link nurses, ward nurses/ specialist nurses, District and Practice Nurses representing Derbyshire, Leicestershire, Northamptonshire and Nottinghamshire undertook a screening process to shortlist generic products for evaluations. Each area then went on to evaluate agreed generic group ranges. In respect to wound care products, there are few randomised controlled trials that are able to establish a clear advantage for any particular dressing product. Where evidence is available on wound care products it can be identified and rated throughout the 200 NICE Guidelines. The range of products recommended within this formulary is mainly based on the outcomes of evaluations by the various Trusts, cost effectiveness, evidence of efficacy, manufacturer s literature, published case studies and practical experience in use / expert opinion. These recommendations have been developed in collaboration with health professionals from primary and secondary care and have been approved by the Drugs and Therapeutics Group and Prescribing Advisory Group. Initially it was agreed that there should be a replication of dressing products across primary and secondary care, however it is recognised that wound care objectives can vary across the two settings. The Acute Trust dressing formulary will therefore hold a limited range of products, which will help meet the most common wound care challenges, without compromising the patients wound, whilst at the same time ensuring continuity across primary and secondary care. Prescribing Dressings Within the Acute Trust, a limited range of dressings, which are covered by PGD S can be ordered by ward staff via NHS Supplies Chain and stored at ward level so that they can be used to manage patients. A reserve stock cupboard will be necessary to ensure adequate supplies for each clinical area. For wounds that present with more complex problems, a restricted range of second line wound care products can be accessed either via Pharmacy or Tissue Viability where a limited selection of more advanced dressings can be prescribed by specialist nurses. Providing an Optimal Wound Environment Knowledge of how dressings work and their limitations in various circumstances is fundamental to appropriate selection and use. The appropriate selection of dressings will contribute to the provision of the optimum wound healing environment. The approach to optimal wound management centres on a comprehensive assessment of the patient and the wound. This should be completed by a person trained in the assessment and management of wounds. The aetiology of the wound should be determined with referral to members of the multi-disciplinary team when further investigation or intervention is required. CG TV/Wound Formulary Review date: August 208

3 Silver Pro Forma: Best practice standards indicate that antimicrobial products should only be used if a wound is clinically infected or critically colonised. They must be used in an appropriate and structured manner for short periods with clear objectives in mind- for example to reduce MRSA or bio burden in wounds failing to heal. A Cochrane review assessed the efficacy of silver-containing wound dressings in preventing wound infection and healing of wounds and concluded that there is insufficient evidence to establish whether silver-containing dressings promote wound healing or prevent wound infection. In view that the evidence is poor there has been a recommendation from Trent Medical Prescribing to restrict usage to s. The Trust has therefore introduced a pro forma which must be completed before Pharmacy will dispense the dressing. Ongoing usage after the first week needs to be reviewed and authorised by a Tissue Viability or other dealing with complex wounds. (See Wound Guidelines) Holistic Patient Assessment Should Include at a Minimum: Past medical history Current and past drug therapies, allergies, dressings and equipment used/treatment prior to admission Identification of factors which have the potential to increase the risk of wounding, increase the risk of non-healing or delayed healing. Wound Bed Assessment Should Include As A Minimum: Type of wound and aetiology of wounding Location of wound Size of wound Condition of the wound bed, presence of slough, necrosis, granular tissue, haematomas or exposed tendons or bone Description and volume of exudate Presence of infection, pain, malodour or foreign body State of surrounding skin and alterations in sensation Ongoing assessment should be performed and evidence provided of wound healing or deterioration in wound healing The timing of on-going assessment should be based on the wound type, exudate management and individual patient factors. CG TV/Wound Formulary Review date: August 208 2

4 Objectives of Wound Management: The wound should be allowed to heal in a moist environment, unless the clinical goal is to maintain eschar in a dry and non-infected condition. For example in the case of an ischaemic wound, our objective may be to protect the wound conservatively until vascular status can be restored to facilitate potential for healing, or it may be a dry gangrenous wound where autoamputation is our objective. The use of any dressing in wound care is of limited value until factors that delay or inhibit wound healing have been identified and addressed. Treatment and management regimes should address local symptoms to minimize complications and address or manage issues identified as part of holistic assessment. Evaluations In order to evaluate the progress of a wound and monitor the effectiveness of a management plan, it is vital to ensure that all wounds are reassessed frequently using a standardised format which includes objective descriptions such as wound size, tissue type, exudate levels etc. as outlined in the Trust s Wound Management Care Pathway. Guide to wound formulary Ward stock: indicates the stock that can be ordered from NHS Supply Chain to be used for general use in the first line management of wounds. Pharmacy: indicates those dressings which require a prescription or specialist approval, for 2nd line products or anti-microbials which require monitoring. Tissue Viability (TV)/ areas: indicates highly specialised dressings in unusual sizes or greater absorbance than is generally required at ward level. There will be a small stock of start-up antimicrobial dressings and Negative Pressure Wound Therapy dressings such as PICO s available from the TV office Monday to Friday hrs. Areas that require dressings specifically for their client group i.e. Dermatology; will be able to order these dressings as they are usually applied under the supervision of a specialist consultant. Usage will be monitored throughout the Trust to ensure compliance is being met. CG TV/Wound Formulary Review date: August 208 3

5 Basic ward level stock ordered from NHS supply chain Generic name Product Indications for use Acquired from NHS supply's TVN Pharmacy Description and usage Alginates Hydrofibre/ Aquafiber Activheal rope alginate packing Sorbsan flat Aquacel extra Aquacel Ribbon WET/MOIST FOR PACKING WET/MOIST SUPERFICIAL/ SHALLOW CRATERS WET/MOIST SUPERFICIAL OR DEEPER CRATERS WET/MOIST SINUS /NARROW Sodium calcium alginate dressing indicated for exuding wounds. The fibres become a cohesive gel once exudate is absorbed, ensuring that the wound stays moist Mannuronic acid influences the development of a soft flexible gel. It is easily removed through irrigation making it ideally suited where adherence is an issue Hydrofiber* technology is a soft absorbent material that gels on contact with exudate. "Extra*" is stitched for additional strength and has a higher absorbency thus improving wear time. Hydrofiber* technology, Ribbon in 2.cm or cm widths are recommended for sinus wounds as the stitching ensures dressing removal Hydrocolloid Duoderm extra thin Tegaderm hydrocolloid DRY SUPERFICIAL DRY SUPERFICIAL Alternative 2nd line Hydrogel Aquaform DRY Hydrocolloids provide effective occlusion, causing necrotic or sloughy tissue to soften. Can be cut to size. Contra-indicated for infected wound or diabetic foot ulcers in this trust. A shaped Hydrocolloid with a film border. For difficult to dress areas and area that require additional adhesives. Can't be cut down for smaller wounds Hydrogels donate fluid to the wound bed promoting liquefaction of dry slough and necrotic tissue. The main ingredient is water and should not be added to wounds that are already wet/heavily exuding 4 CG TV/Wound Formulary Review date: August 208

6 Foams nonadhesive Allevyn flat and heel Permafoam post op high volume MOIST/WET OR SHALLOW GRANULATION MOIST/WET OR SHALLOW GRANULATION Ward stock Ward stock A highly breathable foam with a non-adherent contact layer, soft and conformable, effective bacterial barrier. Flat dressing can be used under compression. The heel shape can be used in other areas such as the elbow or scrotum Y shaped tracheostomy shaped foam dressing, moderately absorbent. Skin protection required in addition as secretion can be erosive. Allevyn Tracheostomy 2nd line high volume MOIST/WET OR SHALLOW GRANULATION Ward stock Alternative shaped Allevyn foam with a breathable top film Trachi-dress thin foam low volume MOIST/LOW EXUDATE AND PROTECTION FROM FRICTION. Ward stock Thinner foam for low volume exudate, less bulky under the tracheostomy Foams with adhesive boarders Adhesive island dressing nonwoven fabric (sterile) Allevyn Classic Tegaderm foam x Softpore range MOIST/WET PRIMARY OR SECONDARY DRESSING. MOIST/WET PRIMARY OR SECONDARY DRESSING. LOW ADHERENT AND LOW ABSORBENT PAD Ward stock Alternative 2nd line only Conformable, absorbent foam dressing which acts as an effective barrier to exogenous bacteria. A breathable top film minimises maceration. Used as a primary dressing on shallow wounds or as a secondary dressing in conjunction with packing. Oval or round shaped dressing ideal for difficult to dress areas such as elbows or feet which require extra securement or if longer wear time is needed. Post op wound dressing, low adherent. Water repellent, soft and breathable. Latex free. CG TV/Wound Formulary Review date: August 208

7 Non-adherents Skin protection Barrier sprays/film Atrauman Telfa NA dressing Cutimed Protect Spray Cutimed Protect foam applicator ml Clinell wipes Tena wash PROTECTIVE REDUCED ADHESION, NON ABSORBENT DRESSING, SUPERFICIAL PROTECTIVE LOW ADHERENT SUPERFICIAL ONLY PROTECTIVE LOW ADHERENT SUPERFICIAL ONLY TO PROTECT PERIWOUND AREAS TO PROTECT PERIWOUND AREAS INCONTINENCE BARRIER WIPES INCONTINENCE WASH CREAM Wound contact layer. Polyester mesh impregnated with neutral triglyceride (fatty acids) which enhances nonadherent properties and reduces pain and trauma on removal. Allows exudate and air to pass through. NEEDS AN ABSORBENT PAD. For use on clean dry suture lines or small superficial non-leaking wounds. NOT SUITABLE FOR LEG ULCERS Wound contact layer Ultra-thin knitted viscose. Allows exudate and air to pass through. NEEDS AN ABSORBENT PAD. Provides up to 96 hrs of moisture barrier action, protects the wound margins and peri-wound skin from external factors:- wound exudate, incontinence, digestive fluids, removal of skin cells by adhesives. Spray application; the wound bed should be protected from spray. Provides up to 96 hrs of moisture barrier action, protects the wound margins and peri-wound skin from external factors:- wound exudate, incontinence, digestive fluids, removal of skin cell by adhesives. Foam application, precise, for small areas only. 7 in action, cleaning, moisturising, antibacterial, antipruritic, barrier protection, deodorising and soothing. Free of Paraben and lanolin (4% dimethicone and 6% liquid paraffin) Non-rinse, leaves the skin moisturised, maintains the skins natural ph (Alcohol-free and soapfree) 6 CG TV/Wound Formulary Review date: August 208

8 Films Clearfilm range Tegaderm with pad Formflex wool padding Knit-band type retention PROTECTION OF SUPERFICAL AREAS, SECONDARY DRESSING FOR SECURING OTHER DRESSINGS PROTECTION OF SUPERFICAL DRY TO LOW EXUDING AREAS. SUB-COMPRESSION/ UNDERCAST PADDING RETENTION BANDAGE FOR LEG ULCERS AND SMALL DRESSINGS Vapour-permeable transparent adhesive dressing. Latex free. Provides a moist healing environment. Island type application. Suitable for all wound types when used with an appropriate absorbent primary dressing. TAKE CARE WHEN APPLING TO FRAGILE SKIN AS THIS CAN CAUSE SKIN STRIPPING Low adherent pad with a film backing. NOT SUITABLE FOR LEAKING OR BLEEDING TAKE CARE WHEN APPLING TO FRAGILE SKIN AS THIS CAN CAUSE SKIN STRIPPING Wool like bandage used to protect bony prominences, and build ankle shape. Check for allergies or irritations. These issues can be overcome by apply a retention bandage or tubular bandage as the primary bandage. Light weight knitted fabric contour bandage for the retention of primary dressings. Retention Hospilite type 2 retention (crepe) RETENTION BANDAGE, LIGHT SUPPORT Cost effective permanently elastic crepe bandage. Not for compression Comfifast range tubular bandage TUBULAR RETENTION Elasticated tubular retention stocking. Ensure that the correct size is used to avoid contraction of blood vessels. Comfigrip ELASTICATED SUPPORT TUBULAR BANDAGE Supportive tubular bandages for minor sprains and soft tissue injuries. Measure for appropriate size. Avoid double layers in patients with oedematous legs or leg ulcer of unknown aetiology 7 CG TV/Wound Formulary Review date: August 208

9 Claripore Plastic perforated surgical tape PAPER TAPE Plastic tape, breathable, radiolucent, hypoallergenic strong adhesion. May cause skin stripping in some patients. Clinipore paper surgical tape PLASTIC PERFORATED SURGICAL TAPE Perforated polyethylene film tape bidirectional tear and strong adhesion Tapes and fixation Steri-strip Hypafix fabric adhesive tape (non-sterile) HYPOALLERGENIC ADHESIVE STRIPS WITH RE-ENFORCING NON-STERILE SOFT CLOTH ADHESIVE TAPE Wound closure strips (may be called butterfly stitches) allows for almost pain free closure of superficial wounds where the skin is too fragile to stitch. Not for use over joints or in wounds more than cm long Non-woven soft conformable cloth adhesive tape, porous and breathable Anti-microbial dressings Inadine Medihoney 0% INFECTED MINOR SUPERFICIAL INFECTED WOUND INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT Povidone-Iodine impregnated on a knitted viscose fabric low exuding colonised or infected wound. The dressing should be changed when the orange/brown colour changes to white. 0% manuka honey (leptospermum honey) thin and runny in consistency may need a secondary dressing to keep it place. Use on infected wounds with or without necrotic or sloughy tissue. Reduces malodour, aids debridement by increasing the body's autolytic response. However this can make the wound seem wetter initially, and may sting due to the enzymatic production of hydrogen peroxide. Medihoney Tulle INFECTED SUPERFICAL LIGHTLY EXUDING Use to reduce bio burden in areas that runny honey might cause problems i.e. around peg or tracheostomy sites 8 CG TV/Wound Formulary Review date: August 208

10 Superabsorbent Zetuvit E range Eclipse non adherent sterile BASIC SECONDARY STERILE PAD FOR MODERATELY EXDUDING SECONDARY DRESSING, HIGH VOLUMES OF EXUDATE Basic sterile absorbent pad for moderately wet wounds/leg ulcers or "wet legs" caused by oedema or cellulitis Superabsorbent for excessively wet wounds/weeping legs. Large sizes for ease of application fluid repellent backing Adhesive remover Wound cleansing Wound Manager bags Pressure redistributing support aid Appeel Normasol Irripods Oakmed Kerrapro 0x2.x0.3 REMOVAL OF ADHESIVE DRESSINGS 0.9% SALINE SOLUTION SACHETS 0.9% SALINE SOLUTION RIGID POD LARGE OPEN ABDOMINAL WITH FISTULAE PRESSURE REDUCING PAD Ward stock Surgery, ICU, Stepdown No sting medical adhesive remover in a spray or wipes Irrigation solution sachets Irrigation solution can be used as a flush Used for the management of larger abdominal wounds with high exudate or fistula management. Can be ordered with or without a port and in vertical or horizontal shapes to fit the patients needs Only for use on intact skin to protect it from friction and shearing or over high pressure contact areas to spread the load, i.e. on the nose under CPAP masks or between knees 9 CG TV/Wound Formulary Review date: August 208

11 Dressing codes and sizes for all products can be found on the following pages. Please be aware that codes change occasionally and should be checked at regular intervals to ensure the correct items are ordered. Basic ward level stock ordered from NHS supply chain Generic name Alginates Hydrofibre/ Aquafiber Hydrocolloid Hydrogel Foams nonadhesive Foams adhesive boarders Amount (box) Price (box) Per item ELS42 30cm/2g Product Code Size Activheal rope alginate packing Sorbsan flat Aquacel extra ELS00 ELS09 ELS08 ELY377 ELY378 ELY379 Xcm Xcm X20cm Xcm Xcm Xcm Aquacel Ribbon ELY03 2X4cm Duoderm extra ELM3 7.X7.cm thin ELM00 Xcm Tegaderm ELM029 X2cm hydrocolloid 2 nd line only Aquaform ELG07 8g ELG00 g.74.7 Allevyn flat Allevyn Heel Permafoam post op high volume Allevyn Tracheostomy 2nd line high volume Trachi-dress thin foam low volume Allevyn Classic Tegaderm foam x 2 nd line only ELA29 ELA3 ELA ELA0 Xcm Xcm X20cm.X ELA266 8X8cm.87.9 ELA2 9X9cm.46. ELY86 6X8.2cm ELA020 ELA3 ELA024 ELA022 ELA08 7.X7.cm Xcm 2.X2.cm 7.X7.cm 22.X22.cm ELA77 Xcm CG TV/Wound Formulary Review date: August 208

12 Adhesive island dressing non-woven fabric (sterile) Nonadherents Skin protection Barrier sprays/film Films Retention Softpore range Atrauman Telfa NA dressing Cutimed Protect Spray Cutimed Protect Foam applicator EIJ023 EIJ03 EIJ04 EIJ024 EIJ02 EIJ027 EKA024 EKA032 EKA036 EKA06 EJE0 EJE03 EJE07 EKG0 EKG03 6X7cm Xcm xcm X20cm X2cm X3cm Xcm 7.Xcm X20cm 20X30cm X7.cm 7.Xcm 7.X20cm 9.X9.cm 9X9.cm ELY39 28ml ELY468 ELY469 ml 3ml Clinell wipes VJT88 2 wipes Tena wash GDW63 0ml.49.0 Clearfilm range Tegaderm With pad Formflex Natural Wool padding Formflex Synthetic Knit-band type retention ELW646 ELW696 ELW707 ELW697 ELW698 ELW00 ELW006 ELW007 ELW008 ELW009 ELW0 EPA029 EPA030 EPA03 EPA032 EPE08 EPE09 EPE060 EPE06 EDB EDB6 EDB7 EDB089 6X7cm X2cm 2X2cm X20cm 20X30cm X7cm 9Xcm 9Xcm 9X20cm 9X2cm 9X3cm x2.7m 7.x2.7m cmx2.7m cmx2.7m x2.7m 7.x2.7m x2.7m x2.7m cmx4cm 7X4cm X4m X4cm CG TV/Wound Formulary Review date: August 208

13 Hospilite type 2 retention (crepe) ECA93 ECA94 ECA9 ECA96 cmx4.m 7.cmX4.m cmx4.m cmx4.m Retention Comfifast range tubular bandage EGP00 EGP066 EGP006 EGP069 EGP007 EGP072 EGP008 EGP009 3.cmXm cmxm Green cmxm Green 7.cmXm Blue 7.cmXm Blue.7cmXm Yellow.7cmXm Yellow 7.cmXm Beige Comfigrip EGA020 EGA022 EGA024 EGA00 EGA006 EGA007 EGA008 EGA026 EGA028 4.cmXm (A) 6.2cmXm (B) 6.7xmXm ( C) 7.cmXm (D) 8.7cmXm ( E) cmxm (F) 2cmXm (G) 7.cmXm (J) 2.cmXm (K) Claripore Plastic perforated surgical tape EHA03 EHA04 2.cmX9.4m cmx9.4m Clinipore paper surgical tape EHU027 EHU028 2.cmXm cmxm Tapes and fixation Steri-strip EIR02 EIR0 EIR03 EIR04 EIR0 6X38mm X 6 3X7mm X 6X7mm X 3 6X0mm X 2X0mm X Hypafix fabric adhesive tape (non-sterile) EHR033 EHR034 EHR049 EHR030 EHR EHR3 EHR03 cmxm cmxm cmxm 2.cmXm cmxm cmxm cmxm ` Antimicrobial dressings Inadine EKB0 EKB02 Xcm 9.X9.cm Medihoney 0% ELZ08 20g CG TV/Wound Formulary Review date: August 208 2

14 Super absorbent Adhesive remover Wound cleansing Zetuvit E range Eclipse non adherent sterile Appeel EJA02 EJA026 EJA027 EJA028 EJE032 EJE030 EXC029 GCF99 Xcm X20cm 20X20cm 20X40cm Xcm 20X30cm wipes 0ml each Normasol MRB38 2ml Irripods MRB742 20ml Wound Manager bags Pressure redistributin g support aid Oakmed Kerrapro 0x2.x0.3 GCE06 GCE062 GCE979 GCE986 GCE987 GCE708 GCE72 GCE709 GCE73 GCE989 GCE990 GCE998 GCE999 GCE707 GCE7 0ml/up to 0mm (M) 300ml / up to 0mm (L) drainable / up to 4mm (inc 3 sitting plates) 90X80mm (XS) 90X80mm (XS) with access port 8X20mm (M) (vertical wounds) 8X20mm (M) (vertical wounds) with access port 60X200mm (vertical wounds) 60X200mm (vertical wounds) with access port 60X260mm (L) (vertical wounds) 60X260mm (L) (vertical wounds) with access port 230X380mm (XL) 230X380mm (XL) with access port 240Xmm (S) (horizontal wounds) 240Xmm (S) (horizontal wounds) with access port FES99 0X2.X0.3cm CG TV/Wound Formulary Review date: August 208

15 AVAILABLE VIA PHARMACY, START UP STOCK FROM TV OFFICE, SPECIALIST AREAS Prescription only Pharmacy and 2nd line specialist products Ward stock items only in those areas specified Generic name Product Indication for use Advised use Adhesive foams nonadhesive foams Anti-microbials Allevyn Gentle bordered range Mepilex Polymem non adhesive Aquacel Ag + Ribbon Aquacel Ag + extra Suprasorb A + Ag MOIST/WET PRIMARY OR SECONDARY DRESSING MOIST/WET, PRIMARY OR SECONDARY DRESSING MOIST/WET SHALLOW GRANULATION OR BURNS INFECTED WET/MOIST SINUS / NARROW INFECTED WET/MOIST SUPERFICIAL OR DEEPER CRATERS INFECTED WET/MOIST SUPERFICIAL OR DEEPER CRATERS NHS supplies 2nd line Paediatrics Only Radiotherapy st line anti-microbial, Aquafiber st line anti-microbial, Aquafiber st line antimicrobial, Alginate TVN Pharmacy Description and usage Soft silicone gel adhesive to minimise trauma at dressing change for fragile sensitive skin. Showerproof backing, conformable and moisture balance foam SAFETAC TECHNOLOGY absorbent foam which minimises maceration reduces trauma on removal from fragile or sensitive skin Can be repositioned after skin assessment if no exudate. This foam contains a cleansing agent, expands to fill the wound bed, wicks away exudate at high levels but will remain moist even when exudate is low. This action soothes and reduces trauma to the wound bed when its removed. Ideal for burns where nerve ending are exposed Hydrofiber* technology is a soft absorbent material that gels on contact with exudate. "Extra*" is stitched for additional strength and has a higher absorbency thus improving wear time. Ag+ has the addition of non-ionic silver and biofilm disrupting agents, effective on a broad spectrum of bacteria. Hydrofiber* technology is a soft absorbent material that gels on contact with exudate. "Extra*" is stitched for additional strength and has a higher absorbency thus improving wear time. Ag+ has the addition of non-ionic silver and biofilm disrupting agents, effective on a broad spectrum of bacteria. Antimicrobial Calcium Alginate, highly absorbent dressing effective on a broad spectrum of bacteria, to be used if there is a reaction to hydrofiber. CG TV/Wound Formulary Review date: August 208 4

16 Anti-microbials Medihoney Apinate Flamazine (Silver sulphadiazine) Anabact ointment INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT INFECTED MOIST SUPERFICIAL DEPTH INFECTED MOIST SUPERFICIAL DEPTH 2nd line Honey st line antimicrobial cream request/ Oncology Honey impregnated alginate dressing appears stiff if the dressing is cool it can be warmed whilst in the packet to improve its malleability Broad spectrum antimicrobial cream particularly effective against gram-negative organisms such as Pseudomonas. Should be applied directly on to effected areas with a secondary dressing such as Atrauman. There may be black staining of underlying structures from the cream not to be mistaken for necrosis Reduces odour by effectively killing anaerobic bacteria, should be used in conjunction with appropriate debridement where possible. Flaminal hydro Flaminal Forte INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT Plastics/ Plastics/ Hydrated alginates with an embedded anti-bacterial enzyme system, for low exuding wounds. Can be used in cavities were packing is an issue. Removed with irrigation. TIP if the gel appears too liquid the wound is too wet and should be changed for Forte. Higher concentration of alginates for higher volumes of exudate. Can be used in cavities were packing is an issue. Removed with irrigation. TIP This is alginate and will help prevent maceration white flakes can appear at the margins however, if they appear in the centre of the wound it is to dry and should be changed for Hydro CG TV/Wound Formulary Review date: August 208

17 Anti-microbials Non Adherents with silicone Not advised for general use Prontosan irrigation Prontosan Gel Cutimed Sorbact Silflex Adaptic touch Jelonet CONTAMINATED ALL WOUND TYPES AND DEPTH CONTAMINATED ALL WOUND TYPES AND DEPTH INFECTED SUPERFICIAL TO FULL THICKNESS MOIST OR WET PROTECTIVE, REDUCED ADHESION, NON ABSORBENT DRESSING, SUPERFICIAL PROTECTIVE, REDUCED ADHESION, NON ABSORBENT DRESSING, SUPERFICIAL PROTECTIVE REDUCED ADHESION, NON ABSORBENT DRESSING, SUPERFICIAL st line cleanser specialist st line cleansing gel. specialist / Dermatology 2nd line specialist areas only areas only unmask on request Consultant request/ theatres and out patients Wound irrigation solution contains PHMB (Polyhexamethylene biguanide) which inhibits the growth of microorganisms and a surfactant (betaine) which is a surface activated cleanser this disrupts biofilms and debrides the wound surface. Can be used in conjunction with KCI Veraflow Negative Pressure Wound Therapy as an irrigation fluid. Wound gel contains PHMB (Polyhexamethylene biguanide) which inhibits the growth of microorganisms and a surfactant (betaine) which is a surface activated cleanser this disrupts biofilms and debrides the wound surface. This hydrophobic dressing attracts bacteria and fungi where they become irreversibly bound to it. As there is no donation to the wound the bed this dressing is safe for use on all ages and has little known side effects. NOT FOR USE ON DRY Soft silicone wound contact layer, more conformable, won't adhere to moist wound bed allows exudate to pass through it so it does require a secondary dressing. Top tip is to wet your gloves before application. Non-Adhering silicone dressing, highly conformable, mesh prevents pooling and maceration. This can be used as a wound contact layer under Negative Pressure Wound Therapy where delicate structures need protection. Soft paraffin coated dressing with wide weave, requires a secondary dressing. DO NOT ALLOW TO DRY OUT. This dressing will adhere to the wound bed if it comes dry allowing granulation tissue to migrate through the weave. If this occurs removal can be traumatic 6 CG TV/Wound Formulary Review date: August 208

18 Films Hydrogel wafers Pastes and creams Opsite large sheets C View Hydrosorb/ Hydrosorb comfort Granuflex paste Zip Zoc/ Viscopaste zinc bandages Medihoney barrier cream USED IN THEATRES FOR RETENTION CLEAR STRONG FILM DRY-MODERATELY EXUDING, SHALLOW ALL WOUND BED TYPES DRY-MODERATELY EXUDING SHALLOW DEPTH NON-INFECTED SUPERFICIAL SKIN BREAKS AND ECZEMA APPLY TO AREAS OF BROKEN SKIN CAUSED BY EXCORIATION Theatres Unmasked on request for 2 nd line use Request Hydrocolloid paste Stoma care Dermatology request Large sizes available to Theatres for securing dressings post operatively Clear film slightly thicker than st line product Hydrosorb has a film backing which helps maintain its integrity. The gel will donate and absorb fluid as necessary to maintain a moist wound environment, reducing the risk of maceration. At the same time it acts to debride necrosis or slough. Cool soothing feel particularly good on shallow abrasion or burns where the nerve endings are exposed. Hydrocolloid paste used to dress minor abrasion/wounds under stoma plates where there is slough or necrotic tissue present. Zinc impregnated stockings and bandages for the treatment/management of chronic eczema/dermatitis in patients with known venous insufficiency this is an adjunct to compression bandaging A barrier cream with active Medihoney to reduce irritation and inflammation caused by incontinence and diarrhoea. Trimovate cream SECONDARY INFECTION OF SUPERFICIAL SKIN BREAKS request Trimovate has 3 active ingredients, clobetasone butyrate (steroid), oxytetracycline (antibiotic) and nystatin (antifungal) and is used to treat inflamed skin conditions that are or may become infected with bacteria or candida species of fungi. NOT FOR LONG TERM USE OR FOR PRIMARY INFECTIONS 7 CG TV/Wound Formulary Review date: August 208

19 ONLY TO BE APPLIED FOLLOWING FULL ASSESSMENT AND UNDER THE MANAGEMENT OF A CONSULTANT OR SPECIALIST NURSE Compression Actico Adhesive K-lite K-plus K-plus long Coban 2 COMPRESSION LIGHT SUPPORT OR PART OF COMPRESSION COMPRESSION COMPRESSION COMPRESSION Lymphoedema/ Dermatology/ Vascular clinics Lymphoedema/ Dermatology/ Vascular clinics Lymphoedema/ Dermatology/ Vascular clinics Lymphoedema/ Dermatology/ Vascular clinics 2 layer Lymphoedema/ Dermatology/ Vascular clinics Cohesive inelastic compression bandage, suitable for all patients requiring compression with or without oedema, applied on full stretch to the lower leg or arm. Provides type 2 light support for sprains and strains and to prevent / reduce oedema. This bandage is also used as a component of four layer compression Provides type 3 light compression. ONLY FOR PATIENTS WITH NO ARTERIAL INSUFFICIENCY (ABPI equal to or greater than 0.8) for use as part of four layer compression Provides type 3 light compression, for longer legs ONLY FOR PATIENTS WITH NO ARTERIAL INSUFFICIENCY (ABPI equal to or greater than 0.8) for use as part of four layer compression 2 Layer compression system for those with an ABPI equal to / greater than 0.8 ONLY FOR PATIENTS WITH NO ARTERIAL INSUFFICIENCY Coban 2 lite COMPRESSION 2 layer Lymphoedema/ Dermatology/V ascular clinics 2 Layer compression system for mixed aetiology leg ulcers (ABPI greater than or equal to 0.) or for those how cannot tolerate full compression Urgo Ktwo COMPRESSION 2 layer Lymphoedema/ Dermatology/ Vascular clinics 2 Layer compression system for those with an ABPI equal to / greater than 0.8 ONLY FOR PATIENTS WITH NO ARTERIAL INSUFFICIENCY Rosidal K Juxta CURES COMPRESSION COMPRESSION Lymphoedema/ Dermatology/ Vascular clinics Lymphoedema/ Dermatology/ Vascular clinics Short stretch compression bandage gives powerful compression ONLY FOR PATIENTS WITH NO ARTERIAL INSUFFICIENCY for those with an ABPI equal to / greater than 0.8 An adjustable wrap-around compression system, ideal for patients who can selfmanage 8 CG TV/Wound Formulary Review date: August 208

20 Compression Actiwrap Comrilian COMPRESSION COMPRESSION Lymphoedema/ Dermatology/ Vascular clinics Lymphoedema/ Dermatology/ Vascular clinics Cohesive bandage 0% cotton short stretch bandage used in the management of lymphoedema 9 CG TV/Wound Formulary Review date: August 208

21 Pharmacy and Areas Only Prescription only and 2 nd line specialist products. (Ward stock only in those areas specified) Generic name Product Code Size Amount (box) Price (box) Per item Adhesive foams Allevyn Gentle bordered range ELA39 ELA36 ELA499 7.cmX7.cm 2.X2.cm X20cm Mepilex EIJ08.X2cm non-adhesive foams Polymem non adhesive ELA32 X6cm Aquacel Ag + Ribbon Aquacel Ag + extra ELY9 ELY8 ELY20 ELY2 ELY22 ELY4 ELY ELY6 ELY7 2cm X 4cm x 4cm 4Xcm 4X20cm 4X30cm Xcm Xcm Xcm 20X30cm Anti-microbials Suprasorb A + Ag ELS446 ELS447 ELS448 ELS449 Xcm Xcm X20cm 30cm/2g Medihoney Apinate EJE076 EJE000 Xcm Xcm Flamazine (Silver sulphadiazine) Prescription only Anabact ointment Prescription only Flaminal hydro ELG02 g Flaminal Forte ELG022 g Prontosan irrigation ELY248 30ml CG TV/Wound Formulary Review date: August

22 Prontosan Gel ELZ23 30ml each Anti-microbials Cutimed Sorbact ELY22 ELY23 ELY24 ELY2 ELY29 ELY28 ELY27 4X6cm (Gauze) 7X9cm (Gauze) 7X9cm (Absorbant Pad) Xcm (Absorbant pad) X20cm (Absorbant pad) 2X0cm (Ribbon Gauze) X200cm (Ribbon Gauze) Non Adherents with silicone Silflex EKH028 EKH029 EKH030 EKH032 X7cm 8Xcm 2Xcm 20X30cm Adaptic touch ELY360 ELY3 ELY36 ELY362 X7.6cm 7.6Xcm 2.7Xcm 20X32cm Not advised for general use Jelonet EKA009 EKA0 EKA03 EKA04 Xcm Xcm X40cm cmx2m (Roll) Opsite large sheets Theatres only specialist order Film C View ELW09 ELW094 ELW84 6X7cm x2cm x2cm Hydrogel wafers Hydrosorb/ Hydrosorb comfort ELE072 ELE02 ELE028 ELE074 ELE06 ELE04 X7.cm Xcm 20X20cm 4.X6.cm (Adhesive) 7.Xcm (Adhesive) 2.X2.cm (Adhesive) Pastes and creams Granuflex paste ELO03 30g each Zip Zoc/Viscopaste zinc bandages EFA006 EFA0 7X3Xcm 7.cmX6m CG TV/Wound Formulary Review date: August 208 2

23 Medihoney barrier cream ELY374 ELY289 2g 0g Trimovate cream Prescription only ONLY TO BE APPLIED FOLLOWING FULL ASSESSMENT AND UNDER THE MANAGEMENT OF A CONSULTANT OR SPECIALIST NURSE Compression Actico Adhesive EBA030 EBA03 EBA032 EBA06 EBA033 4cmX6m 6cmX6m 8cmX6m cmx6m 2cmX6m K-lite ECA084 ECA086 ECA0 ECA9 ECA73 cmx4.m 7cmX4.m cmx4.m cmx4.m cmx.2m K-plus ECA62 cmx8.7m K-plus long ECA72 cmx.2m Coban 2 ECA36 One Size.. Coban 2 lite ECA203 cmx2.7m Compression Urgo Ktwo ECA ECA2 ECA64 Size 0 8-2cm Ankle Circumference 2-32cm Ankle Circumference Rosidal K EBA07 EBA08 EBA040 EBA09 6cmXm 8cmXm cmxm 2cmXm Juxta CURES EGD728 EGD729 EGD7220 EGD722 EGD7222 EDG7223 Short Standard Long (Liner - Pair) Standard (Pair) Large (Pair) CG TV/Wound Formulary Review date: August 208

24 Actiwrap ECD032 ECD033 ECD034 6cmX4m 8cmX4m cmx4m Comrilian areas only - not on supply chain CG TV/Wound Formulary Review date: August

25 TISSUE VIABILITY OFFICE MONDAY-FRIDAY HRS dressings, start-up antimicrobials whilst awaiting pharmacy orders. Ward stock for T&O and Plastics / Hands clinics Generic name Anti-microbials Product Acticoat flex 3 Cutimed Sorbact Medihoney wound gel Iodaflex Flaminal hydro Flaminal forte Indication for use INFECTED SUPERFICIAL TO FULL THICKNESS MOIST OR WET INFECTED SUPERFICIAL TO FULL THICKNESS MOIST OR WET INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT INFECTED SUPERFICIAL TO FULL THICKNESS INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT INFECTED SUPERFICIAL TO FULL THICKNESS ANTIMICROBIAL DEBRIDEMENT AGENT / Dermatology CG TV/Wound Formulary Review date: August NHS supplies TVN Pharmacy Description and usage Effective on a broad spectrum of bacteria for 3 days, rapid kill time, flexible and comfortable. However not for use on patients allergic to silver. Due to its active wear time it can be used under Negative Pressure Wound Therapy. IF THE WOUND IS DRY ACTIVATE THE DRESSING WITH WATER NOT SALINE This hydrophobic dressing attracts bacteria and fungi where they become irreversibly bound to it. As there is no donation to the wound the bed this dressing is safe for use on all ages and has little known side effects. NOT FOR USE ON DRY Contains 70% manuka honey with natural plant waxes to enable it to keep its shape and stay in place better Contains Iodine acts as an antimicrobial and desloughing agent ideal for chronic exuding wounds such as sinus tracks Hydrated alginates with an embedded anti-bacterial enzyme system, for low exuding wounds. Can be used in cavities where packing is an issue. Removed with irrigation. TIP if the gel is too liquid it is too wet and should be changed for Forte, white flakes appear at the margins this is alginate and will help prevent maceration. Higher concentration of alginates for higher volumes of exudate. Can be used in cavities where packing is an issue. Removed with irrigation. TIP This is alginate and will help prevent maceration. White flakes can appear at the margins however, if they appear in the centre of the wound it is to dry and should be changed for Hydro

26 Anti-microbials Films Aquacel Ag + extra x Aquacel Ag + Ribbon Prontosan irrigation Prontosan Gel Tegaderm Diamond INFECTED WET/MOIST SUPERFICIAL OR DEEPER CRATERS INFECTED WET/MOIST SINUS WOUND NARROW CONTAMINATE D ALL WOUND TYPES AND DEPTH CONTAMINATE D ALL WOUND TYPES AND DEPTH PROTECTION OF SUPERFICAL AREA, SECONDARY DRESSING FOR SECURING OTHER DRESSINGS st line antimicrobial, Aquafiber st line antimicrobial, Aquafiber st line cleanser specialist st line cleansing gel. specialist individual patients Hydrofiber* technology is a soft absorbent material that gels on contact with exudate. "Extra*" is stitched for additional strength and has a higher absorbency thus improving wear time. Ag+ has the addition of non-ionic silver and biofilm disrupting agents, effective on a broad spectrum of bacteria. REQUIRES A SILVER PROFORMA Hydrofiber* technology is a soft absorbent material that gels on contact with exudate. "Extra*" is stitched for additional strength and has a higher absorbency thus improving wear time. Ag+ has the addition of non-ionic silver and biofilm disrupting agents, effective on a broad spectrum of bacteria. REQUIRES A SILVER PROFORMA Wound irrigation solution contains PHMB (Polyhexamethylene biguanide) which inhibits the growth of microorganisms and a surfactant (betaine) which is a surface activated cleanser this disrupts biofilms and debrides the wound surface. Can be used in conjunction with KCI Veraflow Negative Pressure Wound Therapy as an irrigation fluid. Wound gel contains PHMB (Polyhexamethylene biguanide) which inhibits the growth of microorganisms and a surfactant (betaine) which is a surface activated cleanser this disrupts biofilms and debrides the wound surface. Promotes moisture evaporation and improves fixation. Effective barrier against bacterial and viral contamination. Used for the protection of invasive intravenous cannula 2 CG TV/Wound Formulary Review date: August 208

27 Allevyn Sacrum MOIST/WET PRIMARY OR SECONDARY DRESSING. individual patients Large shaped Allevyn Classic, conformable, absorbent foam dressing which acts as an effective barrier to exogenous bacteria. A breathable top film minimises maceration. Used as a primary dressing on shallow wounds or as a secondary dressing in conjunction with packing. Foam adhesive Debridement pad Rapid capillary dressings Cutimed Siltec nonadhesive Superabsorbents Cutimed Siltec L Debrisoft Advadraw Eclypse boots Sorbion Sachet border Sorbion sachets WET TO VERY WET PRIMARY OR SECONDARY DRESSING MOIST/WET PRIMARY OR SECONDARY DRESSING. Debridement tool MOIST TO WET SUPERFICIAL TO DEEP SINUS CAVITIES WET TO VERY WET PRIMARY OR SECONDARY DRESSING WET TO VERY WET PRIMARY OR SECONDARY DRESSING WET TO VERY WET PRIMARY OR SECONDARY DRESSING only only only only only unmaking only only Non-adhesive highly absorbent foam with superabsorbent particles, perforated silicone wound contact layer for pain free removal. For heavily exuding wounds. Can be used on sloughy or granular wound beds Absorbent foam with superabsorbent particles, perforated silicone wound contact layer for pain free removal. For moderately exuding wounds. Can be used on granulating or epithelialising wound beds Removes wound debris, necrotic material, slough and exudate and long standing hyperkeratosis. Rapid wick action, ideal for sumping cavities where the integrity of the dressing is important. Large superabsorbent leg wrap for highly exuding lower limbs Non-adhesive superabsorbent dressing with an adhesive border. Rapidly absorbs and locks away exudate, maintains a moist wound environment. Ideal areas where bulky dressings are difficult to keep in place i.e. groins. Non-adhesive superabsorbent dressing. Rapidly absorbs and locks away exudate, maintains a moist wound environment. Ideal areas where bulky dressings are difficult to keep in place i.e. groins. 26 CG TV/Wound Formulary Review date: August 208

28 Negative Pressure consumables Pressure redistributing support aid PICO Negative Pressure Wound Therapy Dressings Foam and gauze kits Kerrapro larger sheets and sacrums SPECIALIST ASSESSMENT REQUIRED OR CONSULTANT SPECIALIST ASSESSMENT REQUIRED OR CONSULTANT PRESSURE REDUCING PAD TV, Hand clinic, orthopaedics TV, Hand clinic, orthopaedics / individual patients For shallow wounds no more than 2cm deep without packing. Ideal for post-surgical procedures where there is a high risk of dehiscence due to co-morbidities. NOT FOR USE ON BLEEDING OR HIGHLY EXUDING Renasys foam or gauze kits available with soft ports or with flat and channel drains. KCI- Ulta with Abthera for use in theatres (open abdo only) Foam or gauze with trac pad and Veraflow which is used for the cleansing of deep cavity wounds with infected tissue or prosthesis Larger shapes and sheets of this gel. Only for use on intact skin to protect it from friction and shearing or over high pressure contact areas to spread the load NOT A SUBSTITUTE FOR REPOSITIONING 27 CG TV/Wound Formulary Review date: August 208

29 dressings from TV Office Monday to Friday hrs dressings start up antimicrobials whilst awaiting pharmacy orders. Ward stock for T&O and Plastics / Hands clinics Generic name Product Code Size Acticoat flex 3 Cutimed Sorbact ELY29 ELY292 ELY293 ELY22 ELY23 ELY24 ELY2 ELY29 ELY28 ELY27 xcm x cm x20 cm 4X6cm (Gauze) 7X9cm (Gauze) 7X9cm (Absorbent Pad) Xcm (Absorbent Pad) X20cm (Absorbent Pad) 2X0cm ( Ribbon Gauze) X200cm (Ribbon Gauze) Amount per box Price (box) Per unit Antimicrobials Films Foam adhesive Medihoney wound gel Iodaflex Flaminal hydro Flaminal forte Aquacel Ag + extra x Aquacel Ag + Ribbon Prontosan irrigation Prontosan Gel Tegaderm Diamond Allevyn Sacrum Cutimed Siltec nonadhesive ELZ03 g EKB007 EKB008 g g ELG02 g ELG022 g ELY20 ELY2 ELY22 ELY4 ELY ELY6 ELY7 ELY9 ELY8 ELY248 ELY67 4Xcm 4X20cm 4X30cm Xcm Xcm Xcm 20X30cm 2gx4cm X4CM 30ml 00ml + adaptor ELZ23 30ml each ELW398 xcm ELS046 ELA28 ELA446 ELA447 7x7cm 22x22cm x6cm x CG TV/Wound Formulary Review date: August 208

30 Foam adhesive Debridement pad Rapid capillary dressings Superabsorbents Negative Pressure consumables Cutimed Siltec L Debrisoft Advadraw Eclypse boots Sorbion Sachet border Sorbion sachets PICO Negative Pressure Wound Therapy Dressings Foam and gauze kits ELA439 ELA440 x6cm x ELZ34 x ELY7 ELY98 EJE08 EME042 EJE EME3 EJE2 EJE6 EJE7 x 0.x40 47xcm 60x70cm xcm (.x.) xcm (8.x8.) x drain x cm x20cm order only order only Pressure redistributing support aid Kerrapro larger sheets and sacrums FES99 FES99 FES994 FES99 Sacrum Heel 30xx0.3cm 0x2.x0.3 each CG TV/Wound Formulary Review date: August 208