PROVIDER SERVICES Wound Care Formulary · Wound Care Formulary Updated September 2014Issued October...

Wound Care Formulary

www. u hmb . n h s . u k

Issued October 2013Updated September 2014Produced by Advanced

Medical Solutions

VERSION 1

PROVIDER SERVICES

This addition was prepared in collaboration with the following Clinical Commissioning Groups:

Lancashire North CCG, Blackpool CCG, Flyde and Wyre CCG

CONTENTS

Introduction 3Dressings 4Alginate Dressings 5Barrier Creams/Films 6Emollient 6Film 6Absorbent Dressings 7Foams 8Low adherents 9Hydrogel 10Hydrocolloid 11Hydrofibre Dressings 12Odour Absorbing Dressings 13Antimicrobial Dressings 15Bandaging 15Miscellaneous 18Specialist products 19Lymphodema / Vascular services only 20Wound Care Algorithm 22EPUAP Guidelines 24Glossary 25Appendix 26

INTRODUCTION

The wound care formulary is available for all practitioners working for provider organisations aligned to Lancashire North CCG, Flyde and Wyre CCG’s.

It aims to provide a clinically effective, appropriate and cost effective choices of products to man-age the vast majority of wounds. However it is recognised that there are factors other than dress-ing choice which influence wound healing and as such a holistic approach to patient care should be taken.

The selection of wound management products should be based on a holistic patient assessment. Accurate wound assessment and appropriate product selection can help promote a wound heal-ing environment and ultimately improve patient outcomes.

Before applying any dressing the practitioner should ask:-

• What is the action of the dressing?• When should it be used?• What are the limitations/contraindications to its use?• Do I know the correct method of application and removal?• Do I have sufficient knowledge about the dressing? Benbow (2005)•

FP10 Stores Only FP10 & Stores Specialist service only

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Dressing PackProduct Size NHSSC

CodeDressings Per Pack

Cost per Pack

Cost Per Dressing

Softdrape EJA046

Absorbent DressingDressing with adhesive border and absorbent central pad.

Mode of Action• For use on wounds closed by primary intention.• To absorb slight oozing from wounds.• Ideal as a protective covering.• Do not provide a moist wound healing environment.

Indications • Low to moderate exuding wounds.• Post-Operative Wounds • Lacerations • Cuts • Abrasions • Minor Burns

Contraindications• For use on arterial bleeds• Heavily exuding wounds • Chronic wounds.

Tissue TypesFor use on superficial wounds and epithelialising wounds or as secondary dressings.

Product Size NHSSC Code

Dressings Per Pack

Cost per Pack

Cost Per Dressing

Zetuvit E (sterile) - 1st Line (Hartmann)

10 x 10cm10 x 20cm20 x 20cm20 x 40cm

EJA025EJA026EJA027EJA028

0.210.240.391.09

C-Sorb Richardson Healthcare(super absorbent dressing pad)

10 x 10cm10 x 20cm

EJE113EJE114

0.130.35

Zetuvit E (non-sterile) low-heavy exudate

10 x 10cm10 x 20cm20 x 20cm20 x 40cm

EJA021EJA022EJA023EJA024

0.070.090.140.27

2

Zetuvit Plus (super-absorbant)

10 x 10cm10 x 20cm15 x 20cm20 x 25cm20 x 40cm

EME046EME047EME048EME049EME050

0.630.870.991.362.09

C-Sorb - Super- absorbant dressing padRichardson

10 x 10cm10 x 20cm

EJE136EJE137

Flivasorb

Activa

10 x 10cm

10 x 20cm20 x 20cm20 x 30cm

EME026

EME027EME025EME029

0.88

1.051.862.35

Kerramax 10 x 10cm10 x 22cm20 x 22cm30 x 20cm

EME045EME023EME024EME025

1.261.652.923.33

Alginate DressingAlginates are highly absorbent dressings derived from seaweed. Mode of ActionThe Alginate dressing gels when it absorbs exudate:• To facilitate moist wound healing.• To maintain a moist wound environment.• To aid autolysis.• To effectively absorb exudate.• Debride slough and encourage granulation of the wound.• Reduces the risk of maceration of the surrounding skin.

Needs a secondary dressing to contain moisture and aid autolysis and maintain optimum wound environment.

Indications• Pressure Ulcers• Leg Ulcers• Cavity Wounds• Skin Donor Sites• Abrasions and Lacerations• Post Surgical Wounds

Contraindications• Surgical Implantation• Full Thickness Burns• Dry Wounds

Tissue TypesSuitable for wounds with moderate and high levels of exudate, with varying tissues types of sloughy, granulating, infected and cavity wounds.2 3


Dressings Per Pack

Cost per Pack

Cost Per Dressing

ActivHeal Alginate

5 x 510 x 1010 x 202 x 30cm Rope

ELS139ELS140ELS141ELS142

101055

5.9011.5014.2010.70

0.591.152.832.13

Kaltostat (Convatec)

5 x 5cm7.5 x 12cm10 x 20cm2g Cavity dressing

ELS299ELS232ELS027ELS241

0.942.054.033.77

Barrier Film & CreamProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Sorbaderm (Aspen Medical)

1ml Foam app.3ml Foam app.28ml Spray2g Cream92g Cream

ELY327ELY329ELY328ELY346ELY345

4.457.205.996.667.19

Proshield plus skin protectant

115g cream ELZ537

Emollient Product Size NHSSC


Cost per Pack

Cost Per Dressing

ZeroAQS emolient cream (light)

500g 3.29

Oliatum emolient cream(creamy)

50g150g500g

1.632.454.99

Zeroderm 125g500g

2.414.10

Zerocream 50g500g

1.174.10

FilmFilms are non absorbent, with moisture levels governed by the moisture vapour transmission rate. Films control the loss of moisture into the environment. Films have an MVTR.MVTR – this means they are permeable to moisture vapour and oxygen but impermeable to bacteria.

4

Mode of Action• Ensure waterproofing of the wound.• Acts as a shield in preventing bacterial and other micro-organisms in the wound tissues.• To protect the skin from friction and external contamination.• Provide a moist wound environment.• Can be used as a primary or secondary dressing

IndicationsGenerally suitable for low exuding , shallow non infected wounds.Can be used as a secondary dressing.

Contraindications• Films should not be used with moderate to heavy levels of exudate as can cause macera-

tion.• Films should not be used to retain dressings that already have a MVTR e.g. Foam dress-

ings.

Tissue TypesCan be used in the management of both granulating and epithelialising wounds with light exudate.

Product Size NHS SCCode

Dressings Per Pack

Cost per Pack

Cost Per Dressing

Paul Hartmann Hydrofilm Plus

9 x 10cm10 x 20cm

ELW292ELW304

0.270.45

ClearfilmRichardson healthcare

6 x 7cm10 x 12cm12 x 12cm15 x 20cm

ELW646ELW642ELW647ELW648

0.250.550.621.15

IV3000 (Smith & Nephew)Use with IV lines and peripheral IV access sites only)

10 x 12cm ELW054 1.39

Absorbent Foam DressingsFoam dressings are designed to absorb large amounts of exudate and provide a moist wound environment.

Mode of Action• Maintain a moist wound environment.• Facilitate moist wound healing.• Absorb and retain exudate.• Provide an effective barrier function.

Indications• Pressure Ulcers.• Arterial Leg Ulcers.• Venous Leg Ulcers.• Superficial Burns.• Graft Wounds and Skin Donor Sites.• Lacerations and Abrasions.• Non Infected Diabetic Foot ulcers.4 5

ContraindicationsFoams should not be used on dry wounds as they may adhere.• Surgical Implantation• Full Thickness Burns • Post Operative Wounds.

Tissue TypesDressings can be used as a primary dressing to protect granulation and epithelial tissue in a wound or to absorb exudate or as a secondary dressing.

Foam AdhesiveProduct Size NHSSC


Cost per Pack

Cost Per Dressing

ActivHeal Foam Adhesive

7.5 x 7.5cm10 x10cm 12.5 x 12.5cm15 x15cm 20 x 20cm18 x 18.5cm

ELM161ELA210 ELA211 ELA212 ELA213

1010101010

11.8016.30 16.80 21.50 45.0

1.181.63 1.68 2.15 4.50 3.20

Askina DresSil Foam (Silicone based)

5 x 7cm10 x 10cm15 x 15cm10 x 20cm20 x 20cm

ELY539ELY540ELY541ELY542ELY544

0.851.452.662.684.26

Advazorb Border(Advancis)

7.5 x 7.5cm10 x 10cm12.5 x 12.5cm15 x 15cm10 x 20cm20 x 20cm

ELA547ELA548ELA549ELA550ELA551ELA552

1.192.102.583.152.905.46

Advazorb Border Lite(Advancis)

7.5 x 7.5cm10 x 10cm12.5 x 12.5cm15 x 15cm10 x 20cm20 x 20cm10 x 30cm

ELA554ELA555ELA556ELA557ELA558ELA559ELA560

1.071.892.322.842.614.913.83

Foam Non AdhesiveProduct Size NHSSC Code Dressings

Per PackCost per Pack

Cost Per Dressing

ActivHeal Non Adhesive Foam

5 x 510 x 10 10 x 20 20 x 20Heel

ELA214 ELA216 ELA246 ELA218ELM160

10101010

6.89 10.29 18.83 33.22

0.75 1.132.34 3.923.48

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Askina Foam (silicone foam)

10 x 10cm10 x 20cm20 x 20cmHeel

ELA410ELA411ELA412ELA409

2.183.445.754.66

Biatain Soft-hold (Coloplast)Highly exuding wounds only

10 x 10cm15 x 15cm10 x 20cm

ELA039ELA041ELA260

2.554.243.87

5 x 7cm ELA414 1.29

Simple Adhesive DressingProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Richardson Softpore

6 x 7 10 x 10 10 x 1510 x 2010 x 30

EIJ023EIJ013EIJ014EIJ024EIJ026

6050503030

3.606.5010,010.5014.70

0.060.130.200.350.49

Opsite Post-op

8.5 x 15.5cm10 x 30cm10 x 35cm9.5cm x 8.5cm6.5 x 5cm10cm x 12cm10 x 20cm10 x 25cm

ELW050ELW045ELW049ELW051ELW052ELW090ELW091ELW092

50 59.0 1.182.913.240.85

1.161.952.46

Low AdherenceProduct Size NHSSC Code Dressings


Cost Per Dressing

HartmannAtraumen

5 x 5 7.5 x 1010 x 2020 x 30

EKA024EKA032EKA036EKA016

50 503010

13.014.018.6017.10

0.260.280.621.71

Adaptic Touch(Acelity))

5 x 7.6cm7.6 x 11cm12.7 x 15cm20 x 32cm

ELY360ELY355ELY361ELY362

1.132.254.6512.50

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Non-adherentProduct Size NHSSC Code Dressings


Cost Per Dressing

N-A Dressing Hartmann Atrauman

9.5 x 9.5cm19 x 9.5cm

EKG011EKG013

0.350.67

N-A Dressing (Acelity) NA Ultra

9.5 x 9.5cm19 x 9.5cm

EKG031EKG033

0.330.63

19 x 19cm EKG035

Hydrogel Hydrogels are a class of dressing composed mainly of water and a stabiliser/preservative to keep the gel intact. hydrogels works by donating water to the wound surface. This debrides the wound by rehydration, promotion of autolysis, and de-sloughing of the necrotic or sloughy wound bed.

Mode of Action• Donating moisture.• Providing a moist wound environment for healing.• Encouraging and facilitating autolysis.• Removing devitalised tissue.• Encouraging growth and migration of epithelial cells.

Needs a secondary dressing to contain moisture and aid autolysis and maintain optimum wound environment.

Indications• Pressure Ulcers• Cavity Wounds• Leg Ulcers• Skin Donor Sites• Diabetic Foot Ulcers

Contraindications• Surgical Implantation• Full Thickness Burns

Note: Please ensure the wound is thoroughly cleaned of hydrogel prior to the application of Lar-vae.

Tissue TypesHydrogels are indicated for use in dry wounds where rehydration is required. Hydrogels should not be used on heavily exuding wounds as this can encourage maceration to the surrounding skin. Hydrogels can be used for the management of necrotic and sloughy wounds.

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Product Size NHSSC Code Dressings Per Pack

Cost per Pack

Cost Per Dressing

ActivHeal Hydrogel

15g ELG018 10 14.10 1.41

Hydrogel SheetsProduct Size NHSSC Code Dressings


Cost Per Dressing

Actiform Cool (Activa)

5 x 6.5cm10 x 10cm10 x 15cm20 x 20cm

ELE083ELE055ELE056

1.792.633.797.93

HydrocolloidHydrocolloids absorb exudate and forms a cohesive gel that facilitates moist wound healing.

Mode of Action• Maintain a moist wound environment.• Aid autolysis.• Promote angiogenesis.• Ensure ease of removal.• Provide a bacterial barrier.• Provide a waterproof barrier.

Indications• Chronic Wounds• Pressure Ulcers• Leg Ulcers• Cavity Wounds• Skin Donor Sites • Superficial and Partial Thickness Burns• Post Operative Surgical Wounds• Abrasions

Contraindications• Full Thickness Burns• Highly Exuding Wounds

Tissue TypesHydrocolloids are interactive dressings, in the presence of wound exudate, absorb exudate and form a cohesive gel. For use on low to moderate exuding wounds. They encourage autolytic debri-dement.

Can be used for the management of necrotic, sloughy, granulating and epithelialising wounds.

8 9


Cost per Pack

Cost Per Dressing

ActivHeal Hydrocolloid

5 x710 x 1015 x 15Sacral

ELM150ELM104ELM105ELM106

1010105

7.8015.8034.3019.90

0.781.583.433.98

3M Tegaderm 17 x 16 sacral10 x 12 oval13 x 15

ELM148ELM084ELM373

4.812.314.30

Hydrofibre DressingsAbsorbent dressing that converts from a fibrous dressing to a soft gel on contact with exudate and retains exudate within the fibres.

Mode of Action• To maintain a moist wound environment• To support the healing process• To aid autolytic debridement.• To absorb exudate effectively• To help encourage granulation• To reduce maceration of the surrounding skin• To assist with intact removal without damaging the healing tissue.

IndicationsChronic Wounds• Pressure ulcers. • Leg ulcers.• Venous ulcers.• Arterial ulcers.• Diabetic ulcers.• Cavity wounds.

Acute Wounds• Lacerations and abrasions.• Graft wounds.• Donor sites.• Post operative wounds.• Trauma wounds.• Superficial and partial thickness burns.

Contraindications• Surgical implantation.• To control heavy bleeding.• Low exuding wounds.

Tissue TypesShould be used on wounds that are either medium to heavy exudate. Can be used on sloughy,

granulating and cavity wounds.

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Cost per Pack

Cost Per Dressing

ActivHeal Aquafiber

5 x 5cm10 x 10cm15 x 15cmRope 2 x 42cm


1055

18.017.09.10

0.761.803.401.81

Convatec Aquacel Extra*HIGHLY EXUDING WOUNDS ONLY*

2 x 45 cm5 x 5cm10 x 10cm15 x 15cm4 x 10cm4 x 20cm4 x 30cm


10510

23.9022.5012.90

2.421.012.394.491.291.892.85

Odour Absorbing Malodour is a result of bacterial metabolism and the production of noxious agents. Activated char-coal dressings absorb toxins.

Mode of ActionEffectively absorbs toxins and controls malodour.

Indications• Chronic wounds• Fungating wounds• Discharging, purulent wounds• Gangrenous lesions.

ContraindicationsNot indicated for dry wounds.

Tissue TypesAny wound type that has a malodour and is exuding.


Cost per Pack

Cost Per Dressing

Clinimed Clinisorb

10 x 10cm10 x 20cm15 x 25cm

ELV051ELV053ELV055

101010

18.6024.8039.90

1.862.483.99

Antimicrobial Dressings Antimicrobial dressings inhibit or kill bacteria and provide a moist environment for healing. They are chemicals which are used to either kill or control the growth of micro-organisms in wounds (White, 2002).

Mode of Action• Killing the common open wound aerobic and anaerobic pathogens.• Control bacteria.• Work against a variety of different micro organisms.• Help control odour and exudate. (Vuolo, 2009).10 11

IndicationsFor use on infected wounds.There are two main generic groups of wound management products that have the potential to reduce the bacterial burden in the wound.• Silver• PHMB

They all have the capability of killing the common open wound aerobic and anaerobic patho-gens. Iodine has antiseptic properties , which control the bacteria on the surface of the wound (Flores et al, 2007).

Ref 1) ARHAI antimicrobial stewardship “start smart then focus”. Guidance for antimicrobial stew-ardship in hospitals (England) 2011.Appendix 1 - Resource Materials: Examples of audit tools, review stickers and drug charts.Ref 3) W.H.O “prevention and management of wound infection” Guidance from W.H.O dept of violence and injury prevention and disability and the dept of essential health technologies.Ref 4) EWMA document: Antimicrobial and non healing wounds, evidence, controversies and sug-gestions, Journal of Woundcare Vol 22 No5 EWMA Document 2013


Dressings Per Pack

Cost per Pack

Cost Per Dressing

Inadine (Acelity)

5 x5cm9.5 x 9.5cm

EKB501EKB502

0.330.49

Idoflex paste (Smith & Nephew)

5g10g17g

EKB007EKB008EKB009

4.068.1212.86

Idosorb Ointment (Smith & Nephew)

10g EKB012 4.49

20g 8.97

Flamazine

50g 3.85

20g250g500g

10.3218.27

Anabact - Metreonidazole*http://ewma.org/filead-min/userupload/EWMA/pdf/EMWAprojects/anti-microbials/JWCEWMAs-upplementNOCROPS.pdf

15g 4.47

30g 7.89

* http://ewma.org/fileadmin/user_upload/EWMA/pdf/EWMA_Projects/Antimicrobial/JWC_EWMA_supplement_NO_CROPS.pdf

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Antimicrobial continued

Honey Dressings Product Size NHSSC Code Dressings


Cost Per Dressing

Actilite - 1st line (Advancis)

5 x 5cm10 x 10cm10 x 20cm

EJE079EJE042EJE040

0.570.981.90

Activon Gel (Advancis)

25g ELZ069 2.05

Bandaging

Retention BandagesProduct Size NHSSC


Cost per Pack

Cost Per Dressing

K-Band (Urgo) 5cm x 4m7cm x 4m10cm x 4m15cm x 4m

EDB034EDB035EDB039ECA173

0.100.260.281.14

K-Lite (Urgo) 5cm x 4.5m7cm x 4.5m10cm x 4.5m 15cm x 4.5m10cm x 5,25m

ECA084ECA086ECA100ECA109ECA173

1616161616

8.8012.2015.8023.0018.20

0.550.760.991.441.14

Wool Bandages Product Size NHSSC


Cost per Pack

Cost Per Dressing

K-Soft (Urgo) 10cm x 3,5m20cm 4.5m (long)

EPA028ECA174

0.450.99

Compression SystemsProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Actico Cohesive (Activa)

10cm x 6m EBA016 3.33

Advasoft

Flexiban wadding 10cm x 3.5m EBA070 0.50

Ko-Flex (Urgo) 10cm x 6m10cm x 7m

ECD018ECD028

3.003.43

12 13

K-Plus (Urgo) 10cm x 8.7m10cm x 10.25m

ECA162ECA172

2.262.61

K-Three (Urgo) 10cm x 3m EBA060 2.81

4 layer CompressionProduct Size NHSSC


Cost per Pack

Cost Per Dressing

K-four reduced compression kit (Urgo)

18cm+ 4.45

K-four Kit Less than 18cm18-25cm25-30cmAbove 30cm

EVN154EVN008EVN155EVN156

7.116.806.809.36

2 layer CompressionProduct Size NHSSC


Cost per Pack

Cost Per Dressing

K-Two Kit (Urgo) 0 (short)18-25cm (10cm)25-32cm (10cm)

ECA197ECA198

6.747.998.72

Coban 2 Kit one size

One size ECA136 8.17

Coban 2 Lite Kit One size ECA203 8.17

Short Stretch Bandage SystemsProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Actico short stretch (Activa)

10 x 6 3.33

Flexiban wadding 10 x 3.5 0.50

StockinettesProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Clinifast Red Line (Clinisupplies)

3.5cm x 10m EGP018

3.5cm x 1m EGP061 0.56

14

Clinifast Green Line (Clinisupplies)

5cm x 10m EGP019

5cm x 1m EGP058 0.58

5cm x 3m 1.62

5cm x 5m 2.81

Clinifast Blue Line (Clinisupplies)

7.5cm x 10m EGP020

7.5cm x 1m7.5cm x 3m7.5cm x 5m

EGP044EGP054

0.772.133.74

Clinifast Yellow Line (Clinisupplies)

10.75cm x 10m EGP021

10.75cm x 1m 1.20

10.75cm x 3m EGP073 3.49

10.75cm x 5m EGP056 6.04

Clinifast Yellow Line (Clinisupplies)

17.5cm x 10

17.5 x 1m EGP057 1.83

Ribbed Stocki-nette (Molnlyce)

5cm x 5m7.5cm x 5m10cm x 5m15cm x 5m20cm x 5m25cm 5m

2.483.264.326.227.198.60

Comfitube

1125678T1T2

EGJ055EGJ056EGJ058EGJ039EGJ059EGJ060

Actiglide stocking applicator

14.40

Sockaid stocking applicator

12.99

Medicated BandagesProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Ichthopaste (Smith & Nephew)

6m x 7.5cm EFA051 3.67

Steripaste (Molnlycke)

6m x 7.5cm EFA016

Viscopaste 6m x 7.5cm EFA011 3.63

14 15

Miscellaneous

Wound ClosureProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Steri-strip (3M Healthcare)

6 x 38mm x 6 EIR502

3 x 75mm x 5 EIR501

6 x 75mm x 3 EIR503 8.69

IrrigationProduct Size NHSSC Code Dressings


Cost Per Dressing

Irripod (CD Medical)

20mls MRB742 25 146.0 5.84

Paraffin GauzeProduct Size NHSSC Code Dressings


Cost Per Dressing

Paragauze 10 x 10cm 0.28

TapesProduct Size NHSSC Code Dressings


Cost Per Dressing

Hypafix (BSN)

2.5cm x 5cm5cm x 5m10cm x 5m2.5cm 10m5cm x 10m10cm x 10m15cm 10m20cm 10m

EHR033EHR034EHR030EHR111EHR113EHR031EHR117

1.422.381.662.634.596.809.02

Clinipore (Clinisupplies)

1.25cm x 5m2.5cm x 55cm x 5m1.25cm x 10m2.5cm x 10m5cm x 10m7.5cm x 10m

EHU027EHU028EHU019EHU020EHU021EHU022

0.350.590.99

0.73

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Maintenance Hosiery


Dressings Per Pack

Cost per Pack

Cost Per Dressing

Activa hosiery (ready made)

7.41 - 14.28 pp

Actilymph hosiery kit

29.75

Actilymph made to measure lower limb hosiery

16.95 - 42.91pp

Specialist ProductsProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Cutimed Sorbat Gel - Hydrogel Sheet (BSN)

7.5cm x 7.5cm7.5cm x 15cm

ELY338ELY339

2.644.40

Flaminal Forte Gel (Ark Therapeutics)

15g ELG022 7.61

Flaminal Hydro 15g ELG021 7.61

Larvae Therapy

Promogran (Acelity)

28cm sq123cm sq

ELZ001ELZ002

5.1915.62

Suprasorb X + PHMB (Acitva)

5 x 5cm9 x 9cm14 x 20cm2 x 21cm rope


2.535.0311.457.13

Prontosan (B Braun)

6cm x 40ml ELY246

30ml Gel ELZ213

350ml

Devbrisoft (Activa)

10 x 10cm 6.35

Kendall AMD (Covidien)

5 x 5cm10 x 10cm15 15cm20 x 20cm

2.504.718.9213.07

Intrasite Gel (Smith & Nephew)

8g15g25g

ELG015ELG000ELG011

1.802.413.57

16 17

Lymphoedema / Vascular Services Only

BandagingProduct Size NHSSC


Cost per Pack

Cost Per Dressing

Coban 2 Comfort Foam Layer (3M)

5cm x 1.2m15cm x 3.5m

ECA209ECA211

2.8311.23

10cm x 3.5m ECA210 7.38

Coban 2 Compression Layer (3M)

5cm x 2.7m15cm x 4.5

ECA213ECA215

1.427.08

10cm x 4.5m ECA214 4.75

Coban 2 lite Comfort foam layer (3M)

7.5cm x 2.7m10cm x 2.7m15cm x 4.5m

ECA217ECA218ECA219

4.655.778.70

Coban 2 lite Com-pression Layer (3M)

2.5cm x 3.5m7.5cm x 3.5m10cm x 3.5m15cm x 3.5

ECA220ECA221ECA222ECA223

2.233.544.556.17

Co Flex Bandages with zinc oxide

7.5cm10cm

EFA004EFA005

5.256.35

Upper LimbProduct Size Cost Per

Dressing

Sigvaris advance - arm sleeves Complete range 17.91 - 27.88

Jobsta Belle Lite Complete range 12.87 - 19.55

Mediven Harmony Complete range 14.79 - 32.86

Toe CapsProduct Size Cost Per

Dressing

Haddenham Microfine Complete range 26.30

GlovesProduct Size Cost Per

Dressing

Haddenham Microfibre Complete range 41.27

18

HosieryProduct Size Cost Per

Dressing

Sigvaris Comfort Range Complete range 27.13 - 52.13

Jobst - Opaque Complete range 26.52 - 50.53

Medi - Elegance Complete range 28.13 - 54.77

Medi - Mediven for men Complete range 27.92 - 28.24

Made to MeasureProduct Size Cost Per

Dressing

Jobst Elvarex Custom Fit range Complete range 35.27 - 70.24

Sigvaris - alternative to flat knit Complete range 33.28 - 51.16

Juzo range - available off the shelf and MtM

Complete range 32.00 - 65.00

BootsProduct Size Cost Per

Dressing

Kerraped Boots 21.30

Debrisoft (Specialist product)

Velcro wraps & applicators to enable patients to apply / remove garments independently.

Podiatry OnlyProduct Size Cost Per

Dressing

Melolin

Velcro wraps & applicators to enable patients to apply / remove garments independently.

18 19

Wound Pink – Epitheliasing

Wound Red – Granulating

Wound Yellow - Sloughy

Typified by pink/pale mauve colored tissue.• Epithelial tissue is formed in the final stages of healing. • The epithelia at the wound margin start to divide rapidly. • It spreads across the wound surface and pale pink in

colour.• This tissue forms the new epidermis.

Treatment AimTo complete the healing process and prevent damage to new epithelium.• Maintain moist, warm, clean environment. • Protect the newly formed tissue - Epithelial tissue

can be disrupted by the presence of foreign material, desiccation, temperature, PH changes and infection.

Mixture of dead white cells, dead bacteria, rehydrated necrotic tissue and fibrous tissue.• Creamy, yellowish/white in colour which are primarily dead

cells.• Made up of dead cells and wound debris that have

accumulated in the exudate.• Related to the end of the inflammatory stage.• Neutrophils have a short life span and can die faster than they

can be removed. • Slough should be removed to enable healing to take place.

Treatment aim - To deslough and remove excess exudate to avoid infection.• Rehydrate the wound• Remove devitalised tissue• Exudate control• Prepare the wound bed for healing

Granulating tissue usually deep pink in colour at the base with red lumps over the surface.• The wound colour is red and made up of new capillary loops

which are across the surface to look granular.• Walls of the capillary loops are thin therefore can be easily

damaged.• Granulation tissue fills the wound as it is healing.

Treatment Aim - Promote granulation by removing excess exudate and prevent damage to delicate granulating tissue.Maintain a moist, warm, clean wound surface. • Exudate control• Protection

Dressing selection should ensure there is adequate exudate control to ensure a moist environment whilst protecting the wound.

Wound Care Treatment Algorithms

Every wound should be individually assessed, and exceptions do occur. The following is guidance to support your assessment, but an holistic must be carried out to determine all factors

affecting wound healing.

20

Wound Black - Necrotic

•

Necrotic wounds are typified by black dead tissue.• Usually black in colour• Tissue becomes ischaemic after a length of time it will die• Accumulation of dead devitalised tissue• Necrotic tissue acts as a culture, providing an ideal

breeding ground for bacteria• Prevents accurate assessment and can be more extensive

than apparent.

Treatment Aim – To rehydrate and debride• Rehydrate the wound• Remove devitalised tissue• Prepare the wound bed for healing

Wound Green - Infected

Maybe identified by signs including oedema, swelling, increased exudate, pungent odour, inflammation and pain.

• Tissue may have signs that include red, bleeding, flimsy, friable and painful granulation

• Cellulitis and spreading erythema• Increasing odour and or exudate• Abscess formation• Discolouration of wound surface• Tissue breakdown• Static, non healing wound

Treatment Aim – To control and manage infection and exudate through the appropriate treatment or antimicrobial dressing.

Has an offensive odour indicating infection or colonization or bacteria.

Odour- Systemic antibiotics, Charcoal dressingsBleeding – AlginateExudate – Alginate and Foam

The selection of wound management products should be based on a holistic patient assessment. Accurate wound assessment and appropriate product selection can help promote a wound healing environment and ultimately improve patient outcomes.

Treatment Aim - To manage odour, bleeding and exudate.

Fungating/Malodorous Wound

Link for Waterlow:www.judy-waterlow.co.uk

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EPUAP Pressure Ulcer Classification

Grade 1 Pressure Ulcer : Non-blanchable erythemanon-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or

hardness may also be used as indicators, particularly on individuals with darker skin.

Grade 2 Pressure Ulcer : Blisterpartial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and

presents clinically as an abrasion or blister.

Grade 3 Pressure Ulcer : Superficial ulcerFull thickness skin loss involving damage necrosis of subcutaneous tissue that may extend down

to, but not through, underlying fascia.

Grade 4 Pressure Ulcer: Deep UlcerExtensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures with

or without full thickness skin loss.

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GlossaryAcute wound - A recently inflicted wound that will usually heal without problems.

Aerobic Bacteria - Bacteria that thrive in an oxygen rich environment.

Alginate - Dressing derived from seaweed.

Anaerobic Bacteria - Bacteria that thrive in an oxygen free environment.

Autolysis - The body’s natural capacity for breaking down necrotic tissue. In wound care autolysis is encouraged through the use of moist wound dressings.

Cellulitis - Inflammation and infection of the cells, associated with heat, redness, swelling and pain.

Chronic wound - Wound that has remained unhealed for more than 6 weeks.

Collagen - Most abundant protein in the body and is responsible for holding the body

together. Collagen is laid down and modified during the proliferation and maturation phase ofwound healing.

Debridement - Removal of devitalised tissue through surgery, larval therapy, autolysis orocclusive dressings.

Dehiscence - Separation of the opposed edges of a surgical wound.

Devitalised Tissue - Tissue that is no longer viable.

Epithelialisation - Wound bed level with the surface, epithelial cells will migrate over thewound bed to complete healing.

Eschar - Hard necrotic tissue.

Erythema - Redness as seen in inflammation surrounding wounds.

Excoriation - Skin has been traumatised, worn away or eroded as a result of incontinence orinappropriate dressing.

Exudate - Serous fluid that has passed through the walls of a damaged or overextended vein.

Fibroblast - In wound healing, fibroblasts stimulate cell migration, angiogenesis, embryonicdevelopment and healing.

Film Dressing - Transparent film that can be used as a primary or secondary dressing.

Gangrene - Devitalised, dead tissue caused by failure of the blood supply.

Granulation - Combination of newly formed vascular tissue and fibroblasts, which lay down amatrix of cellular tissues during wound healing.

22 23

Guluronic acid - Present in alginates, maintains the structure making removal in one piecepossible.

Haematoma - A bruise or collection of blood in the tissues.

Haemostasis - Control of bleeding.

Homeostasis - The body’s natural mechanism for maintaining health constancy and ensuringsurvival. Includes blood pressure and thermoregulation.

Hydrogel - Water based product for rehydrating necrotic tissue.

Hydrophilic - Water loving, absorbent dressing.

Hydrophobic - Water hating, non absorbent dressing.

Hypergranulation - (overgranulation) - Excessive production of granulation tissue.

Infection - Caused by micro-organisms which evade the immunological defences, enter andestablish themselves within the tissues.

Inflammation - Natural defence against bacterial invasion, stimulates wound healing.Ischaemia - Localised deficiency of arterial blood.

Keratinised - The process whereby epidermal cells differentiate to form the stratum Corneum.

Leg Ulcer - Wound of the lower limb that is chronic in nature.

Maceration - Softening of tissue that has remained moist or wet for a long period. The skinbecomes white and soggy and less resilient. Can predispose to tissue breakdown.

Malnutrition - Poor nutritional status from impaired absorption, poor diet.

Mannuronic Acid - Present in alginates, form a soft flexible gel, breaks down in the presenceof sodium and rinses away.

Maturation - Final stage of wound healing which involves wound contraction, fullepithelialisation and reorganisation.

Moisture Vapour Transfer Rate (MVTR) - The rate at which moisture (mainly from woundexudate) passes through a dressing and evaporates into the atmosphere.

Necrosis - Death of tissue or organ in response to injury, disease or occlusion of blood flow.

Oedema - An unnatural accumulation of fluid in the interstitial spaces.

Pressure Ulcer - An area of localised damage to skin and underlying tissue caused bypressure, shear and friction.

Proliferation Phase - Third phase of wound healing, intense proliferation of fibroblasts andendothelial cells.

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Pus - A production of inflammation usually caused by infection containing used cells, debrisand tissue elements.

Sharp debridement - Method of debridement using scalpel or scissors to remove necrotic tissue.

Sinus - An epithelial cell lined tube from the outside of the body to the inside.

Slough - A mixture of dead white cells, dead bacteria, rehydrated necrotic tissue and fibroustissue.

Tissue Viability - The ability of tissue to perform its function optimally.

Vapour Permeable - Gases and water vapour pass through e.g. dressing surface.

Vasoconstriction - The arteries and arterioles constrict under the influence of drugs, hormonesor cold.

Vascularity - Blood supply to an area of tissue.

Vascular Response - May be dilation or contraction, in a response to a variety of stimuli e.g.temperature, inflammatory state and blood volume.

Vasodilation - The lumen of blood vessels opens and becomes wider. Blood flow slows andoxygen reaches the tissues.

Wound - A breakdown in the epidermis that can be related to trauma or pathological changeswithin the skin.

Definitions are taken from Collins, et al. (2002), Benbow (2005) and Vuolo, (2009).

24 25

Blackpool Teaching Hospitals NHS Foundation Trust ID No.

Title: Revision No: Next Review Date: Do you have the up to date version? See the intranet for the latest version

Page 7 of 21

Appendix 1: BMI chart



Page 15 of 21

Appendix 8: MUST screening record



Page 16 of 21

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PROVIDER SERVICES Wound Care Formulary · Wound Care Formulary Updated September 2014Issued October...

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Transcript of PROVIDER SERVICES Wound Care Formulary · Wound Care Formulary Updated September 2014Issued October...