Herefordshire Wound Management Formulary

Transcription

1 Herefordshire Wound Management Formulary July 2015 Michaela Powell Tissue Viability Nurse Wye Valley NHS Trust Hereford HR1 2ER Wound Care Formulary Sub-Group Herefordshire Joint Formulary Working Group Wye Valley NHS Trust NHS Herefordshire CCG v2 July 2015 Page 1 of 19

2 Key Messages There must always be a clear rationale for the choice of dressings Layers of expensive dressings should be avoided The Nurse managing the wound should be aware of the total cost of the dressing regimen Dressing choice should cut the frequency of dressing changes, where appropriate Prescriptions should only be generated for 1-2 weeks of dressings at a time (specify number of dressings required on prescription, not necessarily a full pack) Prescribe by brand to prevent confusion and ensure continuity of supply for patients Aims Best practice in wound management for patients in Herefordshire To guide practitioners in appropriate dressing choice Standardisation of appropriate practice Cost effectiveness including wear time, of particular relevance in the community Dressings are applied to a wound to deliver many benefits: facilitate rapid and cosmetically acceptable healing reduce pain prevent or combat infection contain exudate prevent or reduce scar formation remove or contain odour provide maximum comfort for the patient Wound healing is a dynamic process and the characteristics of a dressing required by the wound can change as the wound moves through the different phases of the healing process. This means it is important to reassess the wound and dressing regimen regularly and not to order too many dressings at one time. The dressings on the formulary are suitable for the majority of wounds and for each wound stage there are appropriate product choices, to accommodate practitioner s preference. The first choice of dressing should be made from the formulary. However, where a satisfactory outcome is not achieved, practitioners should discuss care with Tissue Viability and following this, other products may be recommended based on a clear rationale and evidence base. A specialist practitioner formulary is being devised which will work alongside the general one to offer those dressings that are not necessarily needed on a daily basis, but are necessary to assist in the healing of some complex and/or chronic wounds. Specialist areas such as Maxillo-Facial, Theatres and the Breast Care Unit have very specific wound care needs and the products required for them will be listed in the specialist practitioner formulary. Please remember Prescribing outside of this formulary must be justified by a specific patient need and this will be monitored by the Tissue Viability Team. Exemption forms will be required for each occasion a dressing is prescribed off formulary. Exemption forms can be found on the Tissue Viability Intranet Site. Specialists may be able to recommend or use products that are not included in this or the specialist formulary based on individual patient need. Please do not accept samples of dressings to try on patients without the consent of a specialist (see p18) HO = Hospital Only denotes dressings not listed in the Drug Tariff (June 2015) ie not prescribable on FP10 DT = Drug Tariff prices (June 2015) ** indicates consideration for a secondary dressing to be used. This secondary dressing should be chosen by referring to the wound classification chart for wound exudate levels and should take into consideration the rationale for the primary dressing. Page 2 of 19 Herefordshire Wound Management Formulary v2 July 2015

3 Contents Absorbent Dressings or Pads page 4 Alginate Dressings page 4 Vapour-Permeable Film Dressings page 5 Film + Pad Dressings page 5 Foam Dressings page 6 Hydrocolloids page 7 Hydrofibers page 7 Hydrogels page 8 Intravenous Line Film Dressings page 8 Low/Non-Adherent Dressings page 9 Skin Protectants for Wound Care page 9 Soft Cloth Dressings page 10 Tape page 10 Activated Charcoal Dressings page 11 Anti-Microbial Dressings Honey Dressings page 11 Iodine page 12 Silver dressings page 12 Specialist Therapies / Dressings page 13 LarvE Therapy Topical Negative Pressure / VAC Protease Modulating Dressings PolyMem Soap Substitutes and Emollients page 13 Normal Saline page 13 Sterile Dressing Packs page 14 Tubular Stockinette page 14 Compression page 15 Crepe Bandages page 17 Medicated Bandages page 17 Debridement (Debrisoft pad) page 18 Pressure Relieving (Aderma Dermal Pad) page 18 Dressing Sample Guidance page 18 Appendices Appendix 1: Second Line Foam Dressings page 19 Page 3 of 19 Herefordshire Wound Management Formulary v2 July 2015

4 Absorbent Dressings or Pads These are indicated for high-exudate, difficult-to-manage wounds such as weepy legs *. Quite often, part of the management is the use of tertiary large absorbent pads; these are necessary to manage the high levels of exudate. Refer to wound classification chart for wound exudate levels. * Ensure underlying causes of weepy legs are addressed. Advancis Medical Eclypse - Absorbent Cellulose Dressing Eclypse Adherent with Silicone Wound Contact Layer Alginate Dressings 10x10cm 0.73 Eclypse is placed face down on wound surface with the beige 15x15cm 0.97 (previously blue) backing uppermost. 20x30cm x40cm x10cm x20cm x15cm x30cm 9.99 Wear time will depend on the level of exudate but Eclypse can be left in place for up to seven days. Suitable for a wide range of wound types including cavities, granulating, small amounts of slough and moderate-to-high levels of exudate (alginate dressings can absorb times their weight in fluid). Unsuitable for dry wounds or dry hardened necrotic tissue. Refer to wound classification chart for wound exudate levels. Sorbsan dressings have haemostatic properties and can help manage wounds with minor bleeding or where blood is present in the exudate. Aspen Medical Sorbsan Flat** Sorbsan Plus** 5x5cm 10x10cm 10x20cm 7.5x10cm Because the alginate fibre reacts with sodium ions to form a soluble gel, the dressing may be removed by irrigation with sterile normal saline. 10x15cm x20cm 3.96 Sorbsan Ribbon** 40cm 2.04 Sorbsan Packing** 30cm 3.47 Deeper cavity wounds or sinuses may be dressed with Sorbsan Packing or Ribbon, which should be placed gently in position but not packed in too tightly. Page 4 of 19 Herefordshire Wound Management Formulary v2 July 2015

5 Vapour-Permeable Film Dressings Suitable for superficial and shallow wounds, these dressings protect newly epithelialising wounds from trauma. They can also be used as a secondary dressing over gels and alginates to retain them. Care needs to be taken when removing film dressings and many have a specific method to break the adhesive bond to ensure a non-traumatic removal. They also promote pain relief. Refer to wound classification chart for wound exudate levels. 3M Health Care Tegaderm 6x 7cm 0.39 It is not recommended that the 10x12cm HO dressing be applied over deep cavity wounds, third degree burns, 12x 12cm 1.11 or wounds that show evidence of 15x 20cm 2.41 clinical infection. HO = Hospital Only denotes dressings not listed in the Drug Tariff (June 2015) ie not prescribable on FP10 Film + Pad Dressings Vapour-permeable Adhesive Film Dressing - with absorbent pad. Refer to wound classification chart for wound exudate levels 3M Health Care Tegaderm + Pad 5x 7cm x10cm x 15cm x 20cm x 25cm x 35cm 2.60 Page 5 of 19 Herefordshire Wound Management Formulary v2 July 2015

6 Foam Dressings Foams can be used on a variety of wounds including pressure ulcers, leg ulcers, burns, surgical wounds etc. They are available in adhesive bordered as well as non adhesive format. Some are more suitable for delicate or problematic skin. Foams are best suited for exuding wounds and are not recommended for dry superficial wounds. Refer to wound classification chart for wound exudate levels. Coloplast Biatain Non-adhesive 5x7cm 1.30 Biatain is able to absorb large 10x10cm 2.37 amounts of exudate and lock the exudate away from the wound 15x15cm 4.36 bed. This, in turn, reduces the 10x20cm 3.91 risk of leakage which can cause maceration and damage to the 20x20cm 6.47 wound bed. Biatain Adhesive 10x10cm 1.74 Wear time will depend on the level of exudate but Biatain can 12.5x12.5cm 2.54 be left in place for up to seven 18x18cm 5.13 days. Biatain Silicone 7.5x7.5cm 1.45 Biatain Silicone has substantial 10x10cm 2.13 absorption capacity and conformability to the wound bed 12.5x12.5cm 2.60 which makes it appropriate for 15x15cm 3.86 shallow wounds with less than 2cm depth reducing the 17.5x17.5cm 5.13 requirement for layering/ packing Biatain Silicone Lite 7.5x7.5cm 1.31 with a primary dressing Wear time will depend on the 10x10cm 2.00 level of exudate but Biatain can 12.5x12.5cm 2.37 be left in place for up to seven days. Biatain Soft-hold 5x7cm 1.30 Wear time will depend on the 10x10cm 2.57 level of exudate but Biatain can be left in place for up to seven 10x20cm 3.91 days. 15x15cm 4.28 [replaces Mepilex 2015] 3M Health Care Tegaderm Foam Adhesive 14x14cm (heel) 4.22 For use on more difficult to dress areas i.e. heels, elbows, scapulas etc NB For second line foam dressings see Appendix 1 Page 6 of 19 Herefordshire Wound Management Formulary v2 July 2015

7 Hydrocolloids Hydrocolloids can be used on a variety of wounds including pressure ulcers, leg ulcers, surgical wounds and minor burns. They can also be used in granulating, sloughy or necrotic wounds and they can aid in the rehydration and debridement of dry, sloughy and necrotic wounds. Refer to the wound classification chart for wound exudate levels. 3M Health Care Tegaderm Hydrocolloid 10x12cm 2.33 Do not use in presence of 13x15cm 4.34 infection. Use with caution on diabetic feet or arterial ulcers. Convatec DuoDERM Signal 10x10cm x14cm x20cm 7.38 DuoDERM Extra Thin 5x10cm x7.5cm x10cm x15cm 2.84 Do not use in presence of infection. Use with caution on diabetic feet or arterial ulcers. Hydrofibers Hydrofiber technology absorbs and locks away large amounts of exudate into the fibres preventing lateral wicking which reduces the likelihood of peri-lesion maceration or excoriation. Refer to wound classification chart for wound exudate levels. Convatec Aquacel Extra ** 5x5cm 1.00 Use as second choice to an 10x10cm 2.38 alginate where more absorbency is required. Also for use on 15x15cm 4.48 exuding wounds where slough is Aquacel Ribbon** 2x45cm 2.44 present. Page 7 of 19 Herefordshire Wound Management Formulary v2 July 2015

8 Hydrogels These can be used on dry and sloughy wounds and are good at hydrating dry wounds by providing a most wound environment. They also promote pain relief. Refer to wound classification chart for wound exudate levels. Activa ActiFormCool 5x 6.5cm 1.79 For use on necrotic or exuding 10x10cm 2.63 wounds. Smith and Nephew 10x15cm 3.79 Intrasite Gel** 8g 1.80 For use in cavity wounds. 15g 2.41 Intravenous Line Film Dressings Transparent film dressings designed to secure the catheter in challenging I.V. applications 3M Health Care Tegaderm IV 1610 Paediatric Peripheral Line Tegaderm IV 1633 Peripheral Line Tegaderm IV 1635 Central Line 8.5x 10.5cm 1.16 Tegaderm IV 1650 PICC Line 10x 15.5cm x 5.7cm HO Waterproof dressing that provides an effective barrier to bacteria and 7x 8.5cm 0.59 viruses. Up to 7 days dressing wear time follow local protocol regarding frequency of dressing changes. Page 8 of 19 Herefordshire Wound Management Formulary v2 July 2015

9 Low/Non-Adherent Dressings Low or non-adherent dressings can be used on lightly exuding wounds. Some combine an absorbent layer that can be used in moderately to highly exuding wounds. Refer to wound classification chart for wound exudate levels. Hartmann NA-Ultra 9.5x9.5cm 0.33 Systagenix 19x 9.5cm 0.63 Adaptic Touch ** 5x 7.6cm 1.13 ** Secondary dressing should be 7.6x 11cm 2.25 chosen to manage exudate appropriately. 12.7x 15cm x 32cm [replaces Mepitel 2015] Urgo Urgotul ** 5x5cm 1.53 Use on wound beds where 10x10cm 3.06 slough is present and a noncontact layer is needed. 15x15cm 6.50 Require appropriate secondary 15x20cm 8.66 or retention dressing. Leave in place for 7 days 20x30cm Skin Protectants for Wound Care 1. Conotrane cream is the first line barrier cream preparation. It is water based and with appropriate use can protect patients. The cream should be applied to the affected area several times a day, as necessary after the use of mild skin cleansing agent and warm water to cleanse the affected area which is subsequently dried. 2. Sorbaderm Skin barrier film/cream Sorbaderm products (durable barrier cream and film) are reserved for selected patients who experience skin problems despite appropriate use of Conotrane.The use of Sorbaderm is to: Protect skin from body fluids including wound exudate Provide protection from tapes and dressings Sorbaderm Cream should be applied very sparingly (size of a 10 pence coin) after every third episode of incontinence as a preventative on intact skin (N.B. Cream is not no-sting) Always add prescribing directions to Sorbaderm to ensure appropriate application Over application leads to the skin feeling waxy. If waxy skin occurs then do not apply further cream since there is already sufficient present Sorbaderm Film product is indicated for both intact but primarily for broken irritated skin since it is waterproof Sorbaderm Film will aid adhesion of tapes and adhesive dressings, cream will not prevent dressings from sticking Sorbaderm can be used up to the expiry date on the product once opened therefore no need to discard after 28 days. A 92g tube should be sufficient for 3 months treatment See overleaf for table format Page 9 of 19 Herefordshire Wound Management Formulary v2 July 2015

10 Astellas Conotrane Cream 100g 0.88 Apply several times a day as 500g 3.51 needed after cleansing and drying Aspen Medical Sorbaderm Barrier Cream 28g 3.56 Cream is designed for use on intact 92g 7.19 skin. Reapply each dressing change or 2g x 20 sachets 6.66 every 3 rd wash. Sorbaderm No-Sting Barrier Film - spray Sorbaderm No-Sting Barrier Film Foam Applicators Soft Cloth Dressings 28ml spray ml x ml x Film may be used on damaged skin. Reapply at each dressing change and between hourly depending on indication for use. Absorbent, perforated dressings with adhesive border. The absorbent pad is non adhesive, protecting the wound whilst absorbing drainage. Refer to wound classification chart for wound exudate levels. Molnlycke Softpore 6 x 7cm 10 x 10cm 10 x 15cm Softpore should not be applied under tension to prevent shearing forces causing damage to the skin. It should not be applied to patients 10 x 20cm 0.35 who are known to be sensitive to acrylic adhesives or to individuals 10 x 25cm 0.40 who have very fragile or easily 10 x 30cm 0.49 damaged skin. 10 x 35cm 0.58 [replaces Mepore 2015] Tape Bard Scanpor 2.5cm x 5m cm x 5m M Health Care Micropore (paper) 2.5cmx 9.1m HO Hypafix 15cm x 10m HO Page 10 of 19 Herefordshire Wound Management Formulary v2 July 2015

11 Activated Charcoal Dressings Indications for use include malodorous exuding wounds such as fungating and/or malignant wounds and also infected wounds. Please note that the charcoal becomes rapidly deactivated in its ability to manage malodour once it becomes wet. Refer to wound classification chart for wound exudate levels. Clinimed Clinisorb 10x10cm 1.88 Clinisorb is not intended to be 10 x 20cm 2.50 placed in direct contact with the wound, but should be applied 15 x 25cm 4.03 over a suitable primary dressing Aspen Medical Sorbsan Plus Carbon 7.5x10cm 2.56 Sorbsan Plus Carbon consist of 10x15cm 4.96 calcium alginate (Sorbsan) wound contact layer and a 10x20cm 5.94 secondary absorbent layer to manage exudate. Contains a carbon fabric which absorbs odour from wound exudate Anti-Microbial Dressings Anti-microbial dressings should generally be reserved for situations where the wound is critically colonised and a need to reduce the bacterial burden has been identified (when the practitioner suspects bacteria are contributing to delayed healing or wound breakdown) and/or the patient is particularly susceptible to infection, e.g. due to diabetes, ischaemia, or immunosuppression. Evidence to support the use of these products is limited. Antimicrobial products must not be used long term. Dressing selection should be based on the tissue type in the wound and exudate levels. If the wound does not respond within 2 weeks of antimicrobial therapy, it is not going to be effective and should be discontinued. Honey Dressings Honey has been shown to provide a wide variety of supporting benefits in the management of chronic wounds, including the reduction of odour (anti-microbial activity), promoting autolytic debridement, anti-inflammatory activity (pain reduction), the stimulation of healing and even the reduction of scarring. Refer to wound classification chart for wound exudate levels. Advancis Medical Actilite Honey Dressing** Activon Honey Ointment** Activon Tulle** 10x10cm 10x20cm 25g 5x5cm If the wound does not respond within 2 weeks of antimicrobial therapy, it is not going to be effective and should be discontinued. Algivon Honey impregnated with alginate** 10x10cm x5cm x10cm 3.40 Page 11 of 19 Herefordshire Wound Management Formulary v2 July 2015 NB honey based dressings will add moisture to wound.

12 Iodine Povitulle is indicated for the prophylaxis and treatment of infection in minor burns, leg ulcers, superficial skin-loss injuries and as a dressing for adjunctive therapy in the treatment of infected ulcerative wounds. Iodoflex is used for the treatment of chronic exuding wounds such as leg ulcers, pressure ulcers and diabetic ulcers, particularly when infection is present or suspected. CD Medical Povitulle** 5x 5cm 0.28 See BNF for interactions, 9.5x 9.5cm 0.42 cautions and contraindications. [replaces Inadine 2015] Smith & Nephew Iodoflex Paste Cadexamer Iodine** 5g 4.09 Maximum single application of 50g and must not exceed 150g Iodosorb Ointment Cadexamer 10g 4.51 weekly. Treatment must not Iodine** exceed 3 months. Silver dressings Dressings containing an antimicrobial agent that will kill or prevent growth and multiplication of bacteria. If the wound does not respond within 2 weeks of antimicrobial therapy, it is not going to be effective and should be discontinued. Hartmann Atrauman Ag low/non adherent** 5x5cm 0.51 For use as an antimicrobial 10x10cm 1.25 dressing for burns, acute or chronic wounds, donor graft 10x20cm 2.45 sites, diabetic ulcers. Urgo Urgotul SSD low/non adherent** 10x12cm 3.13 An antimicrobial dressing for dry 15x20cm 8.85 or lightly exuding wounds. Aspen Medical Sorbsan Silver Flat Alginate** 5x5cm 1.57 Silver wound therapy should only 10x10cm 3.97 be used for a short period of time e.g. two to four weeks. 10x20cm 7.26 Sorbsan Silver Plus Alginate** 7.5x 10cm x15cm x20cm 6.77 Sorbsan Silver Ribbon Alginate** 40cm 4.15 Sorbsan Silver Packing Alginate** 30cm 5.76 **Consider secondary dressing Film, Film + Pad or foam depending on exudate level Page 12 of 19 Herefordshire Wound Management Formulary v2 July 2015

13 Convatec Aquacel Ag+ Extra** - Hydrofiber 5x5cm 1.97 Aquacel Ag+ dressings have the 10x10cm 4.68 added advantage of combining two technologies Hydrofiber 15x15cm 8.82 technology (to deal with the high exudate often seen in infected Aquacel Ag+ Ribbon** - Hydrofiber 2x45cm 4.67 wounds) and silver (to deal with the localised infection). Specialist Therapies / Dressings When a specialist therapy or dressing may be required, consult the Trust TVN for the most appropriate course of action. This includes, but is not limited to the following: LarvE Therapy Topical Negative Pressure / VAC Protease Modulating Dressings PolyMem Dressings Soap Substitutes and Emollients Emulsifying Ointment 500g 2.43 Liquid & White Soft Paraffin 50/50 Ointment 500g 4.57 Normal Saline CD Medical Irripods 20ml x 25amps 5.84 (0.23 ea.) Aquettant Ltd Miniversol Irrigation Pods 45ml x 30amps HO 100ml x 30amps HO Page 13 of 19 Herefordshire Wound Management Formulary v2 July 2015

14 Sterile Dressing Packs (For community based staff only) (this section is currently under review June 2015) Product Code / Size DT Unit Cost ( ) 365 Healthcare Community Hospital Dressing Packs Healthcare DN Community Wound Care Packs Healthcare Richardson Page 14 of 19 Herefordshire Wound Management Formulary v2 July 2015 Notes HO For use in community inpatient settings for procedures requiring clean, non-touch or aseptic technique. Order from Sterile Services Small Medium Large HO For use in community settings eg patients home for procedures requiring clean, non-touch or aseptic technique. Please note sterile gauze, dressing fields etc. need to be added as required Order from Sterile Services Dressit Small / Medium 0.60 For use in the community for Medium / Large 0.60 complex procedures when aseptic technique required Tubular Stockinette Clini Supplies Clinifast Red Line 3.5cm x 1m 0.56 For use in the retention of dressings 3.5cm x 10m HO and underneath compression bandages to help prevent skin Clinifast Green Line 5cm x 1m 0.58 irritation. 5cm x 3m cm x 5m cm x 10m HO Clinifast Blue Line 7.5cm x 1m cm x 3m cm x 5m cm x 10m HO Clinifast Yellow Line 10.5cm x 1m cm x 3m cm x 5m cmx10m HO Clinifast - Beige Line 17.5cm x 1m cmx10m HO

15 Compression Below-knee compression graduated from toe to knee, in the form of bandaging or stockings, is viewed as a key component of treatment when venous leg ulceration, chronic oedema or lymphoedema occurs in the absence of significant arterial disease. Ensure appropriate guidelines are followed to assess patients and select the most appropriate compression product eg venous leg ulcer guidelines. Urgo K-Soft (layer #1) K-Soft Long K-Lite (layer #2) K-Lite Long 10cmx 3.5m 10cmx 4.5m 10cmx 4.5m 10cm x 5.25m layer Elastic compression bandages recommended for patients with venous ulceration. Always refer to manufactures application instructions. K-Plus (layer #3) 10cm x 8.7m 2.26 K-Plus Long 10cm x10.25m 2.61 Ko-Flex (layer #4) 10cm x 6m 3.00 Ko-Flex Long 10cm x 7m 3.43 K-Three C (layer #4) 10cm x 3m 2.81 Activa Also available as Bandage Kits K-Two or K Four Ankle circumference up to 18cm Ankle circumference 18 25cm Ankle circumference 25 30cm Ankle circumference above 30cm Reduced Compression Kit Flexi-ban sub bandage wadding 10cmx 3.5m 0.50 Inelastic Short Stretch Actico Cohesive 8cmx 6m 3.21 Bandages recommended for management of both patients 10cm x 6m 3.33 with chronic oedema or venous 12cm x 6m 4.24 ulceration. Always refer to manufactures application instructions. Compression Hosiery - British Standard For use in the management and prevention of the reoccurrence of venous leg ulceration. Complete holistic leg ulcer assessment including Doppler prior to application. See venous leg ulcer guidelines. Activa Price per Pair Activa Compression Hosiery Class mmHg Class mmHg Class mmHg Below Knee and Thigh Below Knee and Thigh Below Knee and Thigh Available in small, medium, large and extra large. Open and closed toe options Always refer to the manufacturers product fitting/selection guide. Page 15 of 19 Herefordshire Wound Management Formulary v2 July 2015

16 Medi Uk Price per Pair Duomed Compression Hosiery Class mmHg Class mmHg Below Knee and Thigh Below Knee and Thigh Available in small, medium, large and extra large. Always refer to the manufacturers product fitting/selection guide. Class mmHg Below Knee and Thigh Compression Hosiery - RAL Standard RAL standard compression hosiery is recommended for patients with lower leg oedema or lymphoedema associated with or without ulceration. Complete holistic leg ulcer assessment including Doppler prior to application. Activa Price per Pair ActiLymph Compression Hosiery Available in small, medium, large and extra large. Class mmhg Below Knee & Thigh Also refer to manufacturers product fitting/selection guide. Class mmhg Below Knee &Thigh Medi UK Mediven Plus Compression Hosiery Available in sizes 1-7. Calf extra wide sizes also available. Class mmhg Class mmhg Below Knee Thigh Below Knee Thigh Available as standard or petite lengths. Also refer to manufacturers product fitting/selection guide. Compression Hosiery Leg Ulcer Management Kits Leg Ulcer compression Hosiery Kits provide a two layer stocking system that gives a lightweight and effective method of applying accurate, graduated pressure to heal an active venous leg ulcer. Recommended for the use in the treatment of small, low exuding venous leg ulceration. Complete full holistic leg ulcer assessment including Doppler prior to application. Activa Activa Hosiery Treatment Kit 2 Layer Stocking System 1 x Class 3 Compression Stocking and 2 x Compression liners = 40mmHg Price per kit Below Knee Available in small, medium, large, extra large and extra extra large. Also refer to manufacturers product fitting/selection guide Page 16 of 19 Herefordshire Wound Management Formulary v2 July 2015

17 Medi UK Price per kit Mediven Ulcer Kit Available in sizes Layer Stocking System 2 x 20mmHg Compression Stockings Below Knee Available as standard or petite lengths Always refer to manufacturers product fitting/selection guide Crepe Bandages Hartmann Product Size DT Unit Cost ( ) Notes Hospicrepe cmx4.5m 0.80 Type 2 light support bandages for Hospicrepe 239 sprains and strains; oedema management and retention of 7.5cmx 4.5m 0.62 dressings Medicated Bandages Medicated bandages used for wound dressings have mild astringent and antiseptic properties. Smith & Nephew Viscopaste PB7 7.5cm x 6m 3.63 Can be used as an adjunct to compression therapy in the management of leg ulcers, where venous insufficiency exists and in the treatment of chronic eczema/dermatitis where occlusion is indicated. ZipZoc One Size 3.13 Used for treatment of chronic leg ulcers. Where chronic venous insufficiency exists, the medicated stocking can be used as a primary contact layer under compression bandaging or hosiery. Page 17 of 19 Herefordshire Wound Management Formulary v2 July 2015

18 Debridement Product Activa Debrisoft pad 10x10cm 6.39 A rapid, safe and easy method of debridement for superficial wounds containing loose slough and debris. Moisten with wound cleansing solution eg saline before use. NOT to be used as a dressing. Pressure Relieving / Low Friction Products Smith & Nephew Aderma Dermal pad Sacrum/ankle wrap One size Heel standard Standard Heel extra large XL Sheet 10x10x0.3cm x10x1.2cm x20x0.3cm Strip 50x2.5x0.3cm x5x0.3cm 6.45 For prevention of pressure ulcers (intact skin) eg patients who may have contractures where pillows/troughs etc may not be able to be used for pressure relief and for the spine as it is difficult to find pressure redistributing equipment for chairs that addresses the spinal problems. Dressing Sample Guidance Please do not accept samples of dressings to try on patients without the consent of the TVN team. Any product evaluations will be co-ordinated by the TVN team and are the only instance where samples will be used within the Trust. Manufacturer s sales representatives have been asked not to offer staff samples of dressings. These samples must not be used to treat NHS patients and all offers from manufacturers must be declined. Orders / prescriptions for new products should not be generated until a specialist nurse has validated the use of the product. Prescribing outside of this formulary must be justified by a specific patient need and this will be monitored by the Tissue Viability Nurse team. Exemption forms will be required for each occasion a dressing is prescribed off formulary. Exemption forms can be found on the Tissue Viability Intranet Site. Also see Herefordshire CCG Medicines Optimisation wound care and Tissue Viability pages for internet based wound care information and guidelines. Page 18 of 19 Herefordshire Wound Management Formulary v2 July 2015

19 Appendix 1 Second Line Foam Dressings For use second line, or when the first line foam range Biatain is not appropriate (e.g. known allergies to Biatain ) Urgo UrgoTul Absorb Border 6.5x10cm x8cm x15cm x10cm x25cm x13xm x20cm 3.89 Convatec Aquacel Foam Adhesive 8x8cm x13cm x10cm x12.5cm x17.5cm x21cm x30cm Aquacel Foam Adhesive - Heel 19.8x14cm 5.43 Aquacel Foam Adhesive - Sacral 20x16.9cm x21.5cm 5.50 Aquacel Foam Non Adhesive 5x5cm x10cm x15cm x20cm x20cm 5.81 Page 19 of 19 Herefordshire Wound Management Formulary v2 July 2015