FIRST CHOICE DRESSING ‐ Integrated 2012 1st April to 31st December 2012 Approved:
MMGG 22nd March 2012
Please note this is the new merged (East and West) version of the First Choice Dressings list. Overseen by Interim Head of Tissue Viability and Intravenous Therapy Support Team,Sara Kray, and Tissue Viably Specialist Nurse, Abi Smith. Recommendations from all Tissue Viability Nurse Viv Turner, Natalie Campbell and Sharon Moon have been incorporated.
Kent Community Health NHS Trust
First Choice Dressing List
CONTENTS Page 3
Introduction Wound Care Policy – principles
4
Dressing choice
5
Dressing algorithms Pink Epithelialising Red Granulating Yellow Sloughy Black Necrotic
6 7 8 9
Dressing groups
10
First Choice Dressings List
15
Foot Ulcers – Podiatry aim and selection guide Antimicrobial Appendix (to follow once approved) Dressing Exception Form
18
Integrated Draft version 0.1
19
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First Choice Dressing List
INTRODUCTION The First Choice Dressings List is available for all practitioners prescribing and/or applying wound care products throughout Kent Community Health NHS Trust (KCHT). The formulary has been devised by KCHT Tissue Viability Support Team, KCHT Community Health Pharmacy Team and the Best Practice Skin Integrity Group. It aims to provide a clinically effective, appropriate and cost effective choice of products to manage the vast majority of wounds. The list will be evaluated and updated on an annual basis to reflect innovations in practice and new, evaluated products. There are some variations between acute and primary care provision and in general products should be selected to maintain a continuum of care for the patient. In most cases, the product list contains three choices to assist in the choice of dressing after a patient assessment. Selection should also be based on frequency of change e.g. planning a change of dressings on a weekly basis would minimise commitment of nursing time. Notes for use The following must be noted: a. this first choice dressings list is to be used in conjunction with the Wound Care Policy (see principles below) and not in isolation; b. the choice of dressing should not replace sound clinical judgement; c. prescribers should only order a quantity that is clinically required, rather than prescribing whole packs to reduce waste and inefficiencies; d. correct initial and ongoing wound assessment as defined in the wound care policy are essential elements to the selection of appropriate dressings.
Notes for external organisations and NHS bodies This first choice dressings list has been produced and agreed in accordance with KCHT’s policies and procedures. It therefore reflects the best practice for KCHT. This list is available to other organisations and NHS bodies to use at their discretion but they should note that their own policies and procedures may not match KCHTs. Should any conflicts or discrepancies arise as a consequence all external bodies should refer to their own polices and procedures. KCHT cannot and would not be responsible for any problems arising from these conflicts.”
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First Choice Dressing List
Wound Care Policy – Basic Care Pathway
The flow chart follows the access, plan, implement and evaluation process (yellow boxes) with expanded points in green that are a ‘must do’ in relation to assessment and treatment of wounds. The blue boxes indicate associated care that may be applicable and should be considered as part of the treatment plan. Refer to Wound Care Policy for further information. Note: Refer to NMC re Accountability / Responsibility, Risk Assess where deemed appropriate.
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First Choice Dressing List
DRESSING CHOICE a. prescribing dressings should take into account: o Personalized Assessment o Wound assessment o wound dressing algorithms; o manufacturers product information; o the British National Formulary Number 62. b. The choice of dressing choice is influenced by: o maximising effectiveness; o minimising a risk; o continuation of treatment between primary and secondary care; o minimising cost; o patient choice; c. it is expected that the vast majority of wound care products will be selected from the First Choice Dressings List. Should a product be required which is not listed, the rationale for this must be supplied in writing on the exemption form attached. This will influence in the updating process of the First Choice Dressings List; d. specialist products listed should only be used following discussion with and where necessary an assessment by Tissue Viability Support Team; e. antimicrobial products should only be used where an increased risk of infection or clinical signs of infection are apparent. Once an infection has resolved, treatment with an antimicrobial dressing should be stopped; f. each practitioner is responsible for ensuring access to and usage of the most recent version of the First Choice Dressing list which can be found on the “Staff Zone” website at http://www.kentcht.nhs.uk g. compression systems should only be applied by practitioners trained in their application. Maintenance hosiery can be prescribed in any size, including made to measure; h. dressing packs should not be prescribed in primary care within the eastern and coastal Kent area, as they are no longer considered to be clinically or cost effective. Appropriate alternatives are listed within this document, and should be ordered via stores or NHS supply chain or FP10; i. new products may be evaluated through the Best Practice Skin Integrity Group, (within the Medicines Management Agreed Product Evaluation Framework requirements), who as a sub-group of the Medicines Management Group, will assess the evidence available, and evaluate wound care products. New products will only be added to the First Choice Dressings List following a positive recommendation from the Best Practice Skin Integrity Group, and endorsement by Medicines Management Group. Products which are not on the First Choice Dressings List should not be used routinely, and only used in exceptional circumstances based on clinical need not preference until they are evaluated fully.
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First Choice Dressing List
Wound Pink (Epithelialising) 0–2 (assess for signs of infection)
Primary dressing
Low exudate
Moderate exudate
Heavy exudate
Infected
Atrauman® / NA-Ultra® / Softpore® / Alldress® / Tegaderm absorbent clear®/ Allevyn Gentle® / Biatain Silicone® / Duoderm®
Aquacel® / Sorbsan® / Allevyn Gentle® / Biatain Silicone® /Allevyn® / Biatain® / Tegaderm Foam® / Versiva XC®
Aquacel® / Sorbsan® / Versiva XC® / Sorbian Sachet S ®
Iodoflex® / Iodosorb® / Medihoney® / Mesitran® / Biatain AG® / Aquacel AG® / Atrauman Ag® / Urgotul SSD®/ SilveCel®/ Kendal AMD® / Suprasorbx+PHMB® / (Refer to BNF for suitable product))
Zetuvit E® / Tegaderm® Secondary dressing if required
Biatain® / Tegaderm Foam® / Zetuvit E® / Allevyn Gentle® / Biatain Silicone®
Biatain® / Tegaderm Foam® / Zetuvit E®
To be used in conjunction with the wound assessment form and first choice dressings list Integrated Draft version 0.1
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First Choice Dressing List
Wound Red (Granulating) 3–4 (assess for signs of infection)
Low exudate
Shallow
Primary dressing
Biatain® / Tegaderm Foam® / Allevyn
Gentle® / Biatain Silicone® / Duoderm® /
Zetuvit E® Secondary dressing if required
Cavity
Aquacel® / Sorbsan® /
Zetuvit E® / Biatain® / Tegaderm Foam® / Allevyn Gentle® / Biatain Silicone® / Duoderm® / Granuflex® Versiva XC®
Moderate exudate
Shallow
Aquacel® / Sorbsan® / Versiva XC® / Allevyn® /Biatain® / Tegaderm Foam® / Duoderm® / Granuflex®
Cavity
Aquacel® / Sorbsan®
Heavy exudate
Shallow
Aquacel® / Sorbsan® /
Infected
Cavity
Aquacel® / Sorbsan®
Sorbian Sachet S ®
Iodoflex® / Iodosorb® / Medihoney® / Mesitran® / Biatain AG® / Aquacel AG® / Atrauman Ag® / Urgotul SSD®/ SilveCel®/ Kendal AMD® / Suprasorbx+PHMB® / (Refer to BNF for suitable product))
Zetuvit E® / Zetuvit Plus®
Versiva XC® / Biatain® / Tegaderm Foam® / Duoderm® / Granuflex® /
Zetuvit E® / Zetuvit Plus® / Allevyn® / Biatain® / Tegaderm Foam® / Versiva XC®
Zetuvit E® / Zetuvit Plus® / Allevyn® / Biatain® / Tegaderm Foam® /
To be used in conjunction with the wound assessment form and first choice dressings list Integrated Draft version 0.1
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First Choice Dressing List
Wound Yellow (Sloughy) 5–7 (assess for signs of infection)
Low exudate
Shallow
Aquacel® / Sorbsan® / Actifoam Sheet®/ Duoderm® / Granuflex® /
Primary dressing
Moderate exudate
Heavy exudate
Cavity
Shallow
Cavity
Shallow
Aquacel® / Sorbsan®
Aquacel® / Sorbsan® / Sorbian Sachet S®
Aquacel® / Sorbsan®
Aquacel® / Sorbsan® / Sorbian Sachet S®
Cavity
Aquacel® / Sorbsan®
Infected
Iodoflex® / Iodosorb® / Medihoney® / Mesitran® / Biatain AG® / Aquacel AG® / Atrauman Ag® / Urgotul SSD®/ SilveCel®/ Kendal AMD® / Suprasorbx+PHMB ®/ (Refer to BNF for suitable
Secondary dressing if required
Duoderm® /
Duoderm® /
Duoderm® /
Duoderm® /
Granuflex® /
Granuflex® /
Granuflex® /
Granuflex® /
Duoderm® / Granuflex® / or Zetuvit E® / Zetuvit Plus®
Duoderm® / Granuflex® / or Zetuvit E® / Zetuvit Plus®
Larvae Therapy Refer to TVN
To be used in conjunction with the wound assessment form and first choice dressings list Integrated Draft version 0.1
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First Choice Dressing List
Wound Black (Necrotic) 8–9 (DO NOT INITAIATE DEBRIDEMENT / HYDRATION on Necrotic Feet Wounds & Wounds on lower limbs, unless Vascular status assessed and above 0.8mmgh, seek advice)
Dry
Low exudate
Vascular impaired Diabetic Black
Primary dressing
Iodine® / NAUltra® / Zetuvit E®
Secondary dressing if required
Softpore® / Alldress® / Zetuvit E®
Shallow
Duoderm® / Granuflex® /
Cavity
Aquacel® / Sorbsan®
Duoderm® / Granuflex® /
Moderate exudate
Shallow
Cavity
Aquacel® / Sorbsan®
Aquacel® / Sorbsan®
Duoderm® / Granuflex® / Allevyn®/ Biatain® / Tegaderm
Duoderm® / Granuflex® / Allevyn®/ Biatain® / Tegaderm Foam®
Heavy exudate
Shallow
Cavity
Aquacel® / Sorbsan®
Aquacel® / Sorbsan®
Duoderm® / Granuflex® /
Duoderm® / Granuflex® /
Zetuvit E® / Zetuvit Plus®
Zetuvit E® / Zetuvit Plus®
Infected
Iodoflex® / Iodosorb® / Medihoney® / Mesitran® / Biatain AG® / Aquacel AG® / Atrauman Ag® / Urgotul SSD®/ SilveCel®/ Kendal AMD® / Suprasorbx+ PHMB® / (Refer to BNF for suitable product))
Zetuvit E® / Zetuvit Plus®
To be used in conjunction with the wound assessment form and first choice dressings list Integrated Draft version 0.1
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First Choice Dressing List
DRESSING GROUPS – BNF Categories Please refer to First Choice Dressing list, manufacturer's instructions and BNF Dressings Basic dressing
Low adherent dressings
Description
Advantages
Disadvantages
Low adherent dressings consisting of viscose and rayon absorbent with adhesive border
Use on light exuding and post operative Non use on high exudating wounds wounds
Interface layer made of knitted viscous primary dressing or silicone.
Non-adherent to the wound bed lessening trauma on dressing changes. Can be an advantage for exudating leg wounds as a primary layer under an absorbent pad. Silicone can be used on skin tears and burns
Alginates
A textile fibre dressing made from the calcium salt of an alginic acid polymer derived from brown seaweed; contain mannuronic and guluronic acids in varying amounts; available as a sheet, ribbon or packing
Provide a moist wound environment; suitable for moderate to heavy exudate; dressing containing silver can be used on infected wounds; useful for sinus and fistula drainage; have haemostatic properties; can be irrigated out of wound with sodium chloride (0.9%)
Hydrofibre
A soft, non-woven dressing composed of 100% hydrocolloid fibres (sodium carboxymethylcellulose); available as sheet or ribbon. May be contained within a dressing
Suitable for highly exuding wounds (able to absorb up to 30 times its weight in fluid); holds exudate within its Requires a secondary dressing structure and keeps it away from surrounding skin; very easy to remove, gels more easily than alginates
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Cannot be used on dry wounds or wound with hard necrotic tissue (eschar); sometimes a mild burning or ‘drawing’ sensation is reported on application; secondary dressing required
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First Choice Dressing List
Dressings
Description
Advantages
Disadvantages
Foams
Suitable for use with open, exuding wounds; highly absorbent, nonadherent and provide a moist, thermally Produced in a variety of forms, most being insulated wound environment. constructed of polyurethane foam and may have In hypergranulating or over granulating May be difficult to use in wounds tissues which can arise from the use of with deep tracts one or more layers; foam cavity dressings are occlusive dressing such as also available hydrocolloids, changing to a more permeable product such as a foam may be beneficial.
Soft Polymer
Dressings with soft polymer are often in a nonadherent layer.
Suitable for light to moderate exuding wounds. Has gentle adhesive properties and can be used on fragile skin areas or where beneficial to reduce the frequency of primary dressing changes
Extra absorbent dressings / pads
Dressings or pads for use on high exudate wounds
Secondary dressing to give extra absorbency
Some can may adhere to the wound bed if applied directly to wound bed, may shred fibres
Hydrocolloids
Usually consist of a base material containing gelatin, pectin and carboxymethylcellulose combined with adhesives and polymers; base material bonded to either a semi-permeable film or a film plus polyurethane foam; some have an adhesive border
Suitable for acute and chronic wounds with low to no exudate; provide a moist wound environment; promote wound debridement; provide thermal insulation; some are waterproof and therefore a barrier to micro-organisms; mould to body shape
May release degradation products into the wound; strong odour produced as dressing interacts with exudate. May cause hypergranulation / over granulation tissue – refer to foams
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Not to be used on heavy bleeding wounds as blood clots can lead to the dressing adhering to the surface.
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Dressings
Hydrogels
First Choice Dressing List
Description
Advantages
Contain 17.5–90% water depending on the product, plus various other components to form a gel or solid sheet
Disadvantages
Suitable for light exudate wounds; absorb small amounts of exudate; donate fluid to dry necrotic tissue; reduce pain and are cooling; low trauma at dressing changes; can be used as carrier for drugs. Take up shape of the wound.
Cool the wound surface; best avoided for infected wounds; can cause skin maceration due to leakage if too much gel is applied or the wound has moderate to heavy exudate
Suitable for chronic wounds with varing exudate that need protection from bacterial contamination by providing a broad range of antimicrobial activity; can reduce or prevent infection
Cannot be used during radiotherapy, sometimes sensitivity occurs with the use of silver and some skin staining can occur; instructions vary with products and dressings are expensive
The 'IFEE' formula is a reminder that infection is indicated by Induration, Fever, Erythema and Edema. An elevated white blood cell count (leukocytosis) can also indicate that an infection is present. Antimicrobials cover Iodine, honey and silver dressings (see below) Refer to Appendix for further guidance (to follow)
Iodine dressings
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These topical dressings should be used as primary dressings on the wound bed. They are available within KCHT as alginates, hydrofibres, foams iodine and honey based. They should only be prescribed where infection is suspected based on a risk assessment using NERDS as a guideline: N - Non-healing E - Purulent exudate R – Redness D – Delay S - Smell
Consist of hydophilic beads which contain iodine Useful in the treatment of infected, in powder or paste form, which swell and form a sloughy and necrotic wounds gel on contact with exudate
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Require retaining dressing; may be difficult to apply, caution in using products containing iodine. Should only be used for 3 months at a time. Not suitable for people with thyroid disorders Systemic absorption may occur
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Dressings
Honey
First Choice Dressing List
Description
Advantages
Disadvantages
Can be messy to use and cause leakage if excess exudate is present; Medical grade honey is applied directly to the Suitable for acute and chronic caution in diabetes due to absorption wound bed. Honey has an osmotic effect that infected, necrotic or sloughy wounds; of glucose and fructose helps deslough wounds and maintains a moist provide a moist wound environment; Only some honey products can be environment. used with caution on diabetic and non-adherent; antibacterial; assist with wound debridement; eliminate arterial wounds, monitoring of the Available as impregnated dressing pads or tubes wound malodour; have an antipatients condition and the wound bed of liquid honey; most widely used is Manuka inflammatory effect is essential where used in this honey instance (e.g. regular blood glucose monitoring) For profuse exudate, a hydrofibre with silver or a foam dressing with silver may be the best choice
Silver
Note : You may require further support from Tissue Viability Team and demonstrate relevant competences when considering using silver.
Antimicrobial dressings containing silver are available as topical treatments for signs or symptoms of infected wounds A hydrofibre dressing combines moist wound healing with the look, feel, and handling properties of gauze and alginates
For low exudating wounds a nonadherent silver dressing would be best choice
Reassess the wound frequently. If the wound doesn't start to heal and shows signs of deterioration and For a wound that has a foul odor as deeper tissue involvement, despite well as toxins from Gram-negative topical antimicrobial treatment, bacteria, charcoal/silver combination systemic antimicrobial therapy may need to be prescribed dressings may be effective.
The cause of the patient's colonisation should be identified and corrected if possible. Maintain the Using the best possible dressing is patient's nutritional status and monitor any key to avoiding tissue toxicity and coexisting disorders possible bacterial resistance. Slow sustained release silver dressings are more advantageous
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Dressings
First Choice Dressing List
Description
Advantages
Disadvantages
Semi-permeable films
Polyurethane film with a hypoallergenic acrylic adhesive; vapour permeable films allow the passing of water but not micro-organisms.
Only suitable for shallow superficial wounds; prophylactic use against friction damage; useful as retention dressing; allow monitoring of the wound
Possibility of adhesive trauma if removed incorrectly; do not contain exudate and can macerate, slip or leak as fluid builds under the dressing
Activated charcoal (odour absorbing dressings)
Contain a layer of activated charcoal that traps odour-causing molecules thereby reducing/removing wound odour
Easy to apply as either primary or secondary dressing; work immediately to reduce odour
Need to obtain a good seal to prevent leakage of odour; some dressings lose effectiveness when wet
Protease Modulating matrix
Capillary wound dressings
Skin barrier cream / film
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Conforms well to wound surface, Protease modulating matrix alters the activity of maintains a moist environment, the protolytic enzymes in chronic wounds; the suitable for most wounds to clinical significance of the approach is yet to be accelerate healing (example: demonstrated. Promogran). Supports ECM
Requires a secondary dressing and not recommended for necrotic wounds
Suitable for light to heavy exudate; debride necrotic tissue; protect and Composed of 100% polyester filament outer insulate the wound; maintain a moist layers and a 65% polyester and 35% cotton environment and prevent woven inner layer; outer layer draws exudate, maceration; encourage development interstitial fluid and necrotic tissue into the inner of granulation tissue; can be cut to layer via a capillary action any shape and are available in large Example: ‘Vacutex’ rolls; can be used as a wick to drain sinus and cavity wounds
Can be hard to cut and are quite stiff to fit into wounds; cannot be used on malignant wounds or where there is the risk of bleeding due to the ‘drawing’ action and resultant increase in blood flow to the wound bed
Non-cytotoxic; do not sting if applied to raw areas of skin; high wash-off resistance; protect the skin from body fluids (including urine, diarrhoea, saliva and wound exudate), friction and shear and the effects of adhesive products
Product selection is vital for correct protection depending on wound type and skin condition. Films to be used for severe dermatis, excoriated weeping areas and prevention of maceration around wound edges. Creams to be used on intact skin only.
Alcohol-free barrier cream or film that forms a protective layer on the skin
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First Choice Dressing List
FIRST CHOICE DRESSING LIST:
First Choice Dressing list for 2012 P= Primary Dressing S= Secondary Dressing Note some dressings can be used as a primary or secondary dressing First Choice Dressing list for 2012 1st Choice 2012
2nd Choice 2012
Basic Dressings
Softpore (P/S)
Solvaline N (P)
Low Adherent Dressings
Atrauman (P) NA-Ultra (P)
Soft Polymer (low adherent)
Mepitel / Mepitel one (P)
Urgotul (P)
Soft Polymer with absorbent pad
Allevyn Gentle (P) Biatain Silicone (P)
Sorbian Sana (P)
Poditary use
Please use soft polymers for the management of wounds on fragile skin and children only
Management of moderate to lightly exuding wounds. Suitable for all wounds with a heterogeneous healing process (mixed wound bed). Mepilex (P) for palliative wounds, burns
Soft Polymer bio-cellulose
Sorbian Sachet S (P)
Not to be used as a super absorbent pad outside of other dressings. Can be used over Low Adherent Dressings Suprasorb X (P) Alginate
Sorbsan (P)
Use as a haemostat only Integrated Draft version 0.1
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First Choice Dressing List
Foam Dressings: Adhesive and non adhesive
Allevyn (Caution can cause skin stripping if not damped to remove)(P/S)
Overgranulation
Biatain (P/S) Tegaderm Foam (P/S) Lyofoam(P)
Haelan Ointment Haelan Tape
(For over granulation enteral feeding sites etc) Sterile / Non-sterile Absorbent Dressings
Zetuvit (S)
Gamgee 500g Pink Label Roll (for use outside bandages etc not to be used as primary dressing)(S) Hydrocolloid –fibrous dressings Hydrocolloid
Aquacel (P) Versiva XC (P/S) Duoderm (P/S) Granuflex (P/S)
Anti-Microbial Dressings Iodine Dressings
Iodoflex (P) Iodosorb (P)
Inadine (only to be used for: Bites; Vascular issues; necrotic areas which are to remain dry and when directed by a consultant) DO NOT USE TO DRY UP SKIN LACERATIONS
Microbial Dressings Honey
Mesitran (P) Medihoney (observe cautions in BNF)
Anti-Microbial Dressings Silver Foam Dressings
Biatain Ag (P)
Anti-Microbial Dressings Silver – Hydrocolloid –fibrous dressings
Aquacel Ag (P) Silvercel / non-adherent (P)
Anti-Microbial Dressings Silver – Non-adherent
Urgotul SSD (P)
Mepilex AG
(For Burns & pallative Only)
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Acticoat 3 Acticoat 7 & Flex (P) Page 16 of 22
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First Choice Dressing List
Antimicrobial gels / soaks
Prontosan soaks (caution can not be used on exposed tendons or any underlying structures)
PHMB Dressings
Kendal AMD Foam (P) Prontosan wound gel (caution can not be used on exposed tendons or any underlying structures) Suprasorb X+ PHMB (P)
Vapour-permeable films
Tegaderm (P/S)
Vapour-permeable films with absorbent pad IV Vapour-permeable films and antimicrobial dressings
Alldress (P/S) Tegaderm Absorbent Clear (P) IV 3000 Tegaderm IV
Charcoal Dressing
Clinisorb
Protease Modulating Matrix
Promogram / Prisma (P)
Acticoat site Tegaderm CHG IV links and IV team to recommend for infected IV sites only
Tegarderm Matrix
(Under TVN advice only) Urgocell Start (P/S) (Not to be used on infected
wounds) Capillary Dressing
TVN Advice
Skin Barrier films For peri-wound protection
Cavilon Film Sorbaderm Film
For Moisture lesions protection from excess moisture and incontinence
Medi-honey Barrier Cream Prosheild
Emollients
50 / 50 Liquid & White Soft Paraffin (ointment and spray) Double Base
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Washes Sodium Chloride Wound Cleansing products – Aerosol cans Sodium Chloride Wound Cleansing Products – Individual sachets Securing Tape Compression Hosiery
Tubular Bandages Elasticated Viscose Stockinette
Light weight conforming bandages
First Choice Dressing List
QV Aqueous Cream QV Stericlens Normosol Clinipore / Generic Tape Hyperfix Activa ® range Carolon range Medi Uk (For any lymphodema patients always discuss with lymphodema service or the local rep prior to application) Generic Elasticated Viscose Stockinette Clinifast Do not use as primary layer on limbs unless clinically indicated i.e. reaction to sub-compression wadding padding layer, use of creams to prevent wadding adhering to skin. Knit- band
Knitted Elastomer and Viscose Bandage
Generic sub compression wadding K-soft Profore ≠ 1 If compression not required consider using subcompression wadding padding layer and tubular bandages elasticated viscose stockinette (top layer only) instead of adding knitted elastomer and viscose bandage.
Support Bandages
K-lite Profore ≠ 2 K-Plus Profore ≠ 3 K-Four
Sub-compression wadding Padding
Cohesive bandage / stretch bandage Integrated Draft version 0.1
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Multi-layer compression bandaging 4 – layer system Multi-layer compression bandaging 2 – layer system Short stretch Bandage Medicated Bandages / Stocking
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First Choice Dressing List
Profore ≠ 4 K- Four multi-layer compression bandage kit Profore multi–layer compression bandage kit Coban K- Two ProGuide Actico Short-stretch Ichthopaste Steripaste
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FORM 1 Page 1 Prescription Request for 1st choice Dressings 2012
First Choice Dressing List Type of dressing
Name of dressing EXAMPLE biatain
Size DO NOT USE SHAPED DRESSINGS ROUTINELY GIVE RATIONAL
e.g. Silicone / Adhesive / non bordered
10cm x 10cm
Number of dressings used at each change
Number of changes per week
Number of weeks supply MAX 4 WEEKS SUPPLY
Qty to be ordered
2 (x)
3 (x)
4 (x)
= 24
Rational e.g. New treatment / change of treatment / wound type/ multiple wounds
Allevyn Gentle / Allevyn Aquacel Atrauman Biatain (NOT ibu) / Biatain Silicone Clinisorb (Charcoal Odour Control) Duoderm Granuflex (Bordered) Mepliex Burns and Palliative wounds only Mepitel / one Medihoney products N-A Ultra Promogram TVN Advice Only Sorbian Sorbsan (NOT AG) Soft pore Supersorb X Tegaderm Foam Tegaderm Absorbent Clear Urgotul Urgotul start TVN Advice Only Versiva XC Zetuvit SILVER DRESSINGS / PHMB’s
Use for a max of 2 weeks
Atrauman AG Aquacel AG Bitatain AG Kendal AMD Foam Silvercel Supersorb X+PHMB Urgotul SSD IODINE BASED DRESSINGS
Use for a max of 12 weeks
Iodoflex Paste ( Max treatment length of time 12 weeks) Iodosorb Ointment (Max treatment length of time 12
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First Choice Dressing List
1 Page 2 Prescription Request for 1st choice Dressings 2012
DATE
Skin protectants / Creams and washes
Type
Size
Qty to be ordered
SURGERY
Skin protectants / Creams and washes PATIENTS NAME
D.O.B
Cavilion cream / film /foam applicatiors Medi-Honey Barrier Cream Sorbaderm cream / film / foam applicatiors Proshield White Soft Paraffin / Liquid Paraffin spray (Emollin) / ointment Doublebase QV cream / ointment / wash Aqueous cream for wash only
NHS. NO TEL.NO PATIENTS ADDRESS
NAME OF NURSE (Please print)
TEL.NO
SIGNATURE OF NURSE
BASE
Normasol Stericlens
Patient wishes prescription to be: (Please tick one box only) Left at surgery for collection by patient or representative
Forwarded to …………..…………………………………. Pharmacy * for collection by patient or representative
4 (x)
.
Prontosan irrigation solution (not to be used on exposed tendons or underlying structures)
Bandages
Forwarded to ……………………………………………… Pharmacy * for delivery to patient.
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First Choice Dressing List
FORM 2 Prescription Request for Non-Formulary / 1stst choice Dressings
THIS FORM SHOULD ONLY BE USED WHEN THERE IS A VALID RATIONLE. THIS RATIONALE SHOULD BE CLEARLY DOCUMENTED IN THE NURSING NOTES.
Name of dressing
DATE
Size
SURGERY PATIENTS NAME
D.O.B TEL.NO
5cm²
Number of dressings used at each change
Number of changes per week
2 (x)
3 (x)
Number of weeks supply MAXIMUM FOUR WEEKS SUPPLY 4 (x)
Quantity to be ordered
(= ) 24
PATIENTS ADDRESS
NAME OF NURSE (Please print) SIGNATURE OF NURSE
YES
NO
Has this been discussed with the Tissue Viability Nurse?
BASE
Was this discussion prior to ordering the above products? TEL.NUMBER Was the decision approved by the Tissue Viability Nurse? FAX NUMBER
*
Please state whether form is to be faxed back to Community Nurse or direct to GP Surgery.
Please use this box to give rationale for prescribing outside of the formulary and attach a copy of the patients current wound care chart. e.g. What is the problem? Is this a new treatment or change of treatment? If a change, please state what is being stopped. What is the likely duration of treatment (more or less than 4 weeks)?
Patient wishes prescription to be: (Please tick one box only) Left at surgery for collection by patient or representative Forwarded to …………..…………………………………. Pharmacy ** for collection by patient or representative Forwarded to ……………………………………………… Pharmacy ** for delivery to patient. Integrated Draft version 0.1
*
Please make sure that you include a Fax number and indicate where the form needs to be sent (e.g. back to Community Nurse or direct to GP surgery) Patient treatment may be delayed if the fax number is omitted.
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