CWHHE OOHS Wound Care Management Formulary November 206 v. INTRODUCTION The CWHHE primary care wound care formulary has been developed by the CWHHE Out of Hospitals Services (OOHS) wound care reference group. It aims to support staff with clinical decision making on wound care products and supports practices with medicines optimisation, whilst encouraging a standardised approach to wound care management across CWHHE. Read all product literature and manufacturers guidelines prior to use. The most common wounds encountered and managed in general practice are uncomplicated in nature, such as post-operative wounds, re-dressing or packing of wounds, and dressings from traumatic lesions or burns. Patients may also present with more complicated wounds that require an onward referral to specialist services with general practice managing wound care, until specialist input can be received. For the purpose of this document, the formulary should be used in conjunction with the Out of Hospital Services wound care specification. In cases where patients are referred to specialist services i.e Tissue Viability Nursing, there may be occasions where specialist dressings outside the formulary are clinically recommended. In such cases, the prescribing clinician should use their discretion and own judgment, with advice from the relevant specialist service who will follow their wound care management product formulary. AIMS The formulary is underpinned by NICE (206) evidence summaries on wound care and focuses on the key priorities; To prescribe the least costly wound dressings that meet the required clinical performance characteristics and evidence base To prescribe the minimum quantity of dressings sufficient to meet people's needs and avoid unnecessary waste To avoid routine prescribing of antimicrobial (for example, silver, iodine or honey) dressings ahead of non-medicated dressings. Practices should ensure a small stock of dressings are available for the first appointment. Patients should then be prescribed dressings on an FP0. Consider the duration of prescription required and prescribe ONLY the number of individual dressings required and not pack size (e.g. 6 x dressings). It is recommended that no more than 2 weeks supply is prescribed as the personalised wound care management plan may change. Pack sizes have been included for information. First and second line choices are highlighted as: FIRST CHOICE SECOND CHOICE
WOUND CLASSIFICATION CHART This guide should be used in conjunction with clinical judgment and as part of a holistic assessment. EPITHELIZING GRANULATING SLOUGHY NECROTIC INFECTED FUNGATING Wound bed is pink and shallow. Minimum exudate Protect and maintain moisture balance Askina DuoDERM Wound bed is red with granular appearance Protect and maintain moisture balance Devitalised tissue; yellow, white or grey Debride and prevent infection ActiFormCool ActivHeal Hydrogel Askina DuoDERM Hydrosorb Devitalised tissue, Black/Brown, dry, leathery Debride and prevent infection ActiFormCool ActivHeal Hydrogel Askina DuoDERM Hydrosorb Erythema, increased exudate, pain, heat, malodour Treat local infection and manage exudate Algivon Plus Ag + Extra Povitulle Necrotic, cauliflower appearance, non-healing, malodour, pain and bleeding Manage exudate, pain, odour and bleeding Adpore, Kliniderm Foam Silicone Border, Premierpore ActivHeal Adhesive Foam, CliniSorb Odour Control, CliniSorb Odour Control,
*single dressings /alternative quantities can be prescribed Dressing Type Dressing name Size Cost (per dressing) Pack sizes* Information PRIMARY DRESSINGS Alginate / Hydrofiber cavity dressings Alginate / Hydrofiber dressings Hydrocolloid dressings Hydrogels Low adherence / soft polymer silicone Ribbon g x 40cm 2.04 5 Ribbon (Calcium alginate dressing) Flat Askina Biofilm Transparent Duoderm extra thin Hydrosorb ActiFormCool Activheal Hydrogel Not to be used on dry wounds. Has haemostatic effect. Includes probe. Cost-effective alternative to Kaltostat. cm x 45 cm.84 5 2cm x 45cm 2.48 5 Not to be used on dry wounds 5cm x 5cm 0.63 0 0cm x 0cm.23 0 5cm x 5cm 0.8 0 Cost-effective alternative to 0cm x 0cm.7 0 0cm x 20cm 3.20 5 0 cm 0 cm.07 0 20cm x 20cm 3.7 5 7.5cm x 7.5cm 0.8 5 0cm x 0cm.33 0 5cm x 5cm 2.88 0 Not indicated for use on diabetic foot wounds 5cm x 0cm 0.76 0 9cm x 5cm.78 0 9cm x 25cm 2.85 0 9cm x 35cm 3.98 0 5 cm 7.5 cm.58 5 0cm x 0cm 2.26 5 Hydrogel Sheet 20cm x 20cm 6.77 3 5cm x 6.5cm.8 5 0cm x 0cm 2.66 5 0cm x 5cm 3.83 3 Hydrogel Sheet 20cm x 20cm 8.0 3 8g.23 0 Can be used in cavities. Cost-effective 5g.4 0 alternative to Intrasite Gel. 5 cm 5 cm 0.27 0, 50 7.5 cm 0cm 0.28 0, 50 0 cm 20 cm 0.63 30 20cm x 30cm.74 0 5cm x 7cm. 0 Silicone dressing can have role in pain 8cm x 0cm 2.27 0 management. may be kept in place for up 2cm x 5cm 4.58 0 to fourteen days depending on the wound 20cm x 30cm.79 0 condition.
Odour absorbent CliniSorb Odour Control 0 cm 0 cm.9 0 0 cm x 20 cm 2.54 0 5 cm x 25 cm 4.09 0 Contains activated charcoal SECONDARY DRESSINGS Absorbent dressings with adhesive border Absorbent dressing without adhesive (for moderately to heavy exuding wounds) Absorbent perforated ActivHeal Foam Adhesive ActivHeal Foam Contact Kliniderm Foam Silicone Border (non-sterile/sterile) Kliniderm superabsorbent Advazorb PremierPore Adpore Dressing 7.5cm x 7.5cm.8 0 0 cm 0 cm.63 0 2.5cm x 2.5cm.68 0 5cm x 5cm 2.5 0 Foam dressing Sacral 8cm x 8.5cm 3.20 0 5cm x 5cm 0.95 5 Primary (Silicone) AND secondary (Foam) 0cm x 0cm.95 5 dressing. Consider instead of separate primary 0cm x 20cm 3.49 5 and secondary dressings. Cost effective 5cm x 5cm 3.95 5 alternative to Mepilex border 0cm x 0cm 0.07/ 0.2 50/25 0cm x 20cm 0.09/ 0.25 50/25 20cm x 20cm 0.4/ 0.39 50/5 20cm x 40cm 0.28/. 30/0 0cm x 0cm 0.49 50 0cm x 5cm 0.69 0 20cm x 20cm 0.99 5 20cm x 30cm.49 0 5cm x 5cm 0.65 0 7.5cm x 7.5cm 0.78 0 0cm x 0cm.08 0 2.5cm x 2.5cm.59 0 0cm x 20cm 3.35 0 5cm x 5cm 2.0 0 20cm x 20cm 3.75 0 5cm x 7cm 0.05 50 0cm x 0cm 0.2 50 0cm x 5cm 0.8 50 0cm x 20cm 0.32 50 0cm x 25cm 0.36 50 0cm x 30cm 0.45 50 0cm x 35cm 0.52 50 7cm x 8cm 0.08 55 0cm x0cm 0.0 40 0cm x 5cm 0.6 40 0cm x 20cm 0.30 30 0cm x 25cm 0.34 30 0cm x 30cm 0.42 30 0cm x 35cm 0.50 30 Non-sterile can be prescribed for single patient use Cost-effective alternative to Kerramax Foam dressing. Cost effective alternative to Alleyvn. Cost-effective alternative to Mepore Cost-effective alternative to Mepore
Vapour-permeable Adhesive Film with absorbent pad PremierPore VP dressing Adpore Ultra 5cm x 7cm 0.3 2 0cm x 0cm 0.6 50 0cm x 5cm 0.24 50 0cm x 20cm 0.36 50 0cm x 25cm 0.38 50 0cm x 30cm 0.57 50 0cm x 35cm 0.69 50 7cm x 8cm 0.2 55 0cm x 0cm 0.4 40 0cm x 5cm 0.22 40 0cm x 20cm 0.33 30 0cm x 25cm 0.35 30 0cm x 30cm 0.52 30 Cost-effective alternative to Tegaderm or Mepore Ultra Cost-effective alternative to Tegaderm or Mepore Ultra ANTIMICROBIAL DRESSINGS Antimicrobial products should only be used where an increased risk of infection or clinical signs of critical colonisation / infection are evident and for a maximum of 2 weeks. Honey or Silver dressings should only be used to optimize the wound bed for TVN assessment, or following TVN advice. Once the infection has resolved, the antimicrobial dressing should be stopped. Consider wound swab +/- oral antibiotics in line with locally agreed antimicrobial prescribing guidelines. Anti-microbial Honey Anti-Microbial Iodine Anti-microbial Silver Algivon Plus Povitulle Ag + Extra 5cm x 5cm 0cm x 0cm.96 3.36 5 5 Should not be used on patients with extreme sensitivity to honey, bee stings or bee products. Patients with diabetes should be monitored for changes in blood-glucose concentrations during treatment with topical honey or honeyimpregnated dressings. 5cm x 5cm 0.28 25 Cautions: iodine may be absorbed particularly if large wounds treated; children under 6 months; 9.5cm x 9.5cm 0.42 0 thyroid disease. Contra-indications severe renal impairment; pregnancy; breast-feeding. Costeffective alternative to Inadine. 5cm x 5cm.95 0 0cm x 0cm 4.64 0 5cm x 5cm 8.75 5 4cm x 0cm 2.83 0 4cm x 20cm 3.69 0 BANDAGES Ag + Extra should not be used on individuals who are sensitive to or who have had an allergic reaction to the dressing or its components Bandages (non-compression) K Band CliniLite bandage 5 cm x 4 m 0.20 7cm x 4m 0.26 0cm x 4m 0.28 5cm x 4m 0.50 5cm x 4.5m 0.44 7.5cm x 4.5cm 0.6 0cm x 4.5cm 0.80 5cm x 4.5cm.6
Bandages (Compression) Stockinettes Adhesive Tape Barrier Products Dressing Packs Irrigation Actico short stretch (cohesive) 4 cm x 6m 6cm x 6m 8cm x 6m 0cm x 6m 2cm x 6m Flexi-ban wool padding 0cm x 3.5m 0.50 3.5m for use with Actico short-stretch bandaging Comfifast Acti-Fast 2-way stretch stockinette CliniFast stockinette Chemifix 2.42 2.83 3.25 3.38 4.3 3.5cm 0.56 m 5cm 0.58/.62/ 2.8 m/3m/5m 7.5cm 0.77/ 2.3/ 3.74 m/3m/5m 0.75cm.20/ 3.49/ 6.04 m/3m/5m 7.5cm.83 m 3.5cm 0.56 m 5cm 0.58/.62/ 2.8 m/3m/5m 7.5cm 0.77/ 2.3/ 3.74 m/3m/5m 0.75cm.20/ 3.49/ 6.04 m/3m/5m 7.5cm.83 m 20cm 3.20/ 6.5 m/5m 3.5cm 0.56 m 5cm 0.58/.62/ 2.8 m/3m/5m 7.5cm 0.77/ 2.3/ 3.74 m/3m/5m 0.75cm.20/ 3.49/ 6.04 m/3m/5m 7.5cm.83 m MISCELLANEOUS 2.5cm x 5m 0.90 5cm 5m.25 0cm 5m 2.0 2.5cm 0m.00 5cm 0m.40 0cm 0m 2.0 Cost-effective alternative to Mefix or hyperfix Cutimed Protect Spray 28ml 5.20 NOT to be used on fungal infection. Where Cutimed Protect Foam Applicator ml/3ml 4.38/ 7.05 5 Multi-Pack Polyfield Nitrile Patient Pack Clinipods Stericlens Aerosol Small, medium, large Small, medium, large Sterile Saline 20ml x 25 Sterile Saline spray 00ml, 240ml 0.46 0.52 4.80 (per pack) 25 2.07/ 3.5 00ml, 240ml fungal infection is present, treat first. Costeffective alternative to Cavilon. Contains: Sterile field, Tray Pair Nitrile Gloves, Blue Drape, White Bag, 5 Non Woven Swabs 4 ply Contains: Pair Powder Free Nitrile AF gloves, Sterile Laminate Sheet, 7 Non-Woven Swabs, Towel, White Polythene Disposable Bag, Apron
Surgical Tape Chemipore tape Clinipore.25cm 0.27 5m 2.5cm 0.45/ 0.70 5m,0m 5cm 0.95 5m.25cm 0.35 5m 2.5cm 0.59/ 0.73 5m/0m 5cm 0.99 5m Cost-effective alternative to micropore References Central London Community Healthcare: Wound Management Product Formulary Version: CLCH 204 Hounslow and Richmond Community Healthcare NHS Trust: Wound Management Product Formulary Version: October 205 London North West Healthcare NHW Trust: Wound Management Guideline. A Clinical Resource for all Healthcare Professionals 205 MeReC Bulletin Vol.2 No.0 June 200 Evidence-based prescribing of advanced wound dressings for chronic wounds in primary care NICE advice [KTT4] Wound care products. February 206 NICE advice [ESMPB2] Chronic wounds: advanced wound dressings and antimicrobial dressings. March 206 Prices obtained from November 206 Electronic Drug Tariff Photos taken with permission from Central London Community Healthcare: Wound Management Product Formulary Version: CLCH 204 Developed by the Out of Hospitals Wound Care Clinical Reference Group CWHHE Collaboration of Clinical Commissioning Groups Formulary approved by the OOHS Steering Group December 206 Addition of Compression Bandages approved March 207 Due for review December 207