Download Dressings Formulary - Worthing Medical Group

Dressings Formulary
Date of issue: June 2013
Review date: June 2015
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 1 of 22
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.
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 2 of 22
A GUIDE TO WOUND MANAGEMENT
Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004
DESCRIPTION OF WOUND
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.
TREATMENT OBJECTIVES
Hydration of eschar,
debridement and
management of exudate.
Be aware of vascular status
before any form of
debridement is considered on
lower limb.
NB: Keep necrotic toes
and heels dry.
Slough
Dead tissue.
Debridement and
management of exudate.
N.B. Yellow tissue may be
tendon or bone.
EXUDATE LEVEL
None – Low
Hydrogel (p 6) and SemiPermeable 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.
Hydrogel (p 6) and SemiPermeable Film (p 8) /Low/Non
Adherent Dressing (p 8)
OR
Hydrocolloid (p 6)
EXUDATE LEVEL
Moderate to High
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.
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing (p 7)
Treat underlying cause of exudate.
Granulating
Process by which the wound
is filled with highly vascular
fragile connective tissue.
Keep warm and moist.
Red in colour.
Protect/promote granulation.
Manage exudate.
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
OR
Low/Non Adherent Dressing (p 8)
Treat underlying cause of exudate.
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 3 of 22
A GUIDE TO WOUND MANAGEMENT (continued)
DESCRIPTION OF WOUND
Epithelialising
TREATMENT OBJECTIVES
Process by which the
wound is covered with
new skin cells.
Keep warm and moist.
Tissue will be pink in
colour.
Protect from further damage.
Manage exudate.
EXUDATE LEVEL
None – Low
Low/Non Adherent Dressing (p 8)
OR
Hydrocolloid (p 6)
EXUDATE LEVEL
Moderate to High
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing or Foam (p 7)
OR
Low/Non Adherent Dressing (p 8)
Treat underlying cause of exudate.
Cavity
Macerated skin
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.
A softening or sogginess
of surrounding tissue.
Check if present dressing
regime is absorbing the
exudate.
If sloughy debride. Manage
exudate. Do not overpack
cavity wounds as this delays
healing.
Protect with a barrier ointment
e.g. liquid/white soft paraffin
mix. Barrier film applicator.
Infected
Occurs when organisms
in the wound evoke a
reaction from the host,
i.e. antigen-antibody
response.
Hydrogel (p 6) and semi
permeable film (p 8)
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent (p 7) or foam dressing
Treat underlying cause of exudate.
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.
To free patient from infection,
pain and discomfort.
To promote wound healing.
Dressings Formulary, 2nd edition 2013. Review date: June 2015
See management information below (p 5)
Page 4 of 22
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
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.
Dressings Formulary, 2nd edition 2013. Review date: June 2015
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 3-5 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
Page 5 of 22
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Alginate Cavity
Do not pack tightly into wound
Change every 2-3 days
If infected change as appropriate
Alginate
Kaltostat has haemostatic properties – reduces bleeding in 10 minutes
Cut to size of wound
Irrigate wound to remove
Hydrogels
Not recommended for heavily exudating wounds. Contra-indicated in
anaerobic infection. Not to be used in ischaemic feet.
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.
Hydrofibre/cellulose dressings
No lateral wicking
Overlap wound by 1cm
Can be left in place for up to 7 days
PRODUCT NAME
Sorbsan packing ribbon (with
probe)
(1st line)
Kaltostat packing rope
(2nd line)
Sorbsan flat
(1st line)
COST/ITEM
£2.04
2g
£3.73
Kaltostat flat
(2nd line)
Intrasite conformable
5cm x 5cm
10cm x 10cm
10cm x 20cm
5cm x 5cm
7.5cm x 12cm
10cm x 10cm (7.5g)
£0.81
£1.71
£3.20
£0.93
£2.03
£1.76
Aquaform hydrogel
8g
£1.64
Intrasite gel
Minimal exudate: Duoderm Extra
Thin
Light exudate: Comfeel Plus
8g
7.5cm x 7.5cm
10cm x 10cm
5cm x 7cm
10cm x 10cm
5cm x 5cm
10cm x 10cm
15cm x 15cm
5cm x 5cm
10cm x 10cm
15cm x 15cm
£1.76
£0.78
£1.29
£0.65
£1.24
£0.99
£2.36
£4.44
£0.88
£2.10
£3.95
5cm x 5cm
10cm x 10cm
15cm x 15cm
1cm x 45cm
2cm x 45cm
£0.99
£2.36
£4.44
£1.79
£2.39
Aquacel flat
Durafiber (cellulose based)
For highly exuding wounds only:
Aquacel Extra
Aquacel ribbon
Dressings Formulary, 2nd edition 2013. Review date: June 2015
SIZE
40cm
Page 6 of 22
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Foams
Change when lateral strike through occurs.
Can be left in place for up to 7 days.
PRODUCT NAME
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
SIZE
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
COST/ITEM
£1.28
£2.32
£4.27
£3.83
£1.71
£2.49
£7.45
£2.52
£3.83
£4.19
£4.31
£5.03
5cm x 5cm
10cm x 10cm
10cm 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
£1.23
£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
Page 7 of 22
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
PRODUCT NAME
Films
Tegaderm
Stretch film parallel to skin to release adhesive and prevent trauma to skin on
(1st line)
removal
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
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)
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 7 days).
Dressings Formulary, 2nd edition 2013. Review date: June 2015
SIZE
6cm x 7cm
12cm x 12cm
15cm x 20cm
COST/ITEM
£0.38
£1.09
£2.37
Opsite Flexigrid
(2nd line)
6cm x 7cm
12cm x 12cm
15cm x 20cm
£0.39
£1.10
£2.78
Opsite Plus
(with absorbent pad)
6.5cm x 5cm
8.5cm x 9.5cm
£0.31
£0.86
Tegaderm IV
IV3000
N-A Ultra
(1st line)
10cm x 15.5cm
10cm x 12cm
9.5cm x 9.5cm
19cm x 9.5cm
£1.62
£1.36
£0.33
£0.63
Atrauman
(2nd line)
5cm x 5cm
7.5cm x 10cm
10cm x 20cm
20cm x 30cm
£0.26
£0.27
£0.61
£1.67
14cm x 20cm
10cm x 10cm
10cm x 20cm
15cm x 25cm
8cm x 15cm
10cm x 10cm
5g
10g
17g
10g
£0.31
£1.84
£2.45
£3.95
£3.74
£3.12
£3.96
£7.91
£12.53
£4.37
5cm x 5cm
9.5cm x 9.5cm
£0.33
£0.49
Profore Wound Contact Layer
(non-silicone dressing)
CliniSorb
(1st line)
Carboflex
(2nd line)
Iodoflex
(1st line)
Iodosorb ointment
(1st line)
Inadine
(Only to be used on toes)
Page 8 of 22
MISCELLANEOUS PRODUCTS
DRESSING TYPE AND COMMENTS ON PRESCRIBING
PRODUCT NAME
Absorbent cellulose dressing (sterile)
Zetuvit E
Primary or secondary dressing for medium to heavily exuding wounds
(1st line)
Absorbent simple dressing
Low adherence dressing
Dressings Formulary, 2nd edition 2013. Review date: June 2015
SIZE
10cm x 10cm
10cm x 20cm
20cm x 20cm
20cm x 40cm
COST/ITEM
£0.21
£0.24
£0.38
£1.06
Zetuvit Plus
(use if higher absorbency
required)
10cm x 10cm
10cm x 20cm
20cm x 25cm
20cm x 40cm
£0.61
£0.85
£1.33
£2.04
Mesorb
(for moderate exudate)
10cm x 10cm
10cm x 20cm
20cm x 25cm
20cm x 30cm
£0.62
£0.99
£2.22
£2.51
KerraMaxCare
(for very high exudate)
10cm x 10cm
10cm x 22cm
20cm x 22cm
20cm x 30cm
£0.94
£1.25
£2.20
£2.51
Mepore
(1st line)
7cm x 8cm
10cm x 11cm
11cm x 15cm
9cm x 35cm
£0.11
£0.21
£0.36
£0.75
Cosmopore E
(2nd line)
5cm x 7.2cm
8cm x 10cm
8cm x 15cm
10cm x 35cm
£0.08
£0.17
£0.27
£0.75
Page 9 of 22
MISCELLANEOUS PRODUCTS (continued)
Cleansing agent
Irripod
For irrigating ulcers or wounds, but warm tap water is often appropriate (BNF).
Stericlens spray
25 x 20ml
£5.76
100mls
240mls
£2.03
£3.09
£0.60
Dressing packs
Used to provide a clean or sterile working surface. Contains apron and gauze
swabs.
Dressit
s/m, m/l
Gauze
A secondary dressing – see notes above under low/non adherence dressings
Non Sterile Gauze Swabs Type
13 Light BP 1988
10cm x 10cm
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
2.5cm x 5m
5cm x 5m
£0.67
£1.16
Clinipore
2.5cm x 5m
5cm x 5m
£0.59
£0.99
Mefix
2.5cm x 5m
5cm x 5m
£1.01
£1.79
Cavilon barrier foam applicator
1ml x 5
£4.88
Cavilon durable cream
28g
92g
£3.92
£7.99
Proshield plus skin protective
(For use on intact or injured skin
associated with incontinence.
Do not use a dressing over the
product)
115g
£9.50
Barrier preparation
Dressings Formulary, 2nd edition 2013. Review date: June 2015
£1.39 for 100
pads
Page 10 of 22
BANDAGES
COMPRESSION (Only health care staff who have undergone the specific training
PRODUCT NAME
SIZE
COST/ITEM
should apply compression bandaging)
Wool (1st layer)
Crepe (2nd layer)
3rd layer
4th layer
Short stretch
Kits
K-soft long
Flexi-Ban
K-Lite
K-Lite long
K-Plus
Ko-Flex
Actico (cohesive)
K-Four kit
K-Three (for larger limbs)
K-Two kit
K-Two Reduced
OTHER BANDAGING
Securing bandages
A secondary dressing – see notes above under low/non adherence dressings
K-Band
Paste bandages
Impregnated woven bandage.
Viscopaste PB7 (10%)
Steripaste
Elasticated viscose stockinette
Lightweight plain-knitted elasticated tubular bandage.
Comfifast blue line large limb
Comfifast yellow line
Dressings Formulary, 2nd edition 2013. Review date: June 2015
10cm x 4.5m
10cm x 3.5m
10cm x 4.5m
10cm x 5.25m
10cm x 8.7m
10cm x 6m
10cm x 6m
< 18cm ankle
18-25cm ankle
25-30cm ankle
> 30cm ankle
10cm x 3m
0 (short)
18-25cm
25-32cm (10cm)
18-25cm
24cm-32cm
£0.55
£0.49
£0.98
£1.13
£2.21
£2.94
£3.26
£6.97
£6.67
£6.67
£9.18
£2.75
£6.66
£7.45
£8.62
£7.90
£8.63
5cm x 4m
7cm x 4m
10cm x 4m
15cm x 4m
7.5cm x 6m
7.5cm x 6m
£0.20
£0.25
£0.27
£0.48
£3.56
£3.24
7.5cm x 1m
7.5cm x 5m
10.75cm x 1m
10.75cm x 5m
£0.77
£3.74
£1.20
£6.04
Page 11 of 22
COMPRESSION HOSIERY
PRODUCT
PRODUCT NAME
Venous ulcer compression systems treatment stockings
Activa leg ulcer kit
N.B. Made-to-measure hosiery should be obtained through your usual route Pack contains 1 stocking and 2
liners - 40mmHg
Dressings Formulary, 2nd edition 2013. Review date: June 2015
SIZE
Small
Medium
Large
Extra large
COST/ITEM
£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
Page 12 of 22
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
Antimicrobial
See notes in infection section (p 5)
PRODUCT NAME
Metronidazole 0.75% gel:
Silver: Aquacel Ag
Aquacel Ag Ribbon
Honey: Activon-tulle
Soft polymer
(for patients who cannot tolerate N-A Ultra, Atrauman or Profore)
Soft silicone
Compression bandages (training required)
Topical Negative Pressure dressings:
Please note: patients to be referred through TVN service.
Irrigation:
Prontosan pod
Prontosan bottle
Prontosan Wound Gel
Urgotul
Mepitel One
Coban 2 multi-layer compression
bandage kit
Coban 2 Lite multi-layer
compression bandage kit
Renasys G/P dressing kit with port
Renasys Go canister kit
PICO
Low Friction Products
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Aderma Dermal Pad
Sheet (fine)
Sheet (thick)
Strip
Heel
SIZE
COST/ITEM
15g
30g
5cm x 5cm
10cm x 10cm
1cm x 45cm
2cm x 45cm
5cm x 5cm
10cm x 10cm
£4.47
£7.89
£1.93
£4.59
£3.02
£4.62
£1.78
£2.94
24 x 40ml
350ml
30ml
10cm x 10cm
£14.00
£4.66
£6.32
£3.00
6cm x 7cm
9cm x 10cm
One size
£1.59
£3.19
£8.08
One size
£8.08
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
10x10x0.3cm
10x10x1.2cm
50x2.5x0.3cm
Standard
£4.21
£12.64
£5.27
£14.72
Page 13 of 22
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 14 of 22
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]
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 15 of 22
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 16 of 22
OTHER USEFUL INFORMATION AND LINKS
ORGNISATION /
INFORMATION
European Wound
Management
Association
DESCRIPTION
LINK / WEB ACCESS
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 17 of 22
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 18 of 22
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#
Dressings Formulary, 2nd edition 2013. Review date: June 2015
Page 19 of 22
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
Dressings Formulary, 2nd edition 2013. Review date: June 2015
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
Page 20 of 22
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 2013. Review date: June 2015
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Dressings Formulary, 2nd edition 2013. Review date: June 2015
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