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CITY HEALTH CARE PARTNERSHIP CIC (CHCP)

WOUND MANAGEMENT FORMULARY (2019)

This Wound Management Formulary outlines for clinicians (nurses and podiatrists) employed by CHCP the wound care products available to them through the total purchasing process for the management of wounds in adults. This process is to be used for patients registered with a GP in the Hull CCG and East Riding of Yorkshire CCG area. This formulary may be used as a guide by other services in the area (e.g. 0 – 19 service; GP practices) but funding via the total purchasing process is provided by the CCGs for adult wound management by CHCP clinicians as outlined in this formulary. The standardisation of ordering and use of wound care products across CHCP is to ensure that clinicians are able to justify their decision making and expenditure on wound care products, after considering the efficacy, safety, patient acceptability and costs of the wound care product. Treatment should be selected on the grounds of current clinical opinion, the clinician’s holistic/wound assessment and available evidence of clinical effectiveness. Details of the management plan must be recorded in the patient’s electronic record on SystmOne. Clinicians must order wound care products that are on the CHCP Wound Management Formulary from NWOS using the online Formeo system. For wound care products that are marked on the Formulary requiring ‘Clinical Reasoning’ it is the responsibility of the prescribing nurse to complete this form and record in the patient’s electronic record. The clinician completing the ‘Clinical Reasoning’ form must inform the TV Link Nurse or identified clinician within the team who has responsibility for monitoring the process or the Tissue Viability Nurse (Hull and East Riding) where appropriate. If all CHCP Wound Management Formulary choices have been exhausted and/or satisfactory outcomes has not been achieved, practitioners may select other products outside of the formulary. Where possible these product(s) should be obtained through an NHS Nurse Prescriber prescription only (V100/V150/V300 prescribers). In all cases the clinician must have supporting evidence and a documented clear rationale for the choice. The process for updating new wound care products on the formulary will be reviewed regularly to reflect innovation in practice and new products. The Wound Management Formulary can be accessed via CHCP Connect

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Guidelines to Generic Wound Care Range

Wound

Type

Necrotic Sloughy Granulating Infected Epithelialising Fungating/

Malodorous

Cavity

Necrotic wounds are characterised by black dead tissue.

Mixture of dead

white cells, dead

bacteria,

rehydrated

necrotic tissue

and fibrous

tissue.

Granulating

tissue usually

pink in colour

at the base

and bumpy

(granular)

appearance.

Friable, dark

red granulation

tissue.

Increased.

Malodour.

Increased pain.

Delayed

healing.

Satellite

lesions.

Typified by pink /pale mauve coloured tissue.

Has an

offensive odour

indicating

infection or

colonisation of

bacteria. Often

palliative

patients may

have a

fungating

wound.

Wound extends to

tissues deep into

the epidermis and

dermis.

Treatment

Aim To soften and

remove

necrotic tissue

by rehydration

and

debridement to

allow

granulation.

To soften and

remove slough

by rehydration

and

debridement.

To maintain

ideal

environment

for

granulation.

To control and

manage

infection.

To protect

epithelialising

tissue until

established. To

promote an ideal

environment for

epithelialisation

and contraction.

To manage

odour,

bleeding and

exudate.

(Wound Bed must

be protected with a

non-adherent

dressing to prevent

adherence of other

dressings).

Antibiotics must be

used only when

appropriate)

To promote

granulation from the

base of the wound.

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NO EXUDATE Hydrogel/sheet

(P)*

Hydrogel/sheet

(P)

Non-Adherent

dressing (P)

Identify wound

infection as per

Protocol/Pathway:

Contaminated

Colonised

Local Infection

Spreading

Infection

Systemic

Treat with the

appropriate Topical

antimicrobial and or

antibiotics.

Film (P)

Non-adherent

Dressing (P)

Foam Dressing

(P & S)

Absorbent Pad

(S)*

Topical

Antimicrobial (P)

Charcoal

Dressing (S)

Gelling Fibre (P)

Foam (S)

Absorbent Pad (S)

LOW EXUDATE

Hydrogel/sheet

(P)

Hydrogel/sheet

(P)

Foam (P)

Absorbent Pad

(S)

Non-Adherent

Dressing (P)

Low Adherent Pad

(P)

Foam (P)

Absorbent Pad (S)

Non-adherent

Dressing (P)

Gelling Pad (P)

Alginate (P)

Foam Dressing

(P & S)

Absorbent Pad

(S)

Antimicrobial (P)

Charcoal

Dressing (S)

Gelling Fibre (P)

Alginate (P)

Foam (S)

Absorbent Pad (S)

MODERATE TO HIGH

EXUDATE (Do not use hydrogel on high exudating wounds

Gell Fibre

dressing (P)

Foam or

Absorbent Pad (P

& or S)

Gell Fibre dressing

(P)

Foam or

Absorbent Pad

(P & or S)

Gelling Fibre (P)

Alginate (P)

Foam (P & S)

Foam (P)

Absorbent Pad (S)

Non-adherent

Dressing (P)

Foam Dressing

(P & S)

Absorbent Pad

(S)

Antimicrobial (P)

Charcoal

Dressing (S)

Gelling Fibre (P)

Alginate (P)

Foam (S)

Absorbent Pad (S)

* (P) Primary dressing (S) Secondary dressing

All patients must have an individual holistic assessment followed by a comprehensive wound assessment to develop a treatment plan that is patient specific for their needs.

All wounds must be re-assessed minimum every 4 weeks or there are any changes in the wound. These assessments are the key to a successful outcome for patients who have acute or chronic wounds. It is the clinician’s responsibility to identify intrinsic factors e.g. diabetes/ischaemia/compliance, on any wound that is acute/chronic or complex as these will influence the potential for that wound to heal. Realistic goals and outcomes must be discussed.

Patient who have an identified wound infection clinicians must refer to the Wound Infection Protocol and pathway and have supporting evidence in the patient record on the use of products, discontinuing products and why products have not been used.

Wound Management Formulary A formulary of wound management products is a clinical and financial necessity in the National Health Service (NHS) today and it is the responsibility of management and the healthcare professional to work within financial constraints and provide effective and cost efficient wound care. The wound management formulary (WMF) is to support the process of total purchasing for wound care products and has the explicit aims to:

Maintain patient safety in wound management. To promote continuity of care and rational prescribing.

Audit the use of wound care dressings that will direct education and training of

healthcare professionals in the organisation.

Provide a process to review all new wound products for future use in clinical practice.

Provide an education programme that supports the appropriate use and application of dressings that will optimise benefits to patients.

Wound care products selected for this formulary is based on:

A multi-professional approach with community healthcare professionals: o medicine management o tissue viability group o organisation management.

Up to date research evidence on wound management. Current prescribing of healthcare professionals in primary care.

The key to successful wound management is the accurate holistic and wound assessment of each individual patient. A clinician undertaking wound care should include the wound assessment tool T.I.M.E within the assessment process. This tool builds on wound bed preparation and help to structure the clinicians approach to wound management. It is an acronym for:

T — Tissue I — Inflammation or infection M — Management of exudates

E — Edges of the wound

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CITY HEALTH CARE PARTNERSHIP CIC WOUND MANAGEMENT FORMULARY (July 2019) NURSING SERVICES

CATEGORIES PRODUCT AVAILABLE TO ALL PRACTITIONERS

PRODUCTS AVAILABLE REQUIRING CLINICAL

REASONING (follow Pathway)

FP10 PRESCRIPTION SUPPLY AND CLINICAL REASONING

Cleansing Agent Irripod Sterile Saline Pods

Low Adherence Dressings Atrauman ActivHeal Silicone Wound Contact Layer

Absorbent Dressings (Suitable for low to moderate exudate)

Softpore

Absorbent Dressing Pads Sterile

Zetuvit E

Hydrogel ActivHeal Hydrogel

Hydrogel Sheets ActiFormCool

Superabsorbent Kliniderm

Cutimed Sorbion Sachet Cutimed Sorbion XL

Hydrocolloids ActivHeal Hydrocolloid Foam Backed (concave & sacral)

Hydrocoll Border Hydrocoll Thin (non-border)

Vapour Permeable Film Hydrofilm

Leukomed - T

Alginates ActivHeal Alginate ActivHeal Alginate Rope

Gelling Fibre filler ActivHeal Aquafiber Extra & Ribbon

Durafiber & Ribbon

Adhesive Foams Allevyn Adhesive Foam

Non-Adhesive Foams Allevyn Non-Adhesive Foam ActivHeal Foam Heel Dressing

Silicone Foam Dressings Allevyn Gentle Border Range including Multisite

Kliniderm Foam Silicone Border Allevyn Life

Skin Protectors Cutimed Protect (including cream, foam & spray)

Surgical Tapes Micropore

Other Tapes CliniTape Clear (Latex Free) Mefix

Charcoal Dressings Odolock

Protease- Modulating Matrix Dressings

UrgoStart Contact UrgoStart Plus (incl Border)

Other Wound Care Accessories

Softdrape Dressing Kit

Aderma Debrisoft Pad Kerraped

Woven and Fabric Swabs

Gauze swab, 8-ply white sterile (Premier)

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Tubular Bandage, elasticated

Comfinette (fingers and toes0 Actifast

Compression Bandages Actico Comprilan

Multi-layer Compression Bandaging

K-Four (four layer system) K-Two (two layer system)

Compression Hosiery and Garments

Graduated Compression Hosiery Jobst FarrowWrap

Topical Negative Pressure Therapy

PICO Single Use Negative Pressure Wound Therapy System

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Renasys Touch Pump Negative Pressure Wound Therapy

Devices

Consumables

Negative Pressure Wound Therapy devices loaned by Smith and Nephew

Hull Order on FP10

East Riding Order direct from Smith and

Nephew or via Formeo system and supply from

base

CITY HEALTH CARE PARTNERSHIP CIC WOUND MANAGEMENT FORMULARY (July 2019)

PODIATRY SERVICES

Low Adherence Dressings

Atrauman

Absorbent Dressings Softpore Melolin Telfa

Superabsorbent Kerramax Care

Alginates ActivHeal Alginate

ANTIMICROBIALS

It is the clinician’s responsibility to use antimicrobials appropriately and as indicated in: CHCP Protocol ‘The Management of Wound Infection 2018’

Antimicrobial Dressings Iodosorb Ointment Inadine

Antimicrobial Silver Silvercel

Antimicrobial Silver Low Adherent dressing

Acticoat Flex 3

Acticoat Flex 7

Antimicrobial with Hydrocolloid Dressing

Aquacel Ag+ Extra Sheets & Ribbon

Antimicrobial Soft Polymer dressing

UrgoTul SSD

Antimicrobial with Charcoal

Other Antimicrobials Cutimed Sorbact Cutimed Sorbact Gel Cutmed Siltec Sorbact

Medihoney Gel Medihoney HCS Medihoney Tulle

Flaminal Forte Flaminal Hydro

Antimicrobial Solutions Prontosan Pods

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Gelling Fibre Filler

ActivHeal Aquafiber Extra

Non Adhesive Foams Allevyn Non-Adhesive ActivHeal Foam Heel Dressing

Silicone Foam Dressings Allevyn Gentle Non-Border Allevyn Gentle Border Allevyn Gentle Border Lite Kliniderm Foam Silicone border

Skin Protectors

Cutimed Protect

Tapes

Mefix tape

Protease – Modulating Dressings

UrgoStart Plus

Non-extensible Bandages Hospiform

Support Bandages Hospicrepe

ANTIMICROBIALS

It is the clinician’s responsibility to use antimicrobials appropriately and as indicated in: CHCP Protocol ‘The Management of Wound Infection 2018’

Antimicrobial Dressings Bactigras Inadine Iodosorb ointment

Antimicrobial Silver Low Adherent Dressing

Acticoat Flex 3

Honey Antimicrobial Dressings Medihoney Gel Medihoney HCS Medihoney Tulle

Antimicrobial with hydrocolloid dressing

Aquacel Ag+ Extra Sheets Aquacel Ag+ Ribbon

Other Antimicrobials

Cutimed Sorbact Cutimed Sorbact Gel

Antimicrobial Solutions Prontosan Pods Prontosan Solution

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Clinical Reasoning Process It is vitally important that all nurses follow the clinical reasoning process to ensure the most effective wound management program. This process has been put in place by CHCP to ensure that complex patients who require any product not in the “product available to practitioners” column, a clinical reasoning form MUST be completed on the patient records and forward to the appropriate clinician who is monitoring this process. The use of antimicrobials must be reviewed as per CHCP Wound Infection Protocol applying the 2 – 4-week review on the effectiveness of treatment. The timeframe for review all wound is minimum 4 weeks or if there is evidence of deterioration of wounds. Any changes in the management plan must be supported by an assessment of the wound/s and the rationale for the change and prescribing of products. It is the assessing Health Care Professional who has assess the need for an antimicrobial must complete the Clinical Reasoning Form for ANTIMICROBIALS. A copy of the clinical reasoning forms is attached at the end of this document

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WOUND MANAGEMENT FORMULARY: ADVICE/INFORMATION ON WOUND CARE PRODUCTS

ACTICOAT FLEX 3/7- Conform to the body’s contours to help you take control against infection in chronic wounds. The dressing is low adherent, which helps minimise wound trauma at dressing changes. The antimicrobial barrier properties of ACTICOAT Flex 3 remain effective for a minimum of 3 days and ACTICOAT FLEX 7 remain effective for 7 days. http://www.smith-nephew.com/key-products/advanced-wound-management/acticoat/acticoat-flex3-flex7/

ACTICO - Actico cohesive inelastic bandage system, to effectively manage venous ulceration and chronic oedema. http://lohmann-rauscher.co.uk/compression-therapy/compression-bandages/actico

ACTIFAST – For dressing retention, the 2 way stretch gives improved conformability and can reduce unnecessary wastage. http://lohmann-rauscher.co.uk/bandages/actifast

Actilite®: is a light viscose non - adherent net dressing coated with antibacterial Manuka honey & Manuka oil. The dressing is designed to protect a wound, promote healing and allow the passage of exudate. http://www.advancis.co.uk/products/activon-manuka-honey/actilite

ACTIFORM COOL- Responds to moisture level in the wound, either donating or absorbing exudate to create and maintain an optimal moist wound environment. http://lohmann-rauscher.co.uk/woundcare/actiformcool

ACTIVHEAL ALGINATE & ROPE - is a sodium calcium dressing indicated for the treatment of heavily exuding wounds as a primary dressing. The versatility of ActivHeal Alginate allows the dressing to be used on a variety of wounds, including cavity wounds, in which the dressing can be packed into the cavity to promote healing from within. Alginate is naturally a biodegradable fibre, which ensures that any small residual fibres that remain in the wound pose no risk to the patient. http://www.activheal.com/home/product-range/activheal-alginate.aspx

ACTIVHEAL ACTIFIBRE EXTRA: soft, conformable, highly absorbent dressing that converts into a soft clear gel when in contact with wound exudate. Contains a reinforcing layer between two layers of absorbent fibres to improve the integrity of the dressing when it is wet, so that it can be removed intact. Can remain in situ for up to 7 days Used for moderate to heavy exudating wounds. http://www.activheal.com/wound-care-dressing-range/aquafiber-extra-dressing/

ACTIVHEAL AQUAFIBER EXTRA: is indicated for moderately to heavily exuding chronic and acute wounds and can act as a haemostat to control minor bleeding in superficial wounds. ActivHeal Aquafiber contains calcium ions that exchange with sodium ions found in wound fluid. Calcium is known to be beneficial in several stages of the wound healing process. http://www.activheal.com/home/product-range/activheal-aquafiber.aspx

ACTIVHEAL NON-ADHESIVE FOAM HEEL DRESSING – Is three- layer construction offers a low friction backing, soft highly absorbent foam and a perforated wound contact layer. This non-adhesive dressing is ideal when reducing trauma is a key part of the wound dressing regime; and its soft and flexible properties mean patients can wear it underneath clothing with comfort and confidence. The ActivHeal® Foam Non-Adhesive heel range the shape to heel wounds http://www.activheal.com/wound-care-dressing-range/foam-dressing/

ACTIVHEAL HYDROCOLLOID FILM AND FOAM BACKED - is ideal wound dressings for the treatment of light to moderately exuding wounds. Available within a range of sizes, formats and shapes, ActivHeal Hydrocolloids provide a versatile dressing choice to promote moist wound healing http://www.activheal.com/home/product-range/activheal-hydrocolloid.aspx

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ACTIVHEAL HYDROGEL - is an effective method for hydrating dry necrotic and sloughy wounds. ActivHeal Hydrogel is an amorphous gel that contains 85% water, and gently increases the moisture level within the wound, encouraging moist wound healing through autolytic debridement. http://www.activheal.com/home/product-range/activheal-hydrogel.aspx

ActivHeal® Silicone Wound Contact Layer: is a sterile primary dressing used when adherence to the wound is a potential problem. The dressing allows exudate to pass into an absorbent secondary dressing. The silicone creates a layer between the dressing and the skin surface which allows the dressing to be removed without causing trauma, pain, or damaging the delicate new tissue at the wound margin. http://www.activheal.com/wp-content/uploads/2016/11/ActivHeal-SWCL-FINAL.pdf

ADERMA: is designed to help prevent pressure ulcers. It is a range of dermal gel pads that redistribute pressure to protect critical areas2. It is typically used on bony areas to help prevent skin damage from pressure, most notably the heel and sacrum. http://www.smith-nephew.com/uk/products/wound_management/product-search/aderma/

ALLEVYN ADHESIVE: ALLEVYN Adhesive, with its unique triple layer formation, has been designed to achieve this combination to ensure optimal fluid handling to support moist wound healing. ALLEVYN Adhesive is an economically-efficient dressing specifically designed to manage chronic or acute exuding wounds. https://www.smith-nephew.com/key-products/advanced-wound-management/allevyn/allevyn-adhesive/ GENTLE BORDER: The ALLEVYN Gentle Border range has been designed for people with particularly sensitive or fragile skin. These dressings have a soft silicone gel adhesive which minimises trauma to the wound at dressing change helping to avoid patient pain without compromising care. http://www.smith-nephew.com/uk/products/wound_management/product-search/allevyn-gentle-border/

ALLEVYN GENTLE BORDER MULITSITE: is a unique tri-lobe foam dressing incorporating the ALLEVYN triple action technology designed to fit the most awkward areas of the body. http://www.smith-nephew.com/canada/products/advanced-wound-management/allevyn-gentle-border-multisite/

ALLEVYN Life: is a multi-layered dressing incorporating hydrocellular foam, hyper-absorber lock away core and masking layer designed specifically for people and their everyday life. https://www.smith-nephew.com/key-products/advanced-wound-management/allevyn/allevyn-life/

AQUACEL® Ag+: Dressings (sheets and ribbon) are antimicrobial primary dressings for use in wounds that are infected or at risk of infection. They are designed to manage the 3 key local barriers to healing - exudate, infection and biofilm. All the benefits of Hydrofiber Technology plus ionic sliver for wounds that are infected. https://www.convatec.co.uk/products/pc-wound-skin-tear/aquacel-ag-plus-dressings

ATRAUMAN: a non-adherent dressing, in relation to the different aspects of wound healing. Atrauman has many characteristics that make it an ideal dressing choice in a number of clinical scenarios, including: pain free removal; promotion of healthy granulation tissue; cost effectiveness and versatility. https://hartmann.info/en-gb/our-products/wound-management/wound-contact-layers/impregnated-wound-contact-layers/atrauman%C2%AE#products

BACTIGAS: Chlorhexidine Acetate BP 0.5% in white soft paraffin BP. Bactigras is a tulle gras presented as a gauze of leno weave, indicated for adjunctive treatment and prevention of infection in skin loss lesions, including wounds, burns and ulcers. http://www.smith-nephew.com/canada/products/advanced-wound-management/bactigras/

CLINITAPE CLEAR (Latex Free): Highly occlusive, transparent, flexible, waterproof, surgical tape which is Hypoallergenic and Latex free: It can be used for patient who have latex allergy https://www.clinisupplies.co.uk/products/24/CliniTape-CLEAR-Surgical-Tape

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CUTIMED PROTECT - provides a long-lasting protective barrier against incontinence dermatitis or damage to skin exposed to exudate, as well as minimising skin water loss. http://www.bsnmedical.co.uk/products/wound-care-vascular/category-product-search/acute-wound-care/medical-skin-care/cutimedr-protect.html

CUTIMED SORBACT - These dressing comprise a DACC-coated acetate and are primary dressings for contaminated, colonised or infected wounds with low to high levels of exudate http://cutimed.com/awc/wound-bed-preparation/antimicrobial-therapy/

CUTIMED® SORBION® SACHET S: Is a versatile fibre Dressing with high wear comfort for primary wound contact which

absorbs wound exudate and locks it in

removes wound debris,

absorbs and irreversibly locks in wound germs in the inner core and supports the wound cleansing phase,

maintains a moist wound environment. https://www.bsnmedical.com/products/wound-care-vascular/category-product-search/advanced-wound-care/exudate-management/cutimedr-sorbionr-sachet-s.html CUTIMED® SORBION® SACHET XL: has been specially designed to treat moderately to highly exuding difficult-to-dress wounds on anatomical sites such as: Lower leg, sacral region, thorax, thigh, lower part of the abdomen. These dressing should not be cut. https://www.bsnmedical.com/products/wound-care-vascular/category-product-search/advanced-wound-care/exudate-management/cutimedr-sorbionr-sachet-xl.html

Debrisoft Pad Debrisoft® - monofilament debridement pad, provides a safe and easy method of debridement, allowing the gentle removal of slough, debris and hyperkeratosis for fast and accurate wound and skin assessment. Newly formed granulation tissues and epithelial cells remain intact. http://www.activahealthcare.co.uk/debrisoft/

COMPRILAN: 100% short-stretch bandage used to support the calf muscle pump action and improve venous return. Washable and re-usable. http://www.bsnmedical.co.uk/products/wound-care-vascular/alphabetical-product-search/c/comprilanr/page.pdf

FLAMINAL FORTE - is a protease modulating matrix containing 5.5% alginate with embedded bacterial enzyme system. The product supports the healing of wounds by providing three clinical benefits in the one product: moisture/ debridement & anti-bacterial action. Flaminal forte is a Hydro Protease modulating matrix containing 3% alginate, sterile for lightly to moderately exuding chronic wounds Choose between Flaminal Forte and Flaminal Hydro based on the amount of exudate. www.crawfordhealthcare.com/woundcare/flaminal/flaminal-forte

FLAMINAL HYDRO FORTE - is a Hydro Protease modulating matrix containing 3% alginate, sterile for lightly to moderately exuding chronic wounds Choose between Flaminal Forte and Flaminal Hydro based on the amount of exudate. www.crawfordhealthcare.com/woundcare/flaminal/flaminal-forte

HYDOCOLL - Gelatin-free hydrocolloid dressing with vapour-permeable film backing and adhesive border with bevelled edge. Suitable for light to moderate exuding wounds. http://www.hartmann.co.uk/hydrocoll.php

HYOCOLL THIN: The thinner hydrocolloid dressing with a lower absorption capacity for use during the epithelialisation phase of the wound healing process. https://hartmann.info/en-gb/our-products/wound-management/advanced-wound-care/hydrocolloids/bevelled-edges/hydrocoll%C2%AE#products

Irripod SterileSaline – Topcial saline solution for topical irrigation and wound cleansing. For external use and should not mix with other fluids. https://www.cdmedical.co.uk/products/irripod/

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KERRAPED: Kerraped is also designed to help prevent foot ulcers by off-loading up to 30% of pressure from the most vulnerable parts of the foot. http://www.crawfordhealthcare.com/woundcare/kerraped

KLINIDERM SUPERABSORBANT - Klinderm Superabsorbent dressing consists of 4 layers – wound contact layer, ultrasonic seal, highly absorbent core with superabsorbent particles and a fluid repellent backing. It demonstrates rapid fluid uptake, reduces maceration and excoriation to the periwound tissue. Due to its formulation it does not adhere to the wound bed and because of the ultrasonic seal no glues or adhesives are used making it Hypoallergenic. www.ariamedical.co.uk/kliniderm-superabsorbent

KLINIDERM FOAM: Kliniderm® foam silicone is a soft, conformable absorbent polyurethane foam dressing with an adhesive silicone wound contact layer and a moisture permeable film backing. https://www.medical-world.co.uk/o/dressings-bandages-tapes/clinical-dressings/kliniderm/kliniderm-dressing-foam-silicone-border-75cm-x-75cm-x-5/40454

KERRIMAX CARE: Comprises a soft, non-woven outer contact layers for comfort with a superabsorbent core to lock in exudate, bacteria and matrix metalloproteinases. The dressing also features a horizontal wicking layer and a heat-sealed border. Suitable for use under all forms of compression. https://www.woundcarehandbook.com/product/27/kerramax_care

Leukomed® T. For secure transparent fixation. Leukomed® T secures cannulae, compresses and other medical aids, making them waterproof and bacteria proof. Non-secreting wounds are also carefully protected from friction and shear. Good visibility at all times. https://www.bsnmedical.ca/products/wound-care-vascular/category-product-search/acute-wound-care/dressings/leukomedr-t.html

3M™ Micropore™ Surgical Tape: Is a paper tape used to dress wounds and secure medical tubing. http://multimedia.3m.com/mws/media/784590O/3m-medical-tapes-full-line-catalog.pdf?&fn=70-2010-8488-9.pdf/?WT.mc_id=C3SD_Twitter_MedicalTape

Medihoney: is an advanced wound care dressing that has a clinical ability to promote the removal of necrotic tissue and advance a wound toward healing. Derived from the Leptospermum species of plant in New Zealand, these unique dressings have properties which are beneficial throughout all phases of wound healing. http://www.dermasciences.com/medihoney

Melolin: A low adherent absorbent dressing. Absorbs wound fluid and provides cushioning. https://www.smith-nephew.com/anz/products/hith/melolin/

MEPITEL – Mepitel is a wound contact layer. The open mesh design enables transfer of exudate to a secondary

dressing and easy delivery of topical treatments. http://www.molnlycke.co.uk/advanced-wound-care-products/wound-contact-layers/mepitel/

MEFIX – Mefix can be used for situations where fixation is required such as the fixation of dressings. http://www.molnlycke.co.uk/wound-care-dressings/fixation-retention/mefix/

ODOLOCK - Odolock Activated Charcoal dressings absorb odour and are suitable for use in the management of all chronic wounds where odour occurs. http://www.systagenix.co.uk/our-products/manage-odour/odolockandtrade-395

PRONTOSAN - Prontosan Wound Irrigation Solution and Gel are products for cleansing, moisturising and decontamination of acute and chronic wounds, to aid in efficient wound bed preparation. http://www.prontosan.co.uk/

SILVERCEL NA - Antimicrobial Alginate Dressing is a non-woven pad composed of alginate, carboxymethylcellulose (CMC) and silver coated nylon fibers, with laminated non-adherent wound contact layer. http://www.acelity.com/products/silvercel-non-adherent

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URGO K-FOUR 1 2 3 & 4 - Multilayer compression bandage system for the treatment of venous and mixed aetiology leg ulcers. Comprising K-Soft sub-bandage wadding, K-Lite type 2 bandage, K-Plus type 3a light compression bandage, Ko-Flex type 3a cohesive bandage or K-threeC (type 3c providing extra pressure for ankles >25cm). Components available in longer length for use with larger limbs. http://www.urgo.co.uk/202-k-four

URGO K-LITE - K-Lite is a type 2 support bandage. Available in a longer size for longer legs.

http://www.urgo.co.uk/305-k-lite

URGO K-TWO - Two-layer bandage system combining elastic and inelastic components that work together to provide sustained graduated compression for up to seven days. The first layer, KTech, is the inelastic component providing compression, absorbency and massage effect. KPress, the second layer, is an elastic, cohesive bandage that keeps the system in place and delivers additional compression to achieve therapeutic pressures and maintain resting pressures. KTwo donates an average pressure of 40mmHg at the ankle. Also available in latex free. http://www.urgo.co.uk/197-k-two

URGO K-TWO REDUCED -Two-layer bandage system combining elastic and inelastic components that work together to provide sustained graduated compression for up to seven days. The first layer, KTech Reduced, is the inelastic component providing compression, absorbency and massage effect. KPress, the second layer, is an elastic, cohesive bandage that keeps the system in place and delivers additional compression to achieve therapeutic pressures and maintain resting pressures. KTwo Reduced donates an average pressure of 20mmHg at the ankle. Also available in latex free. http://www.urgo.co.uk/197-k-two

UrgoStart Contact: is a flexible contact layer with TLC-NOSF comprised of: A conformable polyester mesh impregnated with hydrocolloid, petroleum jelly and NOSF particles (Nano-Oligo Saccharide Factor). http://www.urgomedical.com/products/urgostart-contact/

Urgo Start Plus range: UrgoStart is a soft-adherent foam dressing with TLC-NOSF, comprised of: A soft-adherent TLC-NOSF layer combined with an absorbent polyurethane foam pad, A vapour permeable outer film. is indicated for exuding chronic wounds (leg ulcers, pressure ulcers, diabetic foot ulcers, longstanding acute wounds). UrgoStart is the only wound dressing with demonstrated superiority in wound healing speed: UrgoStart heals wounds twice as fast as a neutral absorbent dressing. http://www.urgomedical.com/products/urgostart/

Zetuvit® E: is a non-irritant absorbent dressing pad with a covering consisting of a non-adherent, non-woven polypropylene material. The absorbent core is made of soft cellulose fluff, a tissue layer for distribution of exudate, with a hydrophobic, blue non-woven polypropylene layer on the backing of the dressing used as protection against contamination https://hartmann.info/en-gb/our-products/wound-management/absorbent-dressings/high-absorbent/zetuvit%C2%AE-e#products

GAUZE SQUARES: Medical gauze, a bleached white cloth or fabric used in bandages, dressings, and surgical sponges, is the most widely used wound care dressing. Commonly known as “4×4s,” gauze is made from fibers of cotton, rayon, polyester, or a combination of these fibres

SOFTDRAPE DRESSING PACK: Softdrape universal aseptic, laxtex free dressing pack, provides you with a one pack solution to effective wound management. Cost effective and strategically designed, the pack supports non-touch technique thus minimising the risk of infection. https://www.richardsonhealthcare.com/softdrape/

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Areas to consider when undertaking the wound prescribing process This formulary to support the decision-making process on prescribing a wound product, following a holistic assessment of the patient. Areas to consider when undertaking this process

Practitioners should avoid multiple dressings that: o Can potentially cause a reaction. o Have no supporting evidence for their use. o Increase cost for treatment prescribed.

The practitioner should use the BNF/or reference sources above to identify the properties of the dressings that are appropriate to the type of wound.

The aetiology of the wound should be established.

Swabbing of the wound should only be undertaken if clinical signs of infection are apparent (Refer to CHCP ‘The Protocol management for wound infection 2018). Once an infection has resolved, treatment with an antimicrobial dressing should be stopped, or have a rationale to continue or use another antimicrobial. Using any antimicrobial must be supported by CHCP Clinical Reasoning form).

Practitioners should question—is the irrigation of a clean granulating wound necessary.

Has a holistic approach been undertaken that includes diet, environmental and health factors and the use of other products/medicines (including alternative medicine)?

Avoid products/solutions that delay healing: are toxic at low concentrations: are of

doubtful value i.e. antiseptics: chlorinated solutions: antibiotic tulles.

Non-medical prescribers are professionally accountable for their prescribing decision, including actions and omissions. All registered nurses are personally accountable for their practice ensuring that they: Prioritise people, Practise effectively, Preserve safety and promote professionalism (NMC 2018).

Authors: Tissue Viability Group, CHCP Medicines Service.

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National Institute for Health and Care Excellence National Prescribing Centre: www.guidelinesinpractice.co.uk/the-national-prescribing-centre/305502.article Nurse and Midwifery Council: The Code (2015): https://www.nmc.org.uk/ Standards for prescribers: https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/ Wound management: https://www.nice.org.uk/guidance/conditions-and-diseases/injuries--accidents-and-wounds/wound-management/products?Status=Published Wound management products and elasticated garments: https://bnf.nice.org.uk/wound-management/ Wound UK: Website that has Best Practice Statements/Journal and Education that is wound related: https://www.wounds-uk.com/ Recommended Reading:

City Health Care Partnership CIC Protocols on:

Wound Infection 2018

Pressure Ulceration 2017

Leg Ulceration 2018

SOP for Negative Wound Therapy

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REQUEST FOR A CLINICAL REASONING FORMULARY & NON-FORMULARY DRESSING

This form should be completed, by the nurse who has prescribed a dressing from CHCP formulary which requires clinical reasoning or a wound care product that has been prescribed through FP10 prescription. It is important that documentation, in the patient records, reflects the rationale for the nurse to prescribe a wound care product. The District Nurse/Complex Case Manger must be involved in the authorization of products and the form sent to the Tissue Viability Link nurse or the nurse identified within the team who has this responsibility to monitor the supply of wound dressings in each team.

Patients details: Name: DOB: NHS No

Dressing/Wound Care Product/Device/Hosiery/Consumables Request: Product/s Name:

Reason for Alternative Dressing:

Indication (please give brief description) Reason why CHCP formulary wound care products needed to be change or prescribed: Identify review timeframe to support continual use (if applicable)

Request made by: Name of Nurse: Contact Number: Locality/Team/Base

Request Authorised by:

District Nurse/Complex Case Manager/TV link Nurse/Tissue Viability Nurse: YES/NO (Please delete where appropriate)

Name Contact No

CLINICAL REASONING FORM FOR ANTIMICROBIALS (2019)

Wound Form: 1 of Initial assessment by: (include date)

Patient Name NHS No DOB:

Wound Type Leg Ulcer Pressure Ulcer Skin Tear Other (Specify)

Site/Category

On the initial assessment is the wound:

Contaminated Yes/No

Colonised Yes/No

Local Infection Yes/No

Spreading infection Yes/No

Biofilms Yes/No

It is the responsibility of the Nurse/Healthcare Professional to have completed, in the patient electronic record, a currently holistic/and or wound assessment with supporting evidence before any antimicrobial is commenced. and with following re-assessment for continuation of the product (within a 4 week period)

Has the use of an antimicrobial been requested by a Specialist: Yes/No (Specify)

Swab taken: Yes/No

Date when this was followed up:

Has the patient been prescribed antibiotics Yes No

Progress entered by the assessing Nurse/Healthcare Professional

Week 1

Week 2

Week 3

Week 4

Date this form is completed

If the patient requires further/ or change of an antimicrobial dressings there must be supporting documentation, in the patient record, to support further use. A further Clinical Reasoning form must be completed. If another wound occurs and requires an antimicrobial then another form must be completed To ensure that there is a continuous and auditable documentation please mark the form, indicating if it is ‘one of one or one of two’ if it is the same wound requiring further antimicrobials.