WOUND CARE FORMULARY

Transcription

1 For the London Boroughs of: Barking and Dagenham, Havering, Redbridge, Waltham Forest WOUND CARE FORMULARY Approved by Barking and Dagenham, Havering and Redbridge Area Prescribing Sub-Committee Approved by Waltham Forest Area Prescribing Sub-Committee February 2017 Tissue Viability Nursing Service Wound Management Products Formulary 1

2 CONTENTS page 1. Introduction 3 Exudate Curve + Healing Aims 4 2. Cleansing 5 3. Wound Contact Layer with Adhesive Border 5 4. Adhesive Tapes 6 5. Absorbent dressings 6 6. Alginates 7 7. Bandages non compression 7 8. Bandages compression 8 9. Barrier Film Preparations Emollients Film Foam Hydrocolloid Hydrofiber Hydrogel Miscellaneous products Compression hosiery Extended formulary for limited use 1. Antimicrobials Silver Codexomer-iodine Polyhexamethylene Biguanide (PHMB) Honey Antimicrobial Alginate Gel Metronidazole Gel Topical Negative Pressure Larvae Therapy 17 Specialist Products for use under guidance of Tissue Viability Service 1. Pain Reduction Antimicrobial dressing Debridement Treatment for over granulated tissue Shoe System for off-loading Emollient Spray Debridement of Painful wounds 19 Podiatry Services Please refer to this section for a selection of dressings Classification of Pressure Ulceration Wound Management Products Formulary 2

3 1. INTRODUCTION This wound care formulary is designed to provide clinical staff with a comprehensive guide to wound dressing products. These products have been selected using available evidence gathered from a number of sources including: the Surgical Materials Testing Laboratory, Bridgend, trials conducted by independent researchers, trials conducted by pharmaceutical companies. Current usage locally along with experience of use of the products has also been considered. The dressings suggested are adequate for the majority of situations. Alternatives should only be used on the recommendation of the Tissue Viability Nurse or following discussion with team leader. This formulary will assist the practitioner in a variety of settings including GP Practices to select a wound care product, following a full assessment using the appropriate clinical guidelines for the type of wound being managed. Whilst this formulary focuses on wound care products, holistic wound care should include holistic assessment and management of the surrounding skin, an understanding of the underlying cause, accurate documentation and continuous monitoring and evaluation of the patient. This formulary will be reviewed on an annual basis and updated bi-annually. The cost effectiveness of these products is not solely based on the unit price, but based instead on the total episode of care. Introduction of new products to the formulary can be made by submitting a request to the NELFT Community Health Services Drug and Therapeutics Group. Prices quoted are from Drug Tariff January Acknowledge Contributors: Veronique Adeyemo Tina Cantwell Elaine Flaherty Jane Hampson Ann Pardoe Hannah Patten Rebecca Philips Clemency Slivnik Deborah Wickens Wilma Williams-Kelly Karen Wise Tissue Viability Nurses contact details: Barking & Dagenham Havering Redbridge Waltham Forest Tissue Viability Service Wound Management Products Formulary 3

4 Tissue Type Exudate Level Exudate Curve + Healing Aims Wet Gelling Fibre Foam Foam Honey Super Absorbents Gelling Fibre with Foam Hydrocolloid Gelling Fibre Gelling Fibre with Foam Gelling Fibre Foam Hydrogel Honey Moist Hydrogel Hydrogel Gelling Fibre Contact layer Dry Rehydrate Absorb Hydrate / Protect Necrotic Sloughy Granulating Epithelialising Infected Wound Progression Model Wound Management Products Formulary 4

5 2. CLEANSING (consider the use of tap water for the cleansing of chronic wounds e.g. in the management of leg ulcers. Sterile solutions should always be used in the management of surgical wounds, burns and grade 4 pressure ulcers). Irripods 20ml Gauze Swabs (Generic brand) 10cm x 10cm Nurse IT Sterile Dressing packs Small/Medium/Large Octenilin Wound Irrigation Solution 350mls WOUND CONTACT LAYER N-A Ultra 9.5cm x 9.5cm cm x 19cm Atrauman 5cm x 5cm cm x 10cm cm x 20cm Mepitel One 6cm x 7cm cm x 10cm cm x 15cm WITH ADHESIVE BORDER Primary dressings can be used on dry or lightly exuding wounds. Cosmopore E 10cm x 8cm cm x 7.2cm cm x 8cm cm x 10cm Cosmopor 5cm x 7.2cm (water repellent) 8cm x 10cm cm x 15cm cm x 20cm cm x 25cm Wound Management Products Formulary 5

6 4. ADHESIVE TAPES For patients with skin sensitivities to other plasters and strapping or when larger sizes may be required. E.g. Large abdominal wounds following dehiscence. Micropore 1.25cm x 5m cm x 5m cm x 5m Mefix 2.5cm x 5m cm x 5m NB: Not to be used to hold 10cm x 5m Bandages in place 15cm x 5m ABSORBENT DRESSINGS These dressings are indicated for highly exuding wounds and/or as a secondary dressing. They should be used with caution under compression therapy as too much padding impairs sub-bandage pressures. Zetuvit Plus 10cm x 10cm cm x 20cm cm x 20cm cm x 25cm cm x 40cm Zetuvit E 10cm x 10cm Non sterile Multiple 10cm x 20cm cm x 20cm cm x 40cm Kerramax Care 10cm x 22cm cm x 22cm cm x 30cm Wound Management Products Formulary 6

7 6. ALGINATE These dressings are for use on moderate to heavily exuding wounds. They can be used on painful ischemic and diabetic wounds, leg ulcers, pressure sores, granulating and fungating wounds and sinuses. When dressing flat non cavity wounds some alginates need to be cut or folded to the size of the wound due to their lateral strike through which could potentially cause maceration. Kaltostat 5cm x 5cm cm x 12cm cm x 20cm Can be used for haemostasis Cavity dressing 2gm in bleeding wounds 7. BANDAGES NON COMPRESSION K Band 5cm cm cm cm Peha-haft Latex free bandage 2.5cm x 4m (self-adhesive) 10cm x 4m Hospicrepe cm x 4.5m cm x 4.5m Viscopaste PB7 7.5cm x 6m Icthopaste 7.5cm x 6m Comfifast 7.5cm blue line x1m x5m cm yellow line x1m x3m x5m cm beige line x1m Wound Management Products Formulary 7

8 8. BANDAGES COMPRESSION Short Stretch System Actico 8cm cm cm Multi-layer System Profore #1 10cm x 3.5m Profore #2 10cm x 4.5m Profore #3 10cm x 8.7m Profore #4 10cm x 2.5m Tensopress 10cm x 3m Ultra four non latex bandage Ultra four soft wadding 10cm x 3.5m Ultra four lite 10cm x 4.5m Ultra four plus 10cm x 8.7m Ultra four fast 10cm x 6.3m Coban 2 Compression system Comprising of a two layer kit system 10cm x3.5m BARRIER FILM PREPARATIONS An alcohol free transparent protective film. Use to provide protection to the skin from excoriation and maceration. Medi Derma-S Aerosol Film Foam Applicator 75ml 1ml Derma-S Barrier Cream 90g Wound Management Products Formulary 8

9 10. EMOLLIENTS (for entire listing please refer to BHRs Emollient Guidelines and Formulary July 2016) Emollients are used to hydrate the skin and can be used as soap substitutes. Emulsifying 500g Ointment * Please note that this product contains paraffin and therefore a fire hazard. Refer to NPSA alert. Zerobase Cream 50g g Zerocream 50g g QV Cream 100g g FILM These dressings can be superficial wounds with low exudate. They can be used in the prevention and treatment of pressure ulcers by preventing friction. IV cm x 7cm Wound Management Products Formulary 9

10 12. FOAM These dressings can be used on shallow moderate to heavy exuding wounds as a primary or secondary dressing. Mepilex Border 7cm x 7.5cm *Has a polyurethane 10cm x 12.5cm foam backing for low to 15cm x 17.5cm moderately exuding 17cm x 20cm wounds Mepilex Border Sacrum Mepilex Transfer Allevyn Gentle Border 15cm x 15cm cm x 18cm cm x 8.5cm cm x 12cm cm x 20cm cm x 7.5cm cm x 10cm cm x 20cm Kerrafoam Gentle Border 7.5cm x 7.5cm *contains a super-absorbent 10cm x 10cm layer, suitable for use on 12.5cm x 12.5cm heavily exuding wounds 17cm x 17.5cm Kerraheel 12cm x 20cm Biatain Silicone 7.5cm x 7.5cm cm x 10cm cm x 12.5cm cm x 15cm HYDROCOLLOID Use Hydrocolloids on light to moderately exuding wounds, e.g. leg ulcers, pressure ulcers, minor burns and donor sites. They can also be used on granulating wounds and will rehydrate necrotic and sloughy wounds encouraging autolysis. They should be avoided on diabetic foot ulcers and heavily exuding wounds. DuoDerm Extra Thin 7.5cm x 7.5cm cm x 10cm cm x 15cm Comfeel Plus transparent 5cm x 7cm cm x 10cm *Light exuding wounds 5cm x 15cm

11 14. HYDROFIBER These dressings can be used on a variety of moderate to highly exuding wounds such as leg ulcers, pressure sores, burns, lacerations and infected wounds. Aquacel Extra 5cm x 5cm cm x 10cm cm x 15cm Aquacel Ribbon 45cm x 1cm cm x 2cm Aquacel Foam Adhesive 8cm x 8cm cm x 10cm cm x 12.5cm Aquacel Adhesive Heel 19.8cm x 14cm HYDROGEL This can be used on dry, sloughy and necrotic wounds as it facilitates hydration, promoting autolysis. They should not be used on heavily exuding wounds. IntraSite Gel 8g g Urgo Clean 6cm x 6cm cm x 10cm Rope 2.5cm x 40cm 2.38 Wound Management Products Formulary 11

12 16. MISCELLANEOUS PRODUCTS Bandage Protector Waterproof bandage protector to allow patients to shower of bath without getting dressings wet. Seal-Tight Adult wide short leg (up to knee) CV27106 Footwear Kerraped All Purpose Boot Small ( Shoe size:2-5.5) Medium (6-7.5) Large (8-10) X-Large ( ) Pressure Reducing Pads KerraPro Pressure reducing Heel pads KerraPro Pressure reducing Sacrum/Ankle pads Cleansing and Debridement For use in the management of chronic leg conditions when cleansing of the skin is required to reduce bacterial burden but no washing facilities are in existence. UCS Debridement Foil-sealed sterile pack Prontosan Wound Gel 30mls Wound Management Products Formulary 12

13 17. COMPRESSION HOSIERY DRESSING DESCRIPTION Graduated elastic compression hosiery in a selection of styles below knee, thigh length, open or closed toe and in a range of colours. Activa hosiery is a circular knit garment containing nylon and Lycra. INDICATIONS 14 17mmHg Class 1 FP10/GP10 Provides light compression and should be used for superficial or early varicose veins and swollen ankles. Other indications Activa Class 1 hosiery should also be considered post operatively and on long distance travel to help prevent deep vein thrombosis in normal risk groups mmHg Class 2 FP10/GP10 Provides medium compression and should be used for medium severity varicose veins and mild oedema. Activa Class 2 hosiery can be used as part of the treatment for and to prevent the occurrence and recurrence of venous leg ulcers. Other indications Activa Class 2 hosiery should also be considered post operatively and on long distance travel to help prevent deep vein thrombosis in high-risk patients mmHg Class 3 FP10/GP10 Provides strong compression and should be used for severe varicose veins and gross oedema. Activa Class 3 hosiery can be used for chronic venous insufficiency and in the treatment and prevention of venous leg ulcers. 40mmHg Hosiery Kit FP10/GP10 Strong compression for effective prevention and treatment for leg ulcers and mild Lymphoedema. 10mmHg Liner (as part of 40mmHg Hosiery Kit) used in conjunction with the 25-35mmHg Class 3 hosiery. CONTRA-INDICATIONS People with diabetes unless under medical or specialist nurse supervision. Significant arterial disease (ischemia) according to vascular assessment. Congestive cardiac failure as compression can lead to cardiac overload. Known sensitivity to the fabric of the stockings. METHOD OF USE Prior to application of compression hosiery patients must have a full holistic assessment including a Doppler reading. If this is <0.8 or >1.2 (RCN 98) specialist referral must be sought. Measure and brand for compression hosiery required. Fit according to manufacturer s inbox patient information leaflet. FREQUENCY OF CHANGE Patients should be re-assessed and measured (refer to local guidelines) every six months (RCN 98). To guarantee the correct compression it is recommended that hosiery should be changed every 3 months OR 6 months if alternating hosiery wear. WARNINGS AND PRECAUTIONS Use with caution where diabetes and rheumatoid arthritis are present as there may be micro vascular disease. People with diabetes may also have some degree of peripheral neuropathy, which could cause problems if the stockings become too tight. Care should be taken when applying hosiery over bony prominences and thin legs to avoid damage to the skin and circulation. Hosiery should not cause you any pain or discomfort, in the unlikely event of this happening please remove your hosiery immediately and seek advice from your pharmacist, nurse or doctor. Wound Management Products Formulary 13

14 17. COMPRESSION HOSIERY HOSIERY SELECTION The Hosiery listed within this formulary may not be suitable for all patients. Please refer to your local Tissue Viability Nurse for alternatives. Activa Class 1 Thigh Length Closed Toe (Sand/Honey/Black) S M L XL 7.89 Activa Class 1 Below Knee Closed Toe (Sand/Honey/Black S M L XL 7.21 Activa Class 1 Below Knee Open Toe (Sand) S M L XL XXL 7.21 Activa Class 1 Unisex Sock Below Knee (Black) S M L XL 7.21 Activa Class 2 Thigh Length Closed Toe (Sand/Honey/Black) S M L XL Activa Class 2 Thigh Length Open Toe (Sand) S M L XL Activa Class 2 Below Knee Closed Toe (Sand/Honey/Black) S M L XL Activa Class 2 Below Knee Open Toe (Sand) S M L XL XXL Activa Class 2 Unisex Ribbed Sock Below Knee (Black/Brown) S M L XL Activa Class 2 Anklets (Sand) S M L XL 6.91 Activa Class 2 Kneecaps (Sand) S M L XL 6.91 Activa Class 3 Thigh Length Open Toe (Sand) S M L XL Activa Class 3 Below Knee Open Toe (Sand) S M L XL XXL LEG ULCER HOSIERY KITS Activa Leg Ulcer Hosiery Kit (1x Class 3 BKOT Stocking & 2 x Liners) S M L XL XXL LINER S Activa Liners (3 x Liners) S M L XL XXL MADE TO MEASURE HOSIERY Refer to local guidelines Altiform Class 1, 2 & 3 MTM Refer to Medi UK Class 1, 2 & 3 MTM Order Credalast Class 1, 2 & 3 STOCKING APPLICATOR MTM Form ActiGlide Stocking Applicator (for open and closed toe) One Size Credenhill Magnide Stocking Applicator (for open and closed toe) Medium 5-7½ Large Ex. Large over Wound Management Products Formulary 14 WOUND MANAGEMENT PRODUCTS FORMULARY 14

15 EXTENDED FORMULARY FOR LIMITED USE 1. ANTIMICROBIALS A number of different approaches can be used to reduce the bacterial burden in wounds. Systemic antibiotics, as confirmed by laboratory sensitivities from a wound swab are usually appropriate for first line treatment of clinically infected wounds. Topical antimicrobials are available in a variety of dressing materials. Usage of antimicrobials should be reviewed at dressing change and within a maximum of two weekly intervals. Long term use should be avoided. When topical antiseptic / antimicrobial agents are utilised and consistent signs of progress towards healing are observed, antimicrobial intervention may be stopped. If the wound is unchanged after 14 days, it is recommended that an alternative topical antiseptic/antimicrobial agent is used. If the wound begins to show further signs of infection, the use of a systemic antibiotic should be considered. After two episodes of antimicrobial use please seek advice from your Tissue Viability service. (1 episode = 2 weeks) 1.1 SILVER Acticoat 5cm x 5cm cm x 10cm cm x 20cm Acticoat Flex 3 5cm x 5cm cm x 10cm cm x 20cm Aquacel Ag+ Extra 5cm x 5cm cm x 10cm cm x 15cm cm x 30cm Ribbon 2cm x 45cm Flamazine (sulfadiazine silver 1%) NMP ONLY 50g Wound Management Products Formulary 15

16 1.2 CODEXOMER IODINE Iodoflex 5g g POLYHEXAMETHYLENE BIGUANIDE (PHMB) Kendall AMD 5cm x 5cm cm x 10cm Suprasorb X+PHMB 5cm x 5cm cm x 9cm cm x 21cm rope HONEY Activon Medical Grade 25g Manuka Honey Activon Tulle (Impregnated 5cm x 5cm with Manuka Honey) 10cm x 10cm ANTIMICROBIAL ALGINATE GEL Flaminal Forte (moderate to 15g heavily exuding wounds) Flaminal Hydro (for light to 15g moderate exuding wounds) 2. METRONIDAZOLE GEL Anabact (0.75% w/w) 15g g Wound Management Products Formulary 16

17 3. TOPICAL NEGATIVE PRESSURE BARKING AND DAGENHAM, HAVERING, REDBRIDGE AND WALTHAM FOREST Pico 10cm x 20cm cm x 30cm cm x 15cm cm x 20cm Renasys GO Canister 300ml Renasys -G Soft Port Gauze Small Kit Medium Large Renasys -F Soft Port Foam Small Kit Medium Large Renasys Y - Connector Each Renasys Individual Port Each Renasys Flat Drain Each Accessory Kit Renasys Channel Drain Each Accessory Kit Renasys Gel Patch 10cm x 7cm LARVAE THERAPY Seek advice from your Tissue Viability Nurse prior to commencing Larvae Therapy QUANTITY IN BioBag 2cm x 2cm 1 Refer to Manufacturers (bagged larvae) 2.5cm x 4cm 1 Website 2.5cm x 15cm 1 5cm x 4cm 7cm x 7cm cm x 10cm 1 7cm x12cm 1 Wound Management Products Formulary 17

18 FOR USE UNDER GUIDANCE OF TISSUE VIABILITY TEAMS ONLY 1. PAIN REDUCTION Biatain Ibu Soft hold 10cm x 12cm cm x 22.5cm cm x 15cm ANTIMICROBIAL DRESSING Traps and binds bacteria under moist wound condition Cutimed Sorbact swab 4cm x 6cm cm x 9cm DEBRIDEMENT Traps and binds bacteria under moist wound condition Debrisoft 10cm x 10cm OVER GRANULATION TREATMENT Fludroxycortide Tape 7.5cm x 50cm Granuflex Border 10cm x 10cm cm x 15cm Wound Management Products Formulary 18

19 5. SHOE SYSTEM FOR OFF-LOADING Kerraped Plantar Combination Kit (S) 2-5½ Ulcer Combination Kit (M) 6-7½ Combination Kit (L) Combination Kit (XL) 10½ EMOLLIENT SPRAY For the treatment of moisture lesions Emollin 150mls DEBRIDEMENT OF PAINFUL WOUNDS Kerralite Cool 6cm x 6cm (non adhesive) 12cm x 8.5cm cm x 12.5cm Kerralite Cool 8cm x 8cm Border 11cm x 11cm cm x 15cm Wound Management Products Formulary 19

20 DRESSING SELECTION FOR PODIATRY SERVICES 1. CLEANSING Irripods 20ml Gauze Swabs (generic brand) 10cm x 10cm ABSORBENT DRESSINGS Zetuvit E Plus 10cm x 20cm ADHESIVE TAPES Mefix 2.5cm x 5m 5cm x 5m 10cm x 5m ALGINATE Activheal Alginate 5cm x 5cm 10cm x 10cm BANDAGES NON COMPRESSION K Band 7cm x 4m 10cm x 4m BARRIER FILM PREPARATIONS Cavilon 1ml foam applicator EMOLLIENTS Dermatonics (once) 75ml 200mls FOAM Activheal Foam 5cm x 5cm 10cm x 10cm Activheal Foam Heel Lyofoam Max 7.5cm x 8.5cm 10cm x 10cm Mepilex Heel 13cm x 20cm Tegaderm Foam 10cm x 10cm Tegaderm Oval 10cm x 11cm HYDROGEL Activheal Hydrogel 15g Wound Management Products Formulary 20

21 10. ODOUR ABSORBING Carboflex 10cm x 10cm PRIMARY DRESSING Cosmopor E (for nail surgery) 5cm x 7.2cm Telfa 5cm x 7.5cm WOUND CONTACT LAYER N-A Ultra 9.5cm x 9.5cm CAPILLARY ACTION DRESSING Advadraw Advancis 5cm x 7.5cm LOW ADHERENCE DRESSING Jelonet 10cm x 10cm SKIN CLOSURE STRIPS Leukostrips 6.4cm x 76mm 3 strips per envelope 6.28 Anti-Microbial Dressings 1.1 SILVER Acticoat 7 5cm x 5cm Acticoat Absorbent 5cm x 5cm Actisorb Silver cm x 6.5cm Aquacel Ag+ Extra 5cm x 5cm Silvercel 5cm x 5cm CADEXOMER IODINE Iodoflex 5g paste POVIDONE IODINE Povitulle 5cm x 5cm Wound Management Products Formulary 21

22 Classification of Pressure Ulceration (Adapted from EPUAP 2009 with recognition to North West Tissue Viability group) CATEGORY 1 CATEGORY 1 CATEGORY 2 CATEGORY 3 Blanching redness Non blanching redness Clear blister Non blanching redness Non blanching redness Superficial skin loss Partially de-roofed blister Intact skin. Superficial skin loss. Full thickness tissue loss: Non blanching redness Pink/Red wound bed Subcutaneous fat may be visible but Usually occurs over bony prominence May present as a clear filled blister with no bone/tendon/muscle is not exposed Individuals with dark skin, observe for discoloration underneath Depth may vary depending on anatomical additional signs e.g. warmth, oedema, pain, Location hardness Wound Management Products Formulary 22

23 CATEGORY 4 SUSPECTED DEEP TISSUE INJURY UNABLE TO BE CATEGORISED DUE TO DEVITALISED TISSUE Full thickness loss: Can extend to expose bone/tendon or muscle or they may be directly palpable Depth can vary by anatomical location Potential deep tissue damage Category 4 Pressure ulcer A localised area of purple discoloration over intact skin, or blood blister, due to damage of underlying soft tissue. May be painful, firm, mushy, boggy, warmer or cooler compared to the adjacent skin May develop into a category 3 or 4 but cannot be confirmed until extent of damage is evident Damage may be recoverable with effective off-loading of affected area Minimal category 3 potential to be a category 4. The wound bed is not visible due to presence of slough or necrotic tissue Classification may not be possible until the ulcer is debrided: report on Datix as cat 3, amend as appropriate once wound bed debrided. Wound Management Products Formulary 23

24 Other Useful Sources of Information: 1. BNF 2. Drug Tariff Mims for District Nurse Formulary Tissue Viability: Barking and Dagenham Havering Redbridge Waltham Forest An Educational Resource Supported by Wound Management Products Formulary 24