Agreed jointly by Ipswich and East Suffolk and West Suffolk Clinical Commissioning Groups GP Practice Woundcare Formulary Version 28 October 2017 Formulary items should be prescribed wherever possible. If a nonformulary item is required, an exception reporting form should be completed (available on IESCCG & WSCCG websites).
1. Saline Item Salipod 2 x 20ml 2 4.99 0.19 1 2. Non Adherent dressing N-A Ultra 9.cm x9.cm 40 13.20 0.33 3. Soft polymer wound contact dressing cm x cm 2.70 0.27 Atrauman 7.cm xcm 2.80 0.28 cm x 20cm 30 18.90 0.63 20cm x 30cm 17.40 1.74 Urgotul cm x cm 31. 3.11 1cm x 20cm 87.90 8.79 4. Soft silicone wound contact dressing 6cm x 7cm 6. 1.22 Mepitel One 9cm x cm 12.0 2.41 13cm x 1cm 24.90 4.98. Adhesive dressing with absorbent pad Tegaderm + Pad Cosmopore E cm x 7cm 2 6.0 0.26 9cm x cm 2 16.2 0.6 9cm x 1cm 2 23.7 0.9 9cm x 20cm 2 3.00 1.40 cm x 7.2cm 0.80 0.08 8cm x cm 2 4.0 0.18 8cm x 1cm 2 7.00 0.28 cm x 20cm 2 11.0 0.46 cm x 2cm 2 14.00 0.6 6. Vapour-permeable adhesive film dressing Tegaderm film 6cm x 7cm 0 39.00 0.39 12cm x 12cm 11. 1.11 4 2 Tap water is preferred for leg ulcers and to irrigate clean wounds To encourage moist wound healing. Use under compression or retention bandages on granulating wounds Lasts up to 7 days; requires a secondary dressing. Suitable for use on fragile/ delicate skin. days Can remain in place for up to 14 days during which time the outer absorbent pad should be changed as needed Low to moderate exudate Suitable for surgical wounds, cuts and abrasions Non-adherent pad Waterproof Can be worn for up to 4 days Primary dressing to cover wounds without the need for additional tape or bandages For use on lightly exuding wounds e.g. post-operative wounds or minor injuries and epithelialising wounds Not suitable for use on leg ulcers Avoid if exudate present risk of maceration Do not use on sensitive skin. Can be left in place up to 7 days
1cm x 20cm 24. 2.41 Often used as a secondary dressing, or as a prophylactic dressing to prevent friction and shearing damage. 7. Hydrogels Intrasite Gel 8g 1 1.82 1.82 Avoid use on ischemic and cm x 6.cm 9.0 1.81 diabetic feet, infected and heavily exuding wounds Actiform Cool cm x cm 13.30 2.66-7 Requires a secondary dressing Actiform Cool can be left in place cm x 1cm 3 11.49 3.83 for up to 7 days. 8.Hydrocolloids 8a) Low exudate Duoderm Extra Thin 8b) Low to moderate exudate cm x cm 7.70 0.77 7.cmx7.cm 4.0 0.81 cm x cm 13.30 1.33 1cm x 1cm 28.80 2.88 Granuflex cm x cm 14.1 2.83 Granuflex Bordered Tegaderm oval (bordered) 9. Alginates Algisite M 6cm x 6cm 8.90 1.78 cm x cm 33.70 3.37 cm x 13cm 39.70 3.97 1cm x 1cm 32.1 6.43 cm x 12cm 11.6 2.33 13cm x 1cm 21.70 4.34 cm x cm 9.30 0.93 cm x cm 19.30 1.93 1cm x 20cm 1.90.19 For minor burns, abrasions, lacerations and post-operative wounds, stage 1-2 pressure ulcers, lightly exuding leg ulcers days; no secondary dressing required. Allow overlap over wound edge Waterproof dressing For pressure ulcers, leg ulcers, minor burns, skin donor sites, other surgical and traumatic wounds Select a dressing that extends at least 3cm beyond the wound edges. days Waterproof dressing days Shower-proof dressing Primary dressing; forms a viscous gel on contact with exudate; do not wet the dressing before application Cut or fold to shape of wound to avoid maceration of surrounding skin; can be left in place for up to 7 days
Flaminal Hydro 1g 38.40 7.68 Slight to moderate exudate Can be re-capped and re-used on the same patient Flaminal Forte 1g 38.40 7.68 Moderate to heavy exudate Can be re-capped and re-used on the same patient. Gelling cellulose dressing Durafiber cm x cm 9.20 0.92 cm x cm 21.90 2.19 1cm x 1cm 20. 4.11 11. Cavity Dressings Aquacel Ribbon 1cm x 4cm 9.1 1.86 2cm x 4cm 12.20 2.48 12. Foam Dressings 12a) Adhesive 7.cm x 7.xm 11.80 1.18 ActivHeal Foam Adhesive Allevyn Gentle Border Allevyn Life cm x cm 16.30 1.63 12.cm x12.cm 16.80 1.68 1cm x 1cm 21.0 2.1 20cm x 20cm 4.00 4.0 7.cmx7.cm 1. 1.1 cmxcm 22. 2.21 cm x 20cm 3.60 3.6.3cmx.3cm 17. 1.71 12.9cmx 12.9cm 2. 2.1 1.4cm x 1.4cm 30.60 3.06 21cm x 21cm 60.40 6.04 Allevyn Gentle 16.8cmx Border Sacrum 17.1cm 40.00 4.00 12b) Non-Adhesive cm x cm 7.0 0.7 ActivHeal Non- Adhesive Foam cm x cm 11.30 1.13 cm x 20cm 23.40 2.34 20cm x 20cm 39.20 3.92 14 14 - - For medium and heavily exuding granulating wounds. Can remain in place for up to 7 days; cover with a moisture retentive dressing. Forms a soft cohesive gel on contact with exudate; do not wet dressing before use Do not pack too tightly days except the sacral area where dressings can be left in place for up to days. days
ActivHeal Foam 18cm x 12cm 34.80 3.48 - Heel 13. Absorbent Dressings - For moderate to heavily exuding wounds cm x cm 0 3.0 0.07 Use as secondary dressing Zetuvit E cm x 20cm 0 4.0 0.09 Not suitable for application under (non-sterile) compression 20cm x 40cm 30 8.40 0.28 Zetuvit E (sterile) Kerramax care cm x cm 2.2 0.21 cm x 20cm 2 6.2 0.2 20cm x 40cm 11. 1.11 cm x 22cm 16.80 1.68 20cm x 22cm 29.80 2.98 20cm x 30cm 17.00 3.40 14. Cellulose dressing Cutimed Sorbion Sachet Extra cm x cm 11.3 2.27 20cm x cm 18.8 3.77 1. Odour absorbent charcoal dressings CliniSorb 16. Debridement Debrisoft pad 16. Anti- Microbials 16a) Povodine Iodine Inadine 16b) Honey Algivon cm x cm 19. 1.91 cm x 20cm 2.40 2.4 1cm x 2cm 40.90 4.09 2 cm x cm 32.0 6.0 14 Use as secondary dressing Not suitable for application under compression Primary or secondary dressing; stackable to increase absorption Primary dressing suitable for moderate to highly exuding wounds; may remain in place for up to 4 days Do not use in conjunction with other dressings unless absolutely necessary. Moderately and lightly exuding wounds (use a separate primary dressing for lightly exuding wounds to prevent adherence) Can be used for up to 7 days cm x cm 2 8.2 0.33 Low adherent knitted viscose fabric containing povidone iodine 9.cm x Colour change from orange to 4.90 0.49 9.cm white as iodine released cm x cm 9.90 1.98 Alginate dressing impregnated with cm x cm 17.00 3.40 honey cm x cm 9.00 1.80 Activon Tulle cm x cm 14.8 2.97 17. Dressing S/M or M/L Nurse It 1 0. 0. gloves Knitted viscose mesh dressing impregnated with honey
18. Adhesive Tapes Micropore 2.cm 1 0.92 0.92 1 cm 1 1.81 1.81 Mefix cm 1 2.90 2.90 1cm 1 3.9 3.9 19. Paste Bandages Zipzoc Stocking 17cm x 13cm x 1cm 4 12.0 3.12 Viscopaste PB7 7.cm x 6m 1 3.69 3.69 20. Retention Bandages K-Band stretched 4m x cm 1 0.26 0.28 21. Support Bandages cm x 4.m 1 0. 0. K-Lite cm x 4.m 1 1.01 1.01 22. Compression Bandages 22a) Short-Stretch Actico (cohesive) 22b) Multi-Layer UrgoKTwo kit UrgoKTwo Reduced 8cm x 6m 1 3.2 3.2 cm x 6m 1 3.38 3.38 12cm x 6m 1 4.31 4.31 18-2cm 1 8.17 8.17 2-32cm 1 8.93 8.93 18-2cm 1 8.18 8.18 2-32cm 1 8.93 8.93 K-Soft layer # 1 cm x 3.m 1 0.46 0.46 K-Lite layer # 2 cm x 4.m 1 1.01 1.01 K-Plus layer # 3 cm x 8.7m 1 2.29 2.29 Ko-Flex layer # 4 cm x 6m 1 3.04 3.04 23. Elasticated Tubular bandages.0cmx 1m (green) 1 0.8 0.8 Comfifast.0cm x 3m 1 1.62 1.62.0cm x m 1 2.81 2.81 1 2 Dressing retention on non-flexing areas Dressing retention on areas prone to rubbing e.g. elbows, heels Light bandage for securing dressings. When applying on legs, apply from toes to knee to prevent oedema. When applying on oedematous limbs make sure K-soft is applied first to prevent the bandage cutting into the skin. To secure dressings and bandages m and 3m lengths are less wasteful than 1m and can accommodate various limb s
7.cm x 1m (blue) 1 0.77 0.77 7.cm x 3m 1 2.13 2.13 7.cm x m 1 3.74 3.74.7cm x 1m (yellow) 1 1.20 1.20.7cm x 3m 1 3.49 3.49.7cm x m 1 6.04 6.04 2. Barrier film (peri-wound protection) Clinimed LBF Sterile No Sting Barrier Film 26. Swabs Non-woven fabric swab Consider if blue (7.cm) line will suffice before requesting a yellow (cm) line bandage Do not use Tubigrip or crepe as a retention bandage 1ml swab 3.86 0.77 1ml swab covers area of at least 1cm x 1cm Reapply at each dressing change 30ml spray 1 6.02 6.02 1 May be used on intact or damaged skin Sterile 7.cmx7.cm Non-sterile cm x cm 0.27 0.27 0 0.84 0.84 1 For cleaning wounds and providing protection to boney prominences. Do not use as a dressing
2 dressings + 1 pump Secondary Formulary Approved non-formulary items for second line use only Item Hydrocolloid fibrous 6cm x 6cm 9.60 0.96 UrgoClean cm x cm 21.40 2.14 1cm x 20cm 40.20 4.02 2.cmx40cm rope 12.0 2.41 Silver Antimicrobials cm x cm.20 0.2 Atrauman cm x cm 12.60 1.26 Ag cm x 20cm 24.70 2.47 Urgotul Silver cm x 12cm 16 7.28 3.8 1cm x 20cm 16 16.00 9.7 cm X cm 17.90 1.79 cm X cm 42.60 4.26 1cm X 1cm 40.0 8.01 Durafibre Ag 2cm X 4cm 21.3 4.27 20cm x 30cm 99.2 19.8 Other antimicrobials Cutimed Sorbact swabs Cutimed Sorbact gel 4cm x 6cm 8.3 1.67 7cm x 9cm 13.90 2.78 7.cm x 7.cm 26.80 2.68 7.cm x 1cm 4.20 4.2 Negative pressure wound therapy cm x 20cm 127.06 - cm x 30cm 126.43 - cm x 40cm 14.68 - Pico 1cm x 1cm 126.43-1cm x 20cm 126.43-1cm x 30cm 14.68-20cm x 20cm 14.68-2cm x 2cm 14.68 - for 2 week - 2 For exuding or sloughy wounds Soft polymer wound contact dressing Soft polymer wound contact dressing; can be left in place for up to 7 days Gelling cellulose dressing Designed to be left in place for up to 7 days Primary dressing for contaminated, colonised or infected superficial or deep wounds. Change every 1 3 days depending on the wound condition Cutimed Sorbact swab with an amorphous hydrogel Change every 1 3 days depending on the wound condition Can be used for all types of dry to low exuding wounds that are contaminated, colonised or infected Canister-free, single-use therapy, provided as a complete seven day kit