Wound Care Products Formulary 2019 Hertfordshire Community ... · PDF file WOUND. Wound bed...

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  • Wound Care Products Formulary 2019 Hertfordshire Community NHS Trust

  • Contents Page Wound Care Products Formulary 2019 Dressing Selection Guide Triangle of Wound Assessment Barrier Cream Barrier Film Low Adherent Dressings Island Dressings Film Dressings Hydrocolloids Alginates Hydrofibers Foams Skin Tears Absorbent Dressing Pads Anti-microbial Dressings Odour Absorbing Dressings Debridement Retention Bandages Compression Bandages Zinc Paste Bandages

    Page Negative Pressure Wound Therapy Other Accessory Items Dressing Packs Pressure Ulcer Prevention Pressure Ulcer Prevention Checklist Leg Ulcer Services Only Podiatry Only Health Visitors Management of Sore & Damaged Nipples

    1 2 3 5 5 6 7 7 8 9 9

    10 12 13 14 16 17 18 19 20

    21 22 23 24 24 25 26 27 28

  • Wound Care Products Formulary 2019 This formulary has been developed to assist any healthcare professional prescribing or requesting dressings for wound management in Hertfordshire. It aims to aid the decision making process and help choose the most appropriate product whilst ensuring value for money in the use of NHS resources.

    Key messages: • All the products in the formulary have been selected taking into account available supporting clinical

    evidence by a panel of trust wide practitioners who have specialist knowledge and expertise in wound care. • Advice in the comments column should be followed when selecting products. • The formulary contains specific sections dedicated for use in podiatry, the leg ulcer service, and health

    visiting. • To avoid waste do not prescribe or request excessive quantities or issue for long term repeats. A maximum

    of 14 days’ supply should be sufficient. • If wound healing does not progress as expected, advice from the Tissue Viability Service should be sought. • Dressings prescribed on FP10 for individual patients must not be used for any other patient or for car boot

    stock • Adherence to the wound products formulary will be monitored and audited. Clinical justification will be

    required for requesting ‘off formulary’. Exception forms must be completed and sent to Tissue Viability. • Where there may be a number of different health professionals visiting a patient, efforts should be made

    to avoid over ordering by ensuring that there are not multiple orders/prescriptions generated for the same dressings.

    • Wound care products must not be added to repeat prescriptions. In exceptional and individual patient cases this may be necessary and will be agreed with the nurse managing the wound care.

    • Prices are subject to change over time and are a guide for comparison of costs of products

    1

  • Dressing selection guide

    Skin Tear Pathway Tegaderm Absorbent clear acrylic dressing as per Skin Tear Pathway

    Skin Care Use appropriate emolients as per

    emollient ladder.

    When to Swab? Wound breakdown, healing delayed, increase pain, heat, exudate, odour,

    bleeding, swelling or redness of surrounding skin. Swab should be obtained at the beginning of any dressing procedure after wound

    cleansing.

    Moisture Lesions Keep skin healthy, clean & dry

    particularly if exudate is excessive. Apply barrier product as required, i.e. Sudocrem/Cavilon as per the

    MASD Pathway.

    Wounds on feet Necrotic or Sloughy wounds on

    feet or heels NEED to be referred to a specialist team, i.e. Podiatry,

    Vascular &/or Tissue Viability.

    Secondary Dressing Where secondary dressings are

    needed consider under bandages: Zetuvit E, Vliwasorb, Kerramax Care. If an adherent secondary dressing is being used consider

    Tegaderm plus pad, Hydrocolloid, Foam adhesive or silicone adhesive

    This is a guide and should not replace clinical judgement. For further dressing choices refer to the HCT Dressing Formulary. Seek further guidance from Tissue Viability Service (01707252467). Email referrals to herts.tvn@nhs.net

    Images are copyright of Coloplast

    Ti ss

    ue T

    yp e

    Epithelialising Granulating Sloughy Necrotic Infected Fungating Malodorous

    Tr ea

    tm en

    t A

    im

    Promote epithelialisation and wound maturation

    Promote Granulation Provide healthy base for

    epilelisation

    Remove Slough Provide clean base for

    granulation tissue

    Debride and remove necrosis *See Wounds on Feet box for

    specific advice If necrotic wound on the foot of someone with diabetes/PVD see

    Wound on Feet box below

    Manage infection (systemic antibiotics must be

    considered where signs of systemic infection exist)

    Manage complex wound e.g. bleeding, exudate, malodour,

    size

    Dressings

    Lo w

    Ex

    ud at

    e

    1st Choice: Low Adherent, e.g. Atrauman/Tegaderm Plus

    Pad 2nd Choice: Hydrocolloid, e.g.

    ActivHeal Hydrocolloid

    1st Choice: Low Adherent, e.g. Atrauman/Tegaderm Plus

    Pad 2nd Choice: Hydrocolloid, e.g.

    ActivHeal Hydrocolloid

    Enzyme Alginogel: e.g. Flaminal Hydro (Consider

    using Debrisoft / UCS Wipes)

    1st Choice Enzyme Alginogel: e.g Flaminal Hydro

    2nd Choice: ActivHeal Hydrocolloid

    Kerracontact Ag or Algivon or Surasorb X PHMB

    1st Choice: Low Adherent, e.g. Atrauman or Urgotul or

    Activheal silicone contact layer

    M od

    er at

    e Ex

    ud at

    e Foam e.g. Biatain Adhesive/ Biatain Silicone (Fragile Skin)/

    Activheal Foam

    1st Choice Hydrofiber e.g. Aquacel Extra (Aquacel

    Ribbon depending on size of Cavity)

    Hydrofiber e.g Aquacel Extra Alginate e.g. Activheal

    alginate or Enzyme Alginogel: e.g.

    Flaminal Forte

    Hydrofiber e.g. Aquacel Extra or Enzyme Alginogel: e.g.

    Flaminal Forte

    Aquacel Ag+ Extra or Flaminal Forte or Iodoflex or

    Kerracontact Ag

    Hydrofiber e.g Aquacel Extra or Enzyme Alginogel: e.g. Flaminal Forte (Consider

    referral to Tissue Viabillity)

    H ig

    h Ex

    ud at

    e

    Not Applicable

    1st Choice Hydrofiber e.g. Aquacel Extra (Aquacel

    Ribbon depending on size of Cavity)

    2nd Choice: Alginate e.g. ActivHeal Alginate if cavity(Consider Negative Pressure Therapy refer to

    Tissue Viability)

    Hydrofiber e.g Aquacel Extra or Enzyme Alginogel:

    e.g. Flaminal Forte (If need further advice regarding specialist treatment e.g. Maggots refer to Tissue

    Viability)

    Hydrofiber e.g. Aquacel Extra or Enzyme Alginogel: e.g.

    Flaminal Forte

    Aquacel Ag+ Extra or Flaminal Forte or

    Kerracontact Ag Refer to Tissue Viability

    2

  • Wound bed

    Wound edge

    Periwound skin

    Triangle of Wound Assessment1

    WOUND

    Wound bed

    Wound edge Periwound skin

    The Triangle of Wound Assessment is a holistic framework that allows practitioners to assess and manage all areas of the wound, including the periwound skin.

    To support optimal clinical decision- making all three areas of the wound should be considered.

    Patient (age, lifestyle, comorbidities, mobility, etc.)

    Wound (3 areas)

    Other factors (e.g. socio-economic factors)

    1. Dowsett C et al. Taking wound assessment beyond the edge. Wounds International 2015;6(1):19-23

    3

  • It offers a simple framework that supports clinical decision-making and better patient outcomes

    Three simple steps of wound assessment

    By systematically taking the user through each of the wound areas, the Triangle of Wound Assessment guides the HCP through the different wound management steps.

    Wound assessment

    Management goals

    Treatment

    4

  • P ra

    ct ic

    e N

    ur se

    s -

    D is

    tr ic

    t N ur

    se s

    - N

    ur si

    ng H

    om es

    BARRIER CREAM Incontinence, slight erythema, mild moisture associated incontinence dermatitis

    Product Size NHSSC Box qty Each Comments

    Sudocrem 125g 400g

    1 1

    Use sparingly, do not apply thickly and do not wipe on pads.

    Cavilon cream 28g 92g 2g (sachets)

    ELY571 ELY568 ELY569

    1 1 30

    £3.28 £6.55 £6.40

    Apply a pea sized amount at a time to cover the affected area. A little goes a long way! Apply daily or twice daily.

    BARRIER FILM Broken skin, severe incontinence associated dermatitis

    Product Size NHSSC Box qty Each Comments

    Cavilon film 28ml pump 1ml applicator 3ml applicator

    ELY040 ELY038 ELY039

    1 25 (FP10 5) 25 (FP10 5)

    £5.79 £4.05

    £6.55

    Prevention and treatment of mod- erate/severe incontinence associ- ated dermatitis (IAD). Prevention of medical adhesive related skin injuries (MARSI) caused by surgical dressings and tapes. Skin protection around stoma/wound sites. Lasts for up to 72 hours.

    5

  • P ractice N

    urses - D istrict N

    urses - N ursing H

    om es

    LOW ADHERENT DRESSINGS Used to protect trauma to granulating or healing wounds. First line dressing for leg ulcers. Can remain in place for up to 7 days

    Product Size (cm) NHSSC Box qty Each Comments

    Atrauman Polyester tulle impregnated with triglyceride ointment

    5 x 5 7.5 x 10 10 x 20 20 x 30

    EKA000 EKA020 EKA016 EKA036

    10 10 1