dressings formulary 2nd edition june 2013 to june 2015 final v6 · 2013. 9. 6. · dressings...

Dressings Formulary, 2nd

edition 2013. Review date: June 2015 of 22

Dressings Formulary

Date of issue: June 2013

Review date: June 2015



Introduction This formulary is based on the CREST Guidelines for Wound Management, 1998 and the NHSSB Wound Care Formulary, January 2004 and was originally developed by a sub-group of community and primary care based professionals involved in wound care. The group included Tissue Viability Nurse Specialists, Podiatrists, Community Nurses and Primary Care Prescribing Advisers. A full review of this formulary was undertaken in March 2013 and shared with stakeholders covering community, primary and secondary care in Coastal West Sussex. Primary care practitioners should note that these guidelines do not replace clinical judgement. There may be some occasions when you consider a non-formulary dressing may be appropriate, this however should not be the norm. Feedback on the formulary The group who developed this formulary is keen to have your feedback and would genuinely welcome any comments you may have. If there are products you feel should be considered for inclusion when the guidelines are next reviewed, please send them at any time, along with associated evidence-based literature supporting the product(s) to one of the Tissue Viability Specialists listed below: Sara Fentiman (North) [email protected]

Louise Scarborough (South East) [email protected]

Sally Jenkins (North) [email protected]

Pauline Stevens (North) [email protected]

Jane Saunders (South West) [email protected]

Gill Walford (North) [email protected]

Electronic copies of the formulary These are available on the CWS GP website at: http://www.coastalwestsussexccg.nhs.uk/formulary Disclaimer The information contained within is intended for use by healthcare professionals within Coastal West Sussex. We have made every effort to check that the information is correct at the time of publication. Coastal West Sussex does not accept any responsibility for loss or damage caused by reliance on this information. Please read dressing instructions before use. All costs taken from March 2013 Drug Tariff.



A GUIDE TO WOUND MANAGEMENT Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004

DESCRIPTION OF WOUND TREATMENT OBJECTIVES EXUDATE LEVEL

None – Low EXUDATE LEVEL Moderate to High

Necrotic

Dead/ischaemic tissue, e.g. eschar and slough. In wound care this term tends to be used to describe dead tissue which is black/brown in colour. NB: Keep necrotic toes and heels dry.

Hydration of eschar, debridement and management of exudate. Be aware of vascular status before any form of debridement is considered on lower limb.

Hydrogel (p 6) and Semi-Permeable Film (p 8)

(not to be used on diabetic or ischaemic feet)

OR Low/Non Adherent Dressing (p 8)

OR Hydrocolloid (p 6)

(not to be used on diabetic or ischaemic feet)

Seek podiatry/surgical opinion for necrotic digits.

Alginate (p 6) OR

Hydrofibre (p 6) with secondary absorbent dressing (p 7)

Treat underlying cause of exudate.

Seek podiatry/surgical opinion

for necrotic digits.

Slough

Dead tissue. N.B. Yellow tissue may be tendon or bone.

Debridement and management of exudate.

Hydrogel (p 6) and Semi-Permeable Film (p 8) /Low/Non

Adherent Dressing (p 8) OR

Hydrocolloid (p 6)

Alginate (p 6) OR

Hydrofibre (p 6) with secondary absorbent dressing (p 7)


Granulating

Process by which the wound is filled with highly vascular fragile connective tissue. Red in colour.

Keep warm and moist. Manage exudate. Protect/promote granulation.

Low/Non Adherent Dressing (p 8) OR

Hydrocolloid (p 6)

Alginate (p 6) OR

Hydrofibre (p 6) with secondary absorbent dressing e.g. Foam (p 7)

OR Absorbent Dressing Pad





A GUIDE TO WOUND MANAGEMENT (continued)

DESCRIPTION OF WOUND TREATMENT OBJECTIVES EXUDATE LEVEL

None – Low EXUDATE LEVEL Moderate to High

Epithelialising

Process by which the wound is covered with new skin cells. Tissue will be pink in colour.

Keep warm and moist. Manage exudate. Protect from further damage.

Low/Non Adherent Dressing (p 8) OR

Hydrocolloid (p 6)

Alginate (p 6) OR

Hydrofibre (p 6) with secondary absorbent dressing or Foam (p 7)



Cavity

A loss of continuity of the skin or mucous membrane with associated tissue loss (epidermal covering) and which involves the dermal layer of the skin.

Allow to granulate from bottom up.

If sloughy debride. Manage exudate. Do not overpack cavity wounds as this delays healing.

Hydrogel (p 6) and semi permeable film (p 8)

Alginate (p 6) OR

Hydrofibre (p 6) with secondary absorbent (p 7) or foam dressing


Macerated skin

A softening or sogginess of surrounding tissue.

Check if present dressing regime is absorbing the exudate.

Protect with a barrier ointment e.g. liquid/white soft paraffin mix. Barrier film applicator.

Macerated skin does not tend to occur in non- or low exuding

wounds unless the dressing has been left in place too long!

Alginate (p 6) OR

Hydrofibre (p 6) and secondary absorbent dressing (p 7)

Treat underlying cause of exudate. Consider more frequent dressing

changes.

Infected

Occurs when organisms in the wound evoke a reaction from the host, i.e. antigen-antibody response.

To free patient from infection, pain and discomfort. To promote wound healing.

See management information below (p 5)



INFECTED WOUNDS Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004

Signs of infection: Pus, exudate increasing, pyrexia >38°C, heat (new or increasing), redness (new or increasing), swelling (new or increasing), tenderness or pain (new or increasing), wound deterioration. Systemic antibiotics and swabs for bacteriology ONLY indicated for INFECTION (i.e. two or more from list above are present). In immunocompromised patients e.g. with diabetes, one or more from list above. Presence of bacteria in a wound alone does not indicate that it is infected. Clinical signs of infection indicate the presence of pathogenic organisms and justify the need for wound swabbing. If a wound swab is required, clean the wound first by irrigating with sterile normal saline to remove surface contamination and debris. Moisten the swab with sterile normal saline or sterile water if the wound surface is dry. Using a zigzag motion and simultaneously rotating the swab between the fingers, sample the whole wound surface, avoiding the surrounding tissue.1

FIRST LINE : IODINE Only use if infection or overload of bacteria is suspected Not recommended: • For prophylaxis or routine use in chronic wounds • During pregnancy/lactation • As a standard non-adherent dressing if there is NO infection Caution: • Monitor thyroid function in patients with known thyroid disease • Contra-indicated in patients on lithium Do: • Change dressing when distinctive orange-brown changes to white • Use for maximum of 3 days

Iodoflex 5g, 10g, 17g (use for wounds with increased exudate level)

OR Iodosorb ointment 10g

OR Povidone-Iodine dressing (Inadine®)

OTHER OPTIONS:

• SILVER2,3 Contained within the “specials list” in this formulary (p 13). Dressings containing silver should only be used when infection is suspected as a result of clinical signs and symptoms. They should not be used on acute wounds or routinely for the management of uncomplicated ulcers (as there is some evidence that they delay healing). Prescriptions for silver dressings should not be written unless documentary evidence of individual patient recommendation by a senior nurse or podiatrist. All prescribing of silver dressings will be closely monitored and audited. Aquacel Ag: 5cm x 5cm, 10cm x 10cm Aquacel Ag Ribbon: 1cm x 45cm, 2cm x 45cm • HONEY Contained within the “specials list” in this formulary (p 13). Activon-tulle: 5cm x 5cm, 10cm x 10cm

Where infection is suspected: • Adhere to general infection control precautions • Swab wound for ‘organisms and sensitivities’ and record all

appropriate information on microbiology form. • Use appropriate SYSTEMIC ANTIBIOTICS • Ensure the prescribed antibiotic is appropriate to the pathogen

identified. • Avoid occlusive dressing if anaerobic bacteria are suspected • Dress infected wounds as appropriate • Choose wound dressing according to type of tissue on wound bed

and level of exudate • Review antimicrobial dressings use after two weeks.



PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Alginate Cavity Do not pack tightly into wound Change every 2-3 days If infected change as appropriate

Sorbsan packing ribbon (with probe) (1st line) Kaltostat packing rope (2nd line)

40cm 2g

£2.04

£3.73

Alginate Kaltostat has haemostatic properties – reduces bleeding in 10 minutes Cut to size of wound Irrigate wound to remove

Sorbsan flat (1st line) Kaltostat flat (2nd line)

5cm x 5cm 10cm x 10cm 10cm x 20cm 5cm x 5cm 7.5cm x 12cm

£0.81 £1.71 £3.20 £0.93 £2.03

Hydrogels Not recommended for heavily exudating wounds. Contra-indicated in anaerobic infection. Not to be used in ischaemic feet.

Intrasite conformable

Aquaform hydrogel

Intrasite gel

10cm x 10cm (7.5g)

8g

8g

£1.76

£1.64

£1.76 Hydrocolloids Occlusive dressing. Overlap wound by at least 2cm. Can be left in place for up to 7 days. Avoid in wounds with anaerobic infection and diabetic feet unless under specialist advice. Not to be used in ischaemic feet.

Minimal exudate: Duoderm Extra Thin Light exudate: Comfeel Plus

7.5cm x 7.5cm 10cm x 10cm 5cm x 7cm 10cm x 10cm

£0.78 £1.29 £0.65 £1.24

Hydrofibre/cellulose dressings No lateral wicking Overlap wound by 1cm Can be left in place for up to 7 days

Aquacel flat Durafiber (cellulose based) For highly exuding wounds only: Aquacel Extra Aquacel ribbon

5cm x 5cm 10cm x 10cm 15cm x 15cm 5cm x 5cm 10cm x 10cm 15cm x 15cm 5cm x 5cm 10cm x 10cm 15cm x 15cm 1cm x 45cm 2cm x 45cm

£0.99 £2.36 £4.44 £0.88 £2.10 £3.95

£0.99 £2.36 £4.44 £1.79 £2.39



PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Foams Change when lateral strike through occurs. Can be left in place for up to 7 days.

Biatain non adhesive

Biatain adhesive

Biatain soft hold

Biatain sacral adhesive

Biatain heel dressing

Allevyn non adhesive

Allevyn adhesive

Allevyn gentle

Allevyn gentle border

Allevyn sacral

Tegaderm heel

5cm x7cm 10cm x 10cm 15cm x 15cm 10cm x 20cm

10cm x 10cm 12.5cm x 12.5cm 18cm x 28cm

10cm x 10cm 10cm x 20cm 15cm x 15cm

23cm x 23cm

19cm x 20cm


7.5cm x 7.5cm 10cm x 10cm 12.5cm x 12.5cm 12.5cm x 22.5cm

5cm x 5cm 10cm x 10cm 15cm x 15cm 10cm x 20cm

7.5cm x 7.5cm 10cm x 10cm 12.5cm x 12.5cm

17cm x 17cm 22cm x 22cm

13.9cm x 13.9cm

£1.28 £2.32 £4.27 £3.83

£1.71 £2.49 £7.45

£2.52 £3.83 £4.19

£4.31

£5.03

£1.23 £2.44 £3.92

£1.46 £2.41 £2.62 £4.07

£1.23 £2.44 £4.10 £3.93

£1.56 £2.14 £2.61

£3.87 £5.57

£4.10



PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Films Stretch film parallel to skin to release adhesive and prevent trauma to skin on removal

Tegaderm (1st line)

Opsite Flexigrid (2nd line)

Opsite Plus (with absorbent pad)

Tegaderm IV IV3000



6.5cm x 5cm 8.5cm x 9.5cm

10cm x 15.5cm 10cm x 12cm

£0.38 £1.09 £2.37

£0.39 £1.10 £2.78

£0.31 £0.86

£1.62 £1.36

Low/Non Adherence A secondary dressing – avoid if possible by using adherent dressings, e.g. Biatain adhesive. Where this is not possible due to skin problems or frequency of dressing changes, use to secure the wound contact layer in place and absorb wound exudates

N-A Ultra (1st line)

Atrauman (2nd line)

Profore Wound Contact Layer (non-silicone dressing)

9.5cm x 9.5cm 19cm x 9.5cm

5cm x 5cm 7.5cm x 10cm 10cm x 20cm 20cm x 30cm

14cm x 20cm

£0.33 £0.63

£0.26 £0.27 £0.61 £1.67

£0.31

Odour absorbing Charcoal dressing: Change daily in clinically infected wounds. Change when malodour is noted. Caboflex is indicated as a primary dressing for shallow wounds or as a secondary dressing over a wound filler for deeper wounds. Metronidazole gel (3rd line - see specials list p13 - for anaerobic infection)

CliniSorb (1st line) Carboflex (2nd line)

10cm x 10cm 10cm x 20cm 15cm x 25cm 8cm x 15cm 10cm x 10cm

£1.84 £2.45 £3.95 £3.74 £3.12

Povidone Iodine See notes in infection section. N.B. Inadine dressings – the antimicrobial effect from one dressing may not last long enough and may require up to four layers of dressings. Best to use Iodosorb (ointment) or Iodoflex (paste) and cover with N-A Ultra so iodine can stay on wound for longer (up to 3 days).

Iodoflex (1st line) Iodosorb ointment (1st line) Inadine (Only to be used on toes)

5g 10g 17g 10g 5cm x 5cm 9.5cm x 9.5cm

£3.96 £7.91

£12.53 £4.37

£0.33 £0.49



MISCELLANEOUS PRODUCTS DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Absorbent cellulose dressing (sterile) Primary or secondary dressing for medium to heavily exuding wounds

Zetuvit E (1st line) Zetuvit Plus (use if higher absorbency required) Mesorb (for moderate exudate) KerraMaxCare (for very high exudate)

10cm x 10cm 10cm x 20cm 20cm x 20cm 20cm x 40cm 10cm x 10cm 10cm x 20cm 20cm x 25cm 20cm x 40cm 10cm x 10cm 10cm x 20cm 20cm x 25cm 20cm x 30cm 10cm x 10cm 10cm x 22cm 20cm x 22cm 20cm x 30cm

£0.21 £0.24 £0.38 £1.06

£0.61 £0.85 £1.33 £2.04

£0.62 £0.99 £2.22 £2.51

£0.94 £1.25 £2.20 £2.51

Absorbent simple dressing Low adherence dressing

Mepore (1st line) Cosmopore E (2nd line)

7cm x 8cm 10cm x 11cm 11cm x 15cm 9cm x 35cm 5cm x 7.2cm 8cm x 10cm 8cm x 15cm 10cm x 35cm

£0.11 £0.21 £0.36 £0.75

£0.08 £0.17 £0.27 £0.75



MISCELLANEOUS PRODUCTS (continued) Cleansing agent For irrigating ulcers or wounds, but warm tap water is often appropriate (BNF).

Irripod Stericlens spray

25 x 20ml 100mls 240mls

£5.76

£2.03 £3.09

Dressing packs Used to provide a clean or sterile working surface. Contains apron and gauze swabs.

Dressit s/m, m/l

£0.60

Gauze A secondary dressing – see notes above under low/non adherence dressings

Non Sterile Gauze Swabs Type 13 Light BP 1988

10cm x 10cm £1.39 for 100 pads

Tape For securing dressings together. Mefix should be reserved for use when direct application to skin is needed for patients whose skin is frail/likely to tear easily. Good for securing padding to pressure ulcers. The apertured structure allows it to be more extensible and conform to the body.

Scanpor Clinipore Mefix

2.5cm x 5m 5cm x 5m 2.5cm x 5m 5cm x 5m 2.5cm x 5m 5cm x 5m

£0.67 £1.16

£0.59 £0.99

£1.01 £1.79

Barrier preparation

Cavilon barrier foam applicator Cavilon durable cream Proshield plus skin protective (For use on intact or injured skin associated with incontinence. Do not use a dressing over the product)

1ml x 5 28g 92g 115g

£4.88

£3.92 £7.99

£9.50



BANDAGES COMPRESSION (Only health care staff who have undergone the specific training should apply compression bandaging)

PRODUCT NAME SIZE COST/ITEM

Wool (1st layer)

K-soft long Flexi-Ban

10cm x 4.5m 10cm x 3.5m

£0.55 £0.49

Crepe (2nd layer) K-Lite K-Lite long

10cm x 4.5m 10cm x 5.25m

£0.98 £1.13

3rd layer K-Plus 10cm x 8.7m £2.21 4th layer Ko-Flex 10cm x 6m £2.94 Short stretch Actico (cohesive) 10cm x 6m £3.26 Kits

K-Four kit < 18cm ankle 18-25cm ankle 25-30cm ankle > 30cm ankle

£6.97 £6.67 £6.67 £9.18

K-Three (for larger limbs) 10cm x 3m £2.75 K-Two kit 0 (short)

18-25cm 25-32cm (10cm)

£6.66 £7.45 £8.62

K-Two Reduced 18-25cm 24cm-32cm

£7.90 £8.63

OTHER BANDAGING Securing bandages A secondary dressing – see notes above under low/non adherence dressings

K-Band 5cm x 4m 7cm x 4m 10cm x 4m 15cm x 4m

£0.20 £0.25 £0.27 £0.48

Paste bandages Impregnated woven bandage.

Viscopaste PB7 (10%) Steripaste

7.5cm x 6m 7.5cm x 6m

£3.56 £3.24

Elasticated viscose stockinette Lightweight plain-knitted elasticated tubular bandage.

Comfifast blue line large limb Comfifast yellow line

7.5cm x 1m 7.5cm x 5m 10.75cm x 1m 10.75cm x 5m

£0.77 £3.74 £1.20 £6.04



COMPRESSION HOSIERY PRODUCT PRODUCT NAME SIZE COST/ITEM Venous ulcer compression systems treatment stockings N.B. Made-to-measure hosiery should be obtained through your usual route

Activa leg ulcer kit Pack contains 1 stocking and 2 liners - 40mmHg

Small Medium Large Extra large

£22.12 £22.12 £22.12 £22.12

Activa compression liner pack (closed toe) Pack contains 3 liners -10 mmHg

Small Medium Large Extra large Extra extra large

£16.58 £16.58 £16.58 £16.58 £16.58

Elastic hosiery (Activa) Class I

Below knee

£7.21

Elastic hosiery (Activa) Class II

Below knee

£10.54

Acti-glide hosiery applicator For open/closed toe

One size £14.12

Jobst UlcerCARE Pack contains 1 stocking and 2 liners

Small Medium Large

£30.47 £30.47 £30.47

Jobst UlcerCARE compression liner pack. Pack contains 3 liners.

Small Medium Large Extra large

£18.40 £18.40 £18.40 £18.40

Easy-slide stocking applicator Open toe hosiery only

Medium Large

£11.98 £11.98



SPECIALS LIST The products contained in the table below are for specialist use only. Patients must have had a full wound assessment documented. You must know the indications and

contraindications of the products used. Please consult the tissue viability service or senior colleague before use or if you need any further advice.

PRODUCT PRODUCT NAME SIZE COST/ITEM Antimicrobial See notes in infection section (p 5)

Metronidazole 0.75% gel: Silver: Aquacel Ag Aquacel Ag Ribbon Honey: Activon-tulle Irrigation: Prontosan pod Prontosan bottle Prontosan Wound Gel

15g 30g 5cm x 5cm 10cm x 10cm 1cm x 45cm 2cm x 45cm 5cm x 5cm 10cm x 10cm 24 x 40ml 350ml 30ml

£4.47 £7.89 £1.93 £4.59 £3.02 £4.62 £1.78 £2.94

£14.00 £4.66 £6.32

Soft polymer (for patients who cannot tolerate N-A Ultra, Atrauman or Profore)

Urgotul 10cm x 10cm £3.00

Soft silicone Mepitel One

6cm x 7cm 9cm x 10cm

£1.59 £3.19

Compression bandages (training required)

Coban 2 multi-layer compression bandage kit Coban 2 Lite multi-layer compression bandage kit

One size One size

£8.08

£8.08

Topical Negative Pressure dressings: Please note: patients to be referred through TVN service.

Renasys G/P dressing kit with port Renasys Go canister kit PICO

Small Medium Large 300ml with solidifier 10cm x 20cm 10cm x 30cm 15cm x 15cm 15cm x 20cm

£16.93 £21.23 £26.94 £19.43 £122.10 £122.10 £122.10 £122.10

Low Friction Products Aderma Dermal Pad Sheet (fine) Sheet (thick) Strip Heel

10x10x0.3cm 10x10x1.2cm 50x2.5x0.3cm Standard

£4.21 £12.64 £5.27 £14.72



TREATMENT FOR HYPERGRANULATION10,11

Please note: This is a very brief guide; please contact the Tissue Viability Service if further information is needed. Hypergranulation (overgranulation) or proud flesh presents as a raised mass of granulation tissue beyond the height of the wound surface. It can occur in a wide range of wounds such as leg ulcers, pressure ulcers and burns. Hypergranulation can be a problem because it impedes wound healing by preventing the migration of epithelial cells across the wound surface. Causes of hypergranlation Little is known about the causes of hypergranulation. The following factors have been identified as being as possible causes:

• Inflammation: Wound infection, irritants from foreign bodies, friction from external devices such as gastrostomy tubes, allergies and sensitivities.

• Use of occlusive dressings such as hydrocolloids

• Cellular imbalance of some kind Treatment There is no consensus on the best way to manage hypergranulation and often the clinician’s anecdotal experience is used. You must exclude malignancy and infection as a cause. Sometimes a ‘wait and see’ option is helpful and the problem resolves without any interventions. If the cause can be identified, one or more of the following approaches may be helpful:

• For inflammation: Treat any infection, consider removal of irritants, secure external devices, consider use of topical steroids (i.e. fludroxycortide/Haelan® tape to treat the inflammation. Licensed usage of steroids must be checked.

• Occlusive dressings: Change to a more permeable product (i.e. foam dressings), apply moderate pressure to the wound (don’t constrict blood supply).

• Cellular imbalance: If you feel that external factors are the cause, then exclude inflammation and occlusion as above. However, if you feel that internal factors are the cause, then this can be more difficult; seeking further advice may be necessary.

Fludroxycortide / Haelan® 4mcg/cm2 tape 7.5cm x 0.5m = £9.27 7.5cm x 2m = £24.95



FOOT CARE Management of diabetic foot ulcers: These should be referred immediately to the local diabetic foot team. They require specialist intervention as per NICE and NSF guidelines on diabetic management.

• Staff should be aware of local diabetic foot care pathways (see links on page 17) If ulceration is discovered it should be dressed with a foam dressing. Do not use hydrogels or hydrocolloids unless specifically under the guidance of the diabetic foot team or a TVN. For further information on types of diabetic foot ulcers, see link on page 17. Contact details for diabetic podiatric leads in West Sussex: Mark Ashby Tel: (01243) 831614 – Diabetes Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, PO19 6SE Email: [email protected] Alison Hesling Tel: (01903) 205111 ext 5539 – Diabetes Centre, Worthing Hospital Or: (01903) 843625 – Podiatry Department, Littlehampton Health Centre, Fitzalan Road, Littlehampton Email: [email protected] Elizabeth Raja-Rayan (Horsham and Crawley) Tel: (01293) 600300 ext 3234/3235 – NHS West Sussex, Podiatry Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH Email: [email protected] Fenella Bird (including East Grinstead) Tel: (01444) 441881 ext 8274 – Podiatry Room, Day Hospital, Princess Royal Hospital, Lewes Road, Haywards Heath, RH16 4EX Email: [email protected]



MANAGEMENT OF VARICOSE ECZEMA

Objective is to return skin to normal through excellent skin care using the following steps: 1. Bath in a bath oil 2. Use of topical steroids 3. Emollients

1. Bath in a bath oil – wash legs using bath oil with added anti-microbial. Note: Arterial ulcers and diabetic foot ulcers are not to be washed unless under specialist advice.

• Oilatum® (especially recommended for the elderly ref: BNF 13.2.1), or

• Dermol® 500 (this may be used as soap substitute but is not intended as a bath additive) If patient complains of pruritus consider using Oilatum Plus® (Note: Ensure that patients are advised on proper mixing as chemical type burns to skin have occurred where mixing the oil/water has not been done correctly). 2. Use of topical steroids - if skin is showing signs of redness (erythema), warmth as well as dryness (xerosis) and itching consider using a topical steroid, prescribed by a GP. Remember to consider differential diagnosis such as cellulitis first.

• Betamethasone 0.025% cream/ointment (Betnovate RD®), or

• Clobetasone 0.05% cream/ointment (Eumovate®). 3. Emollients - if skin is very dry consider using:

• 50/50 white soft paraffin/liquid paraffin

If emollients other than the above products are to be used under bandages consider using:

• Cetraben® cream first-line, or

• Doublebase® gel.

If the varicose eczema is not controlled by group 2 topical steroids refer to community dermatology nursing service for further advice on management (where available).

Apart from 50/50 WSP/LP, all product choices on this page are in line with the current Coastal West Sussex Dermatology Formulary available at: http://www.coastalwestsussexccg.nhs.uk/formulary



OTHER USEFUL INFORMATION AND LINKS ORGNISATION / INFORMATION

DESCRIPTION LINK / WEB ACCESS

European Wound Management Association

The European Wound Management Association (EWMA) was founded in 1991, and the association works to promote the advancement of education and research into native epidemiology, pathology, diagnosis, prevention and management of wounds of all aetiologies.

http://www.ewma.org/english.html

Wounds UK

Provides general, very helpful, wound care information including access to journals, best practice statements and lots more.

http://www.wounds-uk.com/

World Wide Wounds The premier online resource for dressing materials and practical wound management information.

www.worldwidewounds.com

Wound Infection Institute

Up-to-date clinical information on international developments in wound care infection.

http://www.woundinfection-institute.com/

European Pressure Ulcer Advisory Panel

Started in 1996 to lead and support all European Countries in the effort to prevent and treat pressure ulcers.

www.epuap.org

Leg Ulcer Forum Provides a forum for healthcare professionals working within the field of leg ulcer management.

www.legulcerforum.org

National Institute of Health and Clinical Excellence (NICE)

An independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

www.nice.org.uk

Types of diabetic foot ulcers

Summary of types of diabetic foot ulcers including appearance, common sites and management.

http://www.coastalwestsussexccg.nhs.uk/formulary



GLOSSARY OF TERMS Anaerobes organisms which do not need oxygen to survive Debridement the removal of devitalised tissue and foreign matter from a wound Epithelialisation the process by which the wound is covered with epithelial cells Eschar dead tissue that is hard, black and dehydrated Exudate a fluid produced in wounds, made up of serum, leucocytes and wound debris Granulation the process by which the wound is filled with highly vascular connective tissue. Granulation tissue is red and

moist and has an uneven, granular appearance Haemostasis arrest of haemorrhage Infection damage to body tissues by micro-organisms or by poisonous substances released by the organism Maceration a softening or sogginess of the tissue surrounding a wound edge Necrosis the death of previously viable tissue Pus a fluid produced in infections, made up of exudate, bacteria and phagocytes which have completed their work Slough accumulation of dead cellular debris on the wound surface, which tends to be yellow in appearance due to the

presence of leukocytes Strike through exudate visible on the outer surface of the dressing Strike through (lateral) exudate visible at the edges of the dressing



REFERENCES 1. Cooper, R. (2010). Assessment and diagnosis, Infection, Ten top tips for taking a swab. Wounds International. Accessed on 25/05/10 at

http://www.woundsinternational.com/article.php?issueid=303&cont

2. International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012. Accessed on 25/03/13 at: www.woundsinternational.com

3. British National Formulary. 64th Edition. London: BMJ Group &RPSGB; September 2012. Available online at http://bnf.org/bnf/index.htm

4. Thomas, ST. (2009). Formulary of wound management products. A guide for health care staff. 10th Edition. UK, Euromed

Communications Ltd.

5. Surgical Dressing Manufacturers Association (SDMA) 2009. Includes the Code of practice for promotion of surgical dressings to healthcare. Available at www.sdma.org.uk

6. Palfreyman SSJ, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database of Systematic Reviews

2006, Issue 3. Available at: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001103/abstract.html <accessed on 30/06/10>

7. Chaby G, Senet P, Vaneau M, Martel P, Guillaume J, Meaume S, Teot L, Debure C, Dompmartin A, Bachelet H, et al. Archives of Dermatology. Dressings for acute and chronic wounds: a systematic review 2007, 143 (10), pp1297-1304. Available at: http://archderm.ama-assn.org/cgi/content/abstract/143/10/1291 <accessed on 30/06/10>

8. East & South East England Specialist Pharmacy Services. Medicines Use and Safety. Top Tip QIPP messages for prescribing dressings.

9. Surgical Dressings and Wound Management. Stephen Thomas. Medetec 2010 Elsevier.

10. McGrath, A. Overcoming the challenge of overgranulation. Wounds UK 2011, Volume 7, No. 1. Accessed on 22/03/13 at:

http://www.wounds-uk.com/pdf/content_9839.pdf

11. Vuolo J. Hypergranulation: exploring possible management options. British Journal of Nursing 25th March-7th April 2010 7:19(6):S4, S6-8. Accessed on 22/03/13 at: http://www.ncbi.nlm.nih.gov/pubmed/20335928#



INDEX OF PRODUCTS Actico 11 Acti-glide hosiery applicator 12 Activa compression liner pack 12 Activa leg ulcer kit 12 Activon-tulle 5, 13 Aderma dermal pad 13 Allevyn adhesive 7 Allevyn gentle 7 Allevyn gentle border 7 Allevyn non adhesive 7 Allevyn sacral 7 Aquacel Ag 5, 13 Aquacel Ag Ribbon 5, 13 Aquacel Extra 6 Aquacel flat 6 Aquacel ribbon 6 Aquaform hydrogel 6 Atrauman 8 Betnovate RD 16 Biatain adhesive 7 Biatain heel dressing 7 Biatain non adhesive 7 Biatain sacral adhesive 7 Biatain soft hold 7 Carboflex 8 Cavilon barrier foam applicator 10 Cavilon durable cream 10 Cetraben 16 Clinipore 10 CliniSorb 8 Coban 2 13

Coban 2 Lite 13 Comfeel plus 6 Comfifast 11 Cosmopore E 9 Dermol 600 16 Doublebase 16 Dressit 10 Duoderm extra thin 6 Durafiber 6 Easy-slide stocking applicator 12 Elastic hosiery Class I 12 Elastic hosierY Class II 12 Eumovate 16 Flexi-Ban 11 Fludroxycortide/Haelan® 4mcg/cm2 tape 14 Inadine 5, 8 Intrasite conformable 6 Intrasite gel 6 Iodaflex 5, 8 Iodosorb 5, 8 Irripod 10 IV 3000 8 Jobst compression liner pack 12 Jobst UlcerCARE 12 Kaltostat flat 6 Kaltostat packing rope 6 K-Band 11 Kerramax 9 K-Four kit 11 K-Lite 11

K-Plus 11 K-Lite long 11 K-Soft 11 K-Three 11 K-Two kit 11 K-Two Reduced 11 Ko-Flex 11 Mefix 10 Mepitel One 13 Mepore 9 Mesorb 9 Metronidazole gel 0.75% 13 N-A ultra 8 Non-sterile gauze swabs 10 Oilatum 16 Opsite Flexigrid 8 Opsite Plus 8 PICO 13 Povidone-iodine 5, 8 Profore Wound Contact Layer 8 Prontosan 13 Prontosan Wound Gel 13 Proshield plus 10 Renasys Go canister kit 13 Renasys G/P dressing kit 13 Scanpor 10 Sorbsan flat 6 Sorbsan packing ribbon 6 Stericlens spray 10 Steripaste 11 Tegaderm 8

50/50 WSP/liquid paraffin 16 Tegaderm heel 7 Tegaderm IV 8 Urgotul 13 Viscopaste PB7 11 Zetuvit E 9 Zetuvit Plus 9



RECOMMENDATIONS FOR SUSSEX COMMUNITY NHS TRUST STAFF ON MANAGING CONTACT WITH COMPANY

REPRESENTATIVES

• Staff must only see companies with products on the formulary and must rotate these companies.

• Community teams must only see one company per month.

• Staff should not see the same company representative more than once a year.

• Do not allow cold calling by company representatives.

• Please ask company representatives to talk only about their products on the formulary and make them aware that they should not

discuss other company’s products.

Please refer to Sussex Community NHS Trust policy on managing contact with company representatives

All other staff are reminded to refer to their local organisational policy on managing contact with company representatives

dressings formulary 2nd edition june 2013 to june 2015 final v6 · 2013. 9. 6. · dressings...

Documents