Wound Care Management Formulary Amendment History VERSION

DATE

AMENDMENT HISTORY

4.0 5.0

December 2014 September 2015

Previous version Comments – Additional products added and products removed that are no longer available. Update to

REVIEWERS This document had been reviewed by: NAME

DATE

TITLE/RESPONSIBILITY VERSION

ACE

November 2015

Assurance Framework for managing clinical policies and guidelines

5.0

APPROVALS This document has been approved by: NAME

DATE

TITLE/RESPONSIBILITY VERSION

NB: The version of this policy posted on the intranet/internet must be a PDF copy of the approved version. DOCUMENT STATUS This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled. RELATED DOCUMENTS These documents will provide additional information: REFERENCE DOCUMENT TITLE VERSION NUMBER

APPLICABLE LEGISLATION N/A GLOSSARY OF TERMS TERM ACRONYM Clinical Commissioning CCG Group Area Clinical ACE Effectiveness Committee

DEFINITION

1

Wound Management Formulary Group / Authors Minesh Parbat Wound Management Group Chair Prescribing Adviser, Dudley Office of Public Health Lynda Bloomer Diabetes Specialist Podiatrist Clare Carter Clinical Nurse Specialist Tissue Viability Sharon Cole Clinical Nurse Specialist Vascular Sheila Coley Leg Ulcer Clinic Co-ordinator Sue Dunning Leg Ulcer Clinic Co-ordinator Lisa Evans-Dimmock Clinical Nurse Specialist, Infection Control Dawn Flavell Tissue Viability Sister Danielle Hartill Tissue Viability Sister Bryan Mullin Infection Prevention Nurse, Office of Public Health Dudley MBC Karen McBride Tissue Viability Sister Louise Storey Practice Teacher for District Nursing Jag Sangha Pharmaceutical Adviser, Dudley Office of Public Health Claire Taylor Podiatry Tissue Viability Lead Lisa Turley Lead Clinical Nurse Specialist Tissue Viability Wendy Walker Diabetes Specialist Podiatrist Simon Wharton Consultant Plastic Surgeon Alison Whitlock Clinical Pharmacist Michelle Webb District Nurse, Kingswinford Team Contacts Infection Control Nurse Hospital 01384 456111 Ext 2174 Infection Prevention and Control Team 01384 321854 Pharmacy DGNHSFT 01384 244031 Pharmaceutical Public Health Team, 01384 816450 Office of Public Health Tissue Viability Nurse Community Office 01384 321785 Tissue Viability Team Hospital 01384 244368

2

Contents Products Basic Wound Contact Dressings (low adherent) Film dressings Soft polymer wound contact dressings Foams Low tac foam Alginates Hydrofibre Hydrocolloids Hydrogels Charcoal dressings Antimicrobial dressings Bandages Products to be used with Tissue Viability / Specialist advice only Absorbent padding Kerraped footwear Cleansing solutions Skin products Other Therapies Appendix 1 Exceptions monitoring form Appendix 2 Authorisation form for silver containing wound dressing

3

Page 4 4 5 6 7 7 8 8 9 9 10-11 12-14 15 16 16 16 17 17 18-19 20-21

Basic Wound Contact Dressings Perforated film absorbent dressings are suitable for lightly exuding wounds. They are not appropriate for wounds that produce large quantities of viscous exudate. Atrauman Use & tips

Avoid Mepore

Use & tips Tegaderm & Pad Use & tips

NA Ultra Use & tips

5cm x 5cm 10cm x 20cm 7.5cm x 10cm 20cm x 30cm Non-adherent knitted polyester primary dressing impregnated with neutral triglycerides. It is suitable for use on abrasions, burns, and other superficial injuries of the skin including ulcers and post-operative wounds. Apply to overlap dry surrounding skin by at least 1cm. Moderate to heavily exuding wounds. 6cm x 7cm 9cm x 20cm 10cm x 11cm 7cm x 8cm 9cm x 25cm 11cm x 15cm 9cm x 10cm 9cm x 30cm 9cm x 15cm 9cm x 35cm Low adherence dressing consisting viscose and rayon absorbent pad with adhesive border. It is suitable for wounds healing by primary intention. 5cm x 7cm 9cm x 10cm 9cmx15cm 9cmx20cm 9cm x 25cm 9cm x 35cm Vapour-permeable adhesive film dressing with absorbent pad. Please note the wound contact pad sizes are approximately 4 to 5cm square smaller than the overall size of the dressing. Shower proof. 9.5 x 19cm 9.5cm x 9.5cm 19cm x19cm An alternative to tulle dressings for exuding wounds. It can be used as the initial layer of multi-layer compression bandaging in the treatment of venous leg ulcers.

Film Dressings Vapour permeable films allow the passage of water vapour and oxygen but not water or microorganisms. They are highly conformable, convenient to use and provide a moist healing environment. Tegaderm Plus Pad Use & tips

4.4cm x 4.4cm* 10cm x 25cm* 20cm x 30cm* 6cm x 7cm 12cm x 12cm 10cm x 12cm* 15cm x 20cm Film dressing that can be used on superficial and epithelialising wounds as a primary contact layer or as a secondary retention dressing.

* Hospital only sizes

4

Soft Polymer Wound Contact Dressing Dressings with soft polymer in a non-adherent layer are suitable for use on lightly to moderately exuding wounds. They have gentle adhesive properties and can be used on fragile skin areas or where it is beneficial to reduce the frequency of primary dressing changes. For highly exuding wounds, an absorbent secondary dressing is required. Soft polymer dressings should not be used on heavily bleeding wounds as blood clots can cause the dressing to adhere to the wound surface. Urgotul Use & tips

Mepitel One Use & tips

5cm x 5cm 10cm x 10cm 15cm x 20cm 10cm x 40cm 20cm x 30cm Non adherent soft polymer contact dressing with Lipdio-Colloid Technology. It can be left in place for 14 days. It is suitable for use on any acute or chronic low exuding wound. A secondary dressing is required. 6cm x 7cm 9cm x 10cm 13cm x 15cm 24 cm x 27.5cm For use on fragile skin or where it is beneficial to reduce the frequency of primary dressing changes. Can be left in-situ for up to 14 days. A secondary dressing is required.

5

Foam Dressings Dressings containing hydrophilic polyurethane foam (adhesive or non-adhesive) with or without plastic film-backing, are suitable as a primary dressing. Foam dressings are not intended as a debriding agent. Some foam dressings have a moisture-sensitive film backing with variable permeability dependant on the level of exudate. If used under compression bandaging or compression garments, the fluid-handling capacity of the foam dressing may be reduced. Biatain Adhesive (Square)

Biatain Adhesive (Sacral) Biatain Adhesive (Heel) Biatain Adhesive (Contour) Biatain Adhesive (Rectangular) Biatain Non Adhesive (Circular) Biatain Non Adhesive (Square) Biatain Non Adhesive (Rectangular) Use & tips

Avoid Lyofoam Max Use & tips Avoid

10cm x 10cm (circular wound contact pad 6cm diameter) 23cm x 23cm

12.5cm x 12.5cm

18cm x 18cm

19cm x 20cm 17 cm diameter 18cm x 28cm 5cm diameter

8cm diameter

10cm x 10cm

15cm x 15cm

5cm x 7cm

10cm x 20cm

20cm x 20cm

Indicated for the treatment of moderate to heavily exuding wounds. The dressing may be used throughout the healing process, and may be applied under compression bandages. It has a soft, low friction top film which is selectively permeable allowing the passage of gases and water vapour, whilst providing bacteria proof and water resistant outer layer. Use with oxidizing solutions. 7.5 cm x 7.5 cm 10 cm x 17.5 cm 15cm x 15cm 10 cm x 10 cm 15 cm x 20 cm 20cm x 20cm For low to moderately exuding wounds. Useful on over-granulating wounds. A secondary dressing is required. Use with oxidising solutions

6

Low Tac Foams (Soft Polymer Dressings with Absorbent Pad) Wound contact dressings coated with soft silicone have gentle adhesive properties and are for use on fragile skin only.

Allevyn Gentle Allevyn Gentle Border Allevyn Gentle Border (Heel) Allevyn Gentle Border (Sacrum) Use & tips

5cm x 5cm 15cm x 15cm 7.5cm x 7.5cm 17.5cm x 17.5cm

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

10cm x 20cm 12.5cm x 12.5cm

23cm x 23.2cm 16.8cm x 17.1cm For low to moderately exuding wounds. A secondary dressing or bandaging may be required.

Alginates Alginate dressings are derived from seaweed. Alginates form a firm moist gel on contact with wound exudate to conserve moisture at the wound interface, or aid autolytic debridement. Calcium alginate dressings also aid haemostasis in minor bleeding wounds by providing a matrix to support blood clot formation. They are highly absorbent and indicated for use in moderate to heavily exuding wounds. Sorbsan Flat Sorbsan Ribbon/ Packing Sorbsan Plus

Use & tips

5cm x 5cm 10cm x 10cm 10cm x 20cm 40cm 30cm (with probe) (2g with probe) 7.5cm x 10cm Non 10cm x 15cm 10cm x 20cm adhesive Non adhesive Non adhesive 15cm x 20cm Non adhesive Sorbsan Calcium alginate fibre. It should be changed depending on the level of exudate, but can be left in-situ for up to 7 days. A secondary dressing is required. Do not wet before applying to the wound. Sorbsan Plus Alginate dressing bonded to a secondary absorbent viscose pad. It is suitable for moderate to heavily exuding wounds. A secondary dressing is required.

7

Hydrofibre Hydrofibre dressings are highly absorbent and made from hydrocolloid which is spun and made into a soft, non-woven fleece like dressing. The dressing converts to a soft gel when in contact with wound exudate, providing a moist wound healing environment. The absorptive capacity of the dressing is higher than both alginates and gauzes making it suitable for moderate to heavily exuding wounds. Aquacel Extra

Use & tips

Aquacel Foam (Adhesive) Aquacel Foam (Non-Adhesive) Use & tips

Avoid

5cm x 5cm 4cm x 10cm 2cm x 45cm Ribbon 10cm x10cm 4cm x 20cm 15cm x15cm 4cm x 30cm It is suitable as a primary dressing for moderate to highly exuding wounds. Aquacel is applied to the wound with an overlap of at least 2.5cm. Cavity wounds should be filled with care to avoid over packing, leaving a 2cm ‘tail’ outside the cavity wound to facilitate easy dressing removal. A secondary dressing is required. It can be left in-situ for up to 7 days in acute and chronic wounds and up to 14 days in partial thickness burns. 7.5cm x 7.5cm 11cm x 11cm 15cm x 15cm 5cm x 5cm 10cm x 10cm 15cm x 15cm 20cm x 20cm 15cm x 20cm It is suitable as a primary dressing for moderate to highly exuding wounds. Aquacel foam is applied the same as Aquacel Extra but with the added benefit of a protective waterproof outer layer and absorbent soft pad. The adhesive dressing has a gentle adhesive and can be used without a secondary dressing. The non-adhesive would need to be secured with bandage or similar retention product. Known allergies

Hydrocolloids Hydrocolloid dressings are usually presented as a hydrocolloid layer on a vapour-permeable film or foam pad. These dressing form a gel in the presence of exudate to facilitate rehydration in lightly exuding wounds and promote autolytic debridement of dry, sloughy, or necrotic wounds. They are also suitable for promoting granulation and removal of hyperkeratosis. Duoderm Extra Thin Use & tips Avoid

7.5cm x 7.5cm 5cm x 10cm 9cm x 15cm 10cm x 10cm 5cm x 20cm* 9cm x 25cm 15cm x 15cm 4.3cm x 3.8cm* 9cm x 35cm For light exuding wounds as a primary dressing. Apply to extend 2cm beyond the wound edge. Infected wounds and diabetic foot ulcers

8

Hydrogels Hydrogel dressings are generally used to donate liquid to dry, sloughy wounds and facilitate autolytic debridement of necrotic tissue Kerralite Cool (Non-Border) Kerralite Cool (Border) Use & tips

Avoid

5cm x 6.5cm 20cm x 20cm

10cm x 10cm

10cm x 15cm

8cm x 8cm

11cm x 11cm

15cm x 15cm

Hydrogel sheet dressing. Limited fluid handling capacity so avoid highly exuding wounds. It is usually recommended to secure in place with a film dressing or bandage if using the non-adhesive version. The dressing should be applied so that the dressing covers the wound and extends by approximately 25mm on to the skin. The dressing can be cut to the shape of the wound should maceration be a problem. Infected wounds

Charcoal Charcoal dressings are used to absorb and mask odours produced by fungating lesions, faecal fistulae, necrotic pressure ulcers and heavily exuding ulcers. The main aim is to control odour as rapidly as possible. Malodour may indicate the presence of infection and must be treated according to wound care guidance. Clinisorb Use & tips Sorbsan Plus Carbon Use & tips

10cm x 10cm 10cm x 20cm 15cm x 25cm Activated charcoal non - absorbent secondary dressing. Apply over a suitable primary dressing and secure. 7.5cm x 10cm 10cm x 15cm 10cm x 20cm 15cm x 20cm Activated charcoal absorbent dressing. It can be used as a primary dressing. A secondary dressing is required

9

Antimicrobial Dressing Products Prior to prescribing and applying any antimicrobial dressing, please refer to wound care guidelines. Iodine Based Products Povidone-iodine fabric dressing (Povitulle) is a knitted viscose dressing with povidone-iodine. The iodine has a wide spectrum of antimicrobial activity but it is rapidly deactivated by wound exudate. Cadexomer-iodine (Iodosorb / Iodoflex), like povidone-iodine, releases free iodine when exposed to wound exudate. The free iodine acts as an antiseptic on the wound surface, the cadexomer absorbs wound exudate and encourages de-sloughing. The maximum single application is 50g and maximum weekly application is 150g. Systemic absorption of iodine may occur, particularly form large wounds or with prolonged use. Therefore, a three month duration of treatment is recommended. Povitulle Use & tips Avoid

Iodosorb (ointment)

Use & tips Avoid

Iodoflex (paste)

Use & tips

Avoid

5cm x 5cm 9.5cm x 9.5cm It is suitable for use as a wound contact layer for low exuding abrasions and superficial burns. A secondary dressing is required. Foams as a secondary dressing with exception of application to areas where bandaging is inappropriate or impractical. Iodine can be used with caution in children under 6 months and patients with thyroid disease but is contraindicated in use on patients with severe renal impairment, pregnancy, breast feeding. 10g

20g

It is suitable for treatment of light to moderately exuding wounds. A secondary dressing is required. Foams as a secondary dressing with exception of application to areas where bandaging is inappropriate or impractical. Contraindicated in patients receiving lithium treatment. Iodine can be used with caution in children under 6 months and patients with thyroid disease but is contra-indicated in use on patients with severe renal impairment, pregnancy, breast feeding. 5g

10g

17g

Cadexomer-iodine in a paste basis with gauze backing which should be removed prior to application. It is suitable for treatment of moderate exuding wounds. A secondary dressing is required. Foams as a secondary dressing with exception of application to areas where bandaging is inappropriate or impractical. Contraindicated in patients receiving lithium treatment. Iodine can be used with caution in children under 6 months and patients with thyroid disease but is contra-indicated in use on patients with severe renal impairment, pregnancy, breast feeding.

10

Medical Grade Honey Medical grade honey has antimicrobial and osmotic properties, producing an environment that promotes autolytic debridement and can help control wound malodour. Honey dressings should not be used on patients with extreme sensitivity to honey, bee stings or bee products. Patients with diabetes should be monitored for changes in blood-glucose concentrations during treatment with topical honey or honey-impregnated dressings, follow diabetic guidelines on blood glucose monitoring. Actilite 10cm x 10cm 10cm x 20cm Use & tips Knitted viscose impregnated with medical grade honey and manuka oil. It is suitable for low exuding wounds. A secondary dressing is required. Activon 25g tube Use & tips Medical grade honey is applied directly to the wound and covered with a primary low adherence wound dressing. It is suitable for low to moderate exuding wounds. A secondary dressing is required. Algivon 5cm x 5cm 10cm x 10cm Plus Algivon Plus 2.5cm x 20cm Ribbon Use & tips Absorbent, non-adherent calcium alginate dressing impregnated with medical grade manuka honey. For moderate exuding wounds and will require a secondary dressing. Flaminal Flaminal is a hydro-activate alginate gel dressing which has a naturally occurring enzyme system that specifically targets bacterial cells. The gel is in a tube which single patient use only. The tube reseals itself so that it can be used multiple times without risk of contamination. Ensure the wound bed is covered with at least 5 – 10mm thick layer of gel. Flaminal Hydro Gel Use & tips Flaminal Forte Gel Use & tips

15g tube

50g tube

For light to moderately exuding wounds. Will donate moisture to wound bed and promote autolytic debridement. A secondary dressing is required. 15g tube

50g tube

For moderate to heavily exuding wounds as it will absorb large quantities of exudate. A secondary absorbent dressing is required. Silver Dressing Products

There is debate around the efficacy of silver containing dressing products and they are expensive. Where you perceive there to be a clinical need for silver dressings, you will need to discuss with one of the following individuals: Tissue Viability and Vascular Nurse Specialist or Diabetes Specialist Podiatrist. Once the patient has been reassessed and a need for prescribing silver containing dressings is confirmed then an authorisation form for silver containing wound dressings will need to be obtained and signed by one of these designated individuals – see appendix 2 11

Absorbent Padding Non-woven Fabric Swabs Use & tips Avoid Zetuvit E Note: Sterile and Non Sterile Zetuvit Plus (sterile) Use & tips KerraMax Care Use & tips

7.5cm x 7.5 cm 5 10cm x 10cm pads 100 pads Non-sterile gauze swabs for general use swabbing & cleansing. Use dry to swab and moistened to cleanse. Direct contact with wound bed. 10cm x 10cm

10cm x 20cm

20cm x 20cm

20cm x 40cm 10cm x 10cm 10cm x 20cm 15cm x 20cm 20cm x 25cm 20cm x 40cm To absorb exudate in moderate to highly exuding wounds as a secondary dressing 10cm x 10cm 10cm x 22cm 20cm x 22cm 20cm x 30cm 20cm x 50cm 5cm x 5cm Super absorbent dressing. Can be used as a primary or secondary dressing Bandages

Sub-Compression Wadding Bandage Compression Bandages section should be read in conjunction with leg ulcer guidelines K Soft 10cm x 3.5m 10cm x 4.5m (K soft long) Cellona 5cm x 2.75m 10cm x 2.75m 7.5cm x 2.75m 15cm x 2.75m Light Weight Conforming Bandage Lightweight conforming bandages are used for dressing retention, with the aim of keeping the dressing close to the wound without inhibiting movement or restricting blood flow. They are therefore useful bandaging digits for lymphoedema patients, in dressing retention in patients with confirmed arterial disease or patients with uncontrolled heart failure. Easifix Mollelast (Latex free)

5cm

7.5cm

4cm

6cm

10cm

15cm

Support Bandages Since they have limited extensibility, they are able to provide light support without exerting undue pressure. They can be used to prevent oedema. 12

Profore #2 (latex free) K Lite (type 2) K Lite (long) Use & tips

10cm x 4.5m 5cm x 4.5m 7cm x 4.5m 10cm x4.5m 15cm x 5.2m 10cm x 5.2m Use Profore # 1 or K soft under these support bandages to aid patient comfort and absorb any exudates. Always apply joint to joint.

Compression Bandages Doppler assessment is required prior to the application of compression therapy. Doppler assessment and application of compression should only be undertaken by those clinicians who are trained and competent to do so. Light compression (type 3a) K-Plus (type 3a)

10cm x 8.7m

10cm x 10.25m

High Compression K Three C Use & tips Avoid

10cm x 3m Venous leg ulceration and lymphoedema. Arterial disease, arterial ulcers, diabetes and those with small vessel disease.

Cohesive bandage Ko Flex

10cm x 6m

10cm x 7cm (long)

Short Stretch Compression Bandages

Actico bandage Use & tips

Avoid Comprilan Bandage Use & tips

4cm x 6m 8cm x 6m 12cm x 6m 6cm x 6m 10cm x 6m Short stretch bandage for venous leg ulceration and lymphoedema. For use with those patients that are mobile i.e. able to walk to the toilet independently. Applied at full stretch using circular, spiral or figure of 8 technique. Arterial disease, arterial ulcers, diabetes and those with small vessel disease. 6cm x 5m 10cm x 5m 8cm x 5m 12cm x 5m Lymphoedema patients only.

Two Layer Systems Compression is achieved by the combined effects of two extensible bandages applied over a primary dressing. 13

3M Coban Coban lite Use & tips K-Two Use & Tips Actico 2 C Use & tips Actico 2 C Use & tips

1 size only 10cm x 6m For patients with ABPI 0.5 and above 0 short 18-25 cm 25 – 32cm Measure ankle circumference before application 18 – 25cm kit Comfort Layer 1 10cm x 3.5 m Compression Layer 2 10cm x 6m 25 – 32 cm kit Comfort Layer 1 10cm x 3.5 m + 10cm x 2m Compression Layer 2 10cm x 9m

Medicated Bandages Zinc paste bandage can be used to treat mild eczema and / or leg ulceration, after a patch test has been applied to assess for allergic reaction. They can be used under compression if Holistic and Doppler assessment indicates. A retention bandage or wadding plus support bandage will be required. Caution in patients with arterial insufficiency. Viscopaste PB7 Use & tips

Avoid Ichthopaste Use & tips

Avoid

7.5cm x 6cm Zinc oxide paste (10%). It can be used in association with compression for the treatment of venous leg ulcers. Apply toe to below knee by pleating bandage every turn at the front of the leg or can be used in strips. Secure with retention bandage. Zinc allergy. Hydoxybenzoates allergy. Not for macerated skin or severe eczema. 7.5cm x 6cm Zinc oxide 6.32% and ichthamol 2% paste. It can be used in association with compression for the treatment of venous leg ulcers. Used in the treatment of chronic eczema and dermatitis where occlusion is indicated. Apply toe to below knee by pleating bandage every turn at the front of the leg or can be used in strips. Secure with retention bandage. Zinc allergy. Hydoxybenzoates allergy.

Products to be used with the Tissue Viability and Vascular Nurse Advice / Diabetes Specialist Podiatrist use only LarvaE Available in BioBag 4cm x 5cm

Use & tips

Negative Pressure Wound Therapy Use & tips

5cm x 6cm

6cm x 12cm

10cm x 10cm

2.5cm x 4cm

Half pot Full pot for wounds 2cm x 2cm for wounds 5cm x 5cm Sterile maggots for wet, sloughy wounds. For information or to request treatment, contact Tissue Viability Service and refer to Trust TNP guidelines for further information. Refer to dressing order form or Procurement for in-patient use. Topical therapy to assist with closure of a wound by total negative pressure. Will reduce the bacterial burden of the wound, stimulate granulation, and accelerate wound closure. Specialist technique. Must be applied only by trained, competent practitioners. 14

PolyMem Foam Use & tips Caution Kendall AMD Foam Use & tips

Thin polyurethane foam dressings containing a non-toxic cleanser and a moisturiser with a semi-permeable film backing. Due to the action of the dressing, wounds can become wetter. Avoid maceration by use of barrier film. An antimicrobial foam dressing effective against gram positive and gram negative bacteria, fungi and yeasts. The foam absorbs and retains tissue fluid making it suitable for moderate to highly exuding wounds. A secondary dressing may be required. Hard, necrotic tissue. 10cm x 10cm

Avoid Jelonet / Paraffin Gauze Use & tips For plastics use only Sorbion S 7.5cm x 7.5cm 10cm x 10cm 20cm x 20cm 20cm x 10cm 30cm x 10cm 30cm x 20cm 12cm x 5cm Use & tips Absorbent polymers in cellulose matrix, hypo allergenic fleece envelope. It is suitable for moderate to highly exuding wounds. Change dressing when wet or after 4 days. A secondary dressing or bandaging is required. Urgostart Use & tips

All sizes Soft adherent foam dressing made of a TLC layer (technology Lipido Colloid) with healing accelerator (NOSF – nano-oligosaccharide factor) to rebalance wound equilibrium and neutralise proteases. Promotes multiplication of dermal fibroblasts Cleansing Solutions

As recommended in the Wound Care Guidance, sterile saline should be used for aseptic technique and tap water is sufficient for socially clean cleansing of chronic wounds. Skin Care Good skin care is important to prevent damage that may occur from excess moisture, pressure damage, trauma and dehydration. The aim of skin care is to maintain a healthy tissue condition and reduce the risk of infection Soap Substitute Aqueous Cream Use & tips

100g To wash inflamed, damaged or dry skin

500g

Emollients Cetraben Use & tips

50g 125g For inflamed, damaged or dry skin

15

500g pump

Skin Protectants Cavilon Barrier cream Use Cavilon Barrier film Use

Proshield Plus Barrier cream Use

2g sachet

28g tube

92g tube

Prevent skin damage associated with incontinence or for moisturising dry skin 1ml foam applicator 3ml foam applicator 28ml spray bottle Prevent skin damage associated with incontinence, wound exudate, adhesive trauma and friction. Should be reapplied every 24 hours and films every 72 hours. 115g Second line when Cavilon ineffective. For moisture lesions only. Prevent skin damage associated with incontinence or for moisturising severely dry skin Other Therapies

Debrisoft

10cm x 10cm

Use & tips

Physical Debridement Pad

Debrisoft is a soft pad consisting of monofilament knitted fibres which can be used to aid rapid, safe and easy debridement. The pad can be used to debride stubborn slough and necrosis as well as hyperkeratosis. The pad should be moistened with normal saline or water then with gentle pressure applied to the surface in a circular motion for a few minutes until the required amount of debridement has been achieved. The pad may need to be used again on a separate occasion. All emollients must be washed off before using debrisoft as they can reduce the effectiveness of the product. Avoid Do not use as a dressing Stop use once the wound is red and vascular Do not use if the patient experiences pain during debridement Kerrapro All sizes Use & tips

A prophylactic dressing to prevent pressure ulcer formation.

Kerraped Footwear

All sizes

Use & tips

For patients with neuropathic foot ulcer or patients with bulky bandages who cannot wear normal shoes, this footwear offers a supportive alternative.

16

Appendix 1

Non Formulary Exception Reporting Form To be completed when a non-formulary product is to be used. This will help monitor the appropriateness of the present formulary and influence future decision-making. Patient NHS No:………………………………..Team/Ward:………………………………………... GP Practice:………………………………………………………………………………………………. Tick all that apply Type of wound

Wound bed description

Wound depth

Exudate levels

Aim of treatment

Skin Tear/ Laceration

Epithelialsing

Superficial

Dry

Protection

Surgical

Granulating

Shallow

Minimal

Warm moist environment

Sloughy

Cavity

Moderate

Rehydration

Critically Colonised

Deep cavity

Heavy

Desloughing

Infected

Sinus

Pressure Ulcer Venous Ulcer Arterial Ulcer Diabetic Ulcer Other

Absorption

Necrotic

Odour control

Fungating

Anti-microbial effect

Current Products in use Formulary Products Used

Duration Used

Reasons discontinued / not suitable

1.

2.

3.

(Continued overleaf)

17

Information relating to non-formulary products used Name of product chosen

Time used

Rationale for choice

Did this product achieve the aims that were highlighted in the rationale for choice? Yes

No

If no please give reasons

Name of person submitting this report:………………………………………………………… Base/Hospital:…………………………………………………………………………………….. Contact number:……………………………………………Date:………………………………. Signature and Designation:……………………………………………………………………… Please return completed forms to Tissue Viability Service, Russells Hall Hospital.

18

Appendix 2 Authorisation Form Silver-Containing Wound Dressings Patients Name and details (including NHS number)

GP/ Consultant

Indications for use: Short term treatment of infection in leg ulcers and pressure sores. Prophylaxis of infection in skin graft and donor sites. Prophylaxis and treatment of infection in burns. 3 or more signs of infection – please tick Increased erythema/swelling around wound Cellulitis Increased/unexpected pain Delayed healing and breakdown of the wound Bridging of the wound Wound that probes to bone/exposed bone Pus/abscess formation Fever Malodour Increased exudate Friable and/or discoloured/exuberant granulation tissue New areas of devitalised tissue(slough/necrosis) Wound swab

Yes

Yes

No

No

Microbiology Results (if known) ………………………………………………………

History of any oral antibioticsName Dose Duration Details of any previous Antimicrobials used; ……………………………………………………………………………………………………………… …………………………………………………………………...

19

You must have considered the products below first

- Iodine Based Products

Yes

No

- Honey

Yes

No

Requested Silver-containing Formulary Product………………………………... Rationale for use…………………………………………….................................. ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… …………………………………………….... Must be maximum 14 days use. Not to be issued as a repeat Any further comments/actions …………………………………………………………………………………………. …………………………………………………………………………………………. …………………………………………………………………………………………. Clinicians contact (Applicants)

NB

Name

……………………………

Number

mobile -………………. Landline -……………….

Designation

…………………………….

Signature

…………………………….

Please submit this form to one of the below clinicians as appropriate.

Tissue Viability Nurse - 01384 244368 Authorised / not authorised (please circle)

Authorised Signature: Date:

20