Policy Number LCH-144 This document has been reviewed in line with the Policy Alignment Process for Liverpool Community Health NHS Trust Services. It is a valid Mersey Care document, however due to organisational change this FRONT COVER has been added so the reader is aware of any changes to their role or to terminology which has now been superseded. When reading this document please take account of the changes highlighted in Part B and C of this form. Part A Information about this Document Policy Name Wound Product Formulary Policy Type Board Approved (Trust-wide) Trust-wide Divisional / Team / Locality Action Approval No Change Minor Change Major Change New Policy No Longer Needed As Mersey Care s Executive Director / Lead for this document, I confirm that this document: a) complies with the latest statutory / regulatory requirements, b) complies with the latest national guidance, c) has been updated to reflect the requirements of clinicians and officers, and d) has been updated to reflect any local contractual requirements Signature: Date: Part B Changes in Terminology (used with Minor Change, Major Changes & New Policy only) Terminology used in this Document New terminology when reading this Document Part C Additional Information Added (to be used with Major Changes only)
Section / Paragraph No Outline of the information that has been added to this document especially where it may change what staff need to do Part D Rationale (to be used with New Policy & Policy No Longer Required only) Please explain why this new document needs to be adopted or why this document is no longer required Part E Oversight Arrangements (to be used with New Policy only) Accountable Director Recommending Committee Approving Committee Next Review Date LCH Policy Alignment Process Form 1
SUPPORTING STATEMENTS This document should be read in conjunction with the following statements: SAFEGUARDING IS EVERYBODY S BUSINESS All Mersey Care NHS Foundation Trust employees have a statutory duty to promote the welfare of children and adults, including: being alert to the possibility of child / adult abuse and neglect through their abuse, or by professional judgement made as a result of information gathe child / adult; knowing how to deal with a disclosure or allegation of child / adult abuse; undertaking training as appropriate for their role and keeping themselves upd being aware of and following the local policies and procedures they need to have a child / adult concern; ensuring appropriate advice and support is accessed either from managers Ambassadors or the trust s safeguarding team; participating in multi-agency working to safeguard the child or adult (if appr role); ensuring contemporaneous records are kept at all times and record keep adherence to Mersey Care NHS Foundation Trust policy and procedures an guidelines. Roles, responsibilities and accountabilities, will differ depending o hold within the organisation; ensuring that all staff and their managers discuss and record any safeguard arise at each supervision session EQUALITY AND HUMAN RIGHTS Mersey Care NHS Foundation Trust recognises that some sections of socie prejudice and discrimination. The Equality Act 2010 specifically recognises characteristics of age, disability, gender, race, religion or belief, sexual o transgender. The Equality Act also requires regard to socio-economic fac pregnancy /maternity and marriage/civil partnership.
The trust is committed to equality of opportunity and anti-discriminatory practi provision of services and in our role as a major employer. The trust believes have the right to be treated with dignity and respect and is committed to the unfair and unlawful discriminatory practices. Mersey Care NHS Foundation Trust also is aware of its legal duties under the Act 1998. Section 6 of the Human Rights Act requires all public authorities promote Human Rights in everything they do. It is unlawful for a public authority act which contravenes the Human Rights Act. Mersey Care NHS Foundation Trust is committed to carrying out its function delivery in line the with a Human Rights based approach and the FREDA Fairness, Respect, Equality Dignity, and Autonomy
Wound Product Formulary
October 2009
Wound Product Formulary NHS Liverpool Community Health (LCH) is committed to supporting the provision of quality care for the management of patients with wounds. The aim of the formulary is: To promote cost effective, evidence based wound care practice to optimise patient care To promote continuity and rational wound care prescribing practices by clinicians employed within LCH. Whilst useful prescribing information has been included in this formulary, for full product information refer to individual manufacturer guidance. This wound product formulary should be used in conjunction with the resource guide: A Practical Guide to the Management and Treatment of Wounds in Primary Care. NHS Liverpool Community Health. October 2009 Available on NHS Liverpool Community Health Intranet: http://nww.liverpoolhealth.nhs.uk/clinicalinfo/policies/skin.asp Please note: Product sizes shown are not necessarily full range of product. Pack sizes have been included for information purposes, although products should be prescribed according to required need. Prices indicated are per single unit and correct as of September 2009 Drug Tariff. Authors: This guide has been produced by the Skin Care Service & Medicines Management Team with contributions from NHS Liverpool Community Health Wound Management Group. 1
Amendments A Practical Guide to the Management and Treatment of Wounds in Primary Care. Liverpool PCT Sept 2006 The above resource guide has been updated and amended on October 2009, to reflect changes in best practice, wound product availability and price changes. Section 1 Introduction changes in line with renaming of Liverpool PCT to NHS Liverpool Community Health Section 2 Infected / Critically Colonised Wound Management Algorithm has been updated to reflect guidance contained within; NICE (2008) Surgical Site Infection: Prevention and treatment of surgical site infection. Clinical guideline 74 Infection Continuum Treatment options for critically colonized and infected wound section has been updated in line with best practice guidance Nutrition and Wound Healing title changed (from nutrition in wound care) and content updated Section 3 Burns Other considerations sentence included establish mechanism of injury Diabetic Foot Ulcers Linked Information addition of best practice guidance web site Hypergranulated wound - linked information to Hypergranulated wound guideline PEG Site Care Treatment and other considerations updated Sinus Wound Other considerations information updated in line with NICE (2008) Surgical Site Infection: Prevention and treatment of surgical site infection. Clinical guideline 74 2
Skin Lacerations Dressings and other considerations information updated Sutured / Stapled Wounds - Other considerations information updated in line with NICE (2008) Surgical Site Infection: Prevention and treatment of surgical site infection. Clinical guideline 74 Section 4 Absorbent additional product: Sorbion Sachet S Antimicrobial Contreet - has been renamed Biatain Ag Silvercel manufacturer change to Systagenix Wound Management Capillary Action product dressing selection changed from Vacutex to Sumar Emollients Additional products Foams Addition of Biatain Soft-Hold to Biatain range Product dressing selection changed Allevyn Gentle replaces Mepilex Honey amended to reflect changes in product formulations of Activon Range including method of application Hydrocolliod Tegasorb has been renamed Tegaderrm hydrocolliod Granuflex Contraindications updated as not suitable for infected wounds Hydrofibre method of application amended in line new formulation of Aquacel ribbon Larval Therapy Amended to include changes in formulation of product Low Adherent NA Ultra: manufacturer change to Systagenix Wound Management Product dressing selection changed from Mepore Ultra to Softpore Protease modulating matrix Promogran manufacturer change to Systagenix Wound Management. Linked information removed. Section 5 Wound Product Formulary - updated Section 6 Linked Information Updated Section 7 References - Updated 3
ABSORBENT Eclypse: Absorbent cellulose dressing with fluid repellent backing. Indicated for medium to highly exuding wounds, may require a low adherent primary dressing. Not suitable under compression Sorbion Sachet S: Absorbent hydroactive dressing for highly exuding wounds, for use under compression ECLYPSE Advancis Medical SORBION SACHETS Sorbion 20 97p 15cm x 15cm 20 2.14 20cm x 30cm 10 8.15 60cm x 40cm 10 2.22 10cm x 10cm 10 3.68 20cm x 10cm ALGINATE An absorbent calcium alginate dressing, high in mannuronic acid that produces a soft gel when in contact with wound exudate. Suitable for moderate to highly exuding flat or cavity wounds. Has haemostatic properties. SORBSAN Aspen medical SORBSAN PACKING (with probe) SORBSAN RIBBON (with probe) SORBSAN PLUS (with absorbent backing) SORBSAN PLUS SA (with adhesive border) 10 78p 5cm x 5cm 10 1.64 10cm x 10cm 5 3.08 10cm x 20cm 5 3.41 30cm/2g 5 1.99 40cm 5 1.66 7.5cm x 10cm 5 2.93 10cm x 15cm 10 2.89 11.5cm x 14cm 10 4.22 14cm x 19cm 5 5.10 14cm x 24cm 4
ANTIMICROBIAL DRESSING Topical antimicrobial wound products may be used in the management of critically colonised or infected wounds (in conjunction with systemic antibiotics). There is little robust evidence to support the efficacy of one antimicrobial above another and a decision should be made of the product that provides the optimum wound environment. However prolonged use should be avoided and the use of antimicrobial dressings should be reviewed after 2 weeks. CADEXOMER IODINE DRESSING for use on moderate / heavily exuding wounds (check patients thyroid status) IODOFLEX Smith & Nephew SILVER BASED DRESSINGS 5 3.76 5g (6 x 4cm) 3 or 5 7.51 10g (8 x 6cm) 2 11.90 17g (10 x 8cm) Low Adherent Containing Hydrocolloid for use on low exuding wounds URGOTUL SSD Urgo 16 2.97 11cm x 11cm 16 8.42 16cm x 21cm ALGINATE for use on moderate / heavily exuding wounds SILVERCEL Systagenix Wound Management 5 1.68 5cm x 5cm 5 4.14 11cm x 11cm 5 7.68 10cm x 20cm 5 4.45 2.5cm x 30.5cm FOAM for use on moderate / heavily exuding wounds BIATIAN Ag Non adhesive Coloplast BIATIAN Ag Adhesive Coloplast 5 3.07 5cm x 7cm 5 3.13 5cm round 5 7.47 10cm x 10cm 5 15.00 15cm x 15cm 5 13.73 10cm x 20cm 5 8.61 12.5cm x 12.5cm 5 17.27 18cm x 18cm 5
HYDROFIBRE for use on moderate / heavily exuding wounds AQUACEL Ag 10 1.85 5cm x 5cm ConvaTec 10 4.40 10cm x 10cm 5 8.29 15cm x 15cm 10 2.65 4cm x 10cm 10 3.46 4cm x 20cm AQUACEL Ag RIBBON 5 4.43 2cm x 45cm BANDAGES BANDAGES - COMPRESSION K FOUR COMPRESSION BANDAGE LAYERS Urgo K Soft (Layer # 1) 1 42p 10cm x 3.5m K Lite (Layer # 2) 1 94p 10cm x 4.5m K Plus (Layer # 3) 1 2.12 10cm x 8.7m Ko Flex (Layer # 4) 1 2.82 10cm x 6m K ThreeC 1 2.64 10cm x 3m K - FOUR - MULTI LAYER COMPRESSION BANDAGE KIT Size dependant upon 1 6.93 Less than 18cm ankle circumference 1 6.64 18 25cm 1 6.64 25 30cm 1 9.05 Above 30cm K - FOUR - MULTI LAYER REDUCED COMPRESSION BANDAGE KIT 1 4.43 18cm + K TWO MULTI LAYER COMPRESSION BANDAGE KIT 1 9.68 18 25cm 1 10.33 25 32cm COMPRILAN Short Stretch Bandages BSN Medical Ltd 1 2.96 8m x 5m 1 3.18 10m x 5m 1 3.87 12m x 5m 6
ACTIVA LEG ULCER HOSIERY KIT Activa Healthcare Pack contains 1 stocking 1 21.20 S,M,L,XL,XXL and 2 liners 40mmHg Bandages Securing EASYFIX 1 33p 5cm x 4m BSN Medical Ltd 1 47p 10cm x 4m K-Soft (wool) 1 42p 10cm x 3.5m Urgo K-Lite support type 2. Urgo 1 94p 10cm x 4.5m CAPILLARY ACTION Tri layered product draws exudate up in a capillary action and retained within central layer. Can be applied in multiple layers to increase exudate management. Suitable for low (in conjunction with vapour permeable film) to highly exuding wounds SUMAR - Lantor SUMAR LITE - low to moderate exudate SUMAR MAX - moderate to high exudate 10 93p 5cm x 5cm 10 1.59 10cm x 10cm 10 2.12 10cm x 15cm 10 95p 5cm x 5cm 10 1.61 10cm x 10cm 10 2.15 10cm x 15cm SUMAR SPIRAL 10 1.57 0.5cm x 40cm CLEANSING Sterile sodium chloride solution IRRIPOD CD Medical 25 5.50 20ml 7
DRESSING PACK Sterile dressing pack containing sterile gloves, laminate sheet, towel, swabs, disposable bag and apron Polyfield Nitrile Patient Pack. Shermond 20 52p Small / Medium / Large EMOLLIENTS Lower leg skin conditions - Hydromol ointment is cost effective as a soap substitute and moisturiser. However patient choice is central in the management of generalised skin conditions. Hydromol bath emollient: can be applied to wet skin or diluted in bath water. Ointments are most effective moisturiser; however creams are often more cosmetically acceptable but less effective and require frequent application. HYDROMOL (ointment) Alliance EPADERM (cream) Molnlycke HYDROMOL (bath emollient) Alliance 1 2.79 125g 1 4.74 500g 1 6.50 500g 1 3.80 350ml 1 5.14 500ml 1 9.00 1 litre 8
FOAM Biatain: Absorbent polyurethane foam dressing, available in non adhesive and with a border of hydrocolloid adhesive. Suitable for moderate to highly exuding wounds BIATAIN NON 10 1.22 5cm x 7cm ADHESIVE 10 2.22 10cm x 10cm Coloplast 5 3.66 10cm x 20cm 5 4.08 15cm x 15cm 5 6.06 20cm x 20cm BIATAIN ADHESIVE 10 1.63 10cm x 10cm (6cm circular pad) 10 2.38 12.5cm x 12.5cm 5 4.80 18cm x 18cm 10 7.11 18cm x 28cm BIATAIN SACRAL 5 4.11 23cm x 23cm adhesive BIATAIN HEEL 5 4.80 19cm x 20cm adhesive BIATAIN CONTOUR adhesive 5 4.62 17cm round Biatain Soft-Hold has a thin layer of skin friendly adhesive to assist application, maintain dressing to wound contours and minimise trauma on removal. Not suitable under compression as contours of dressing are not bevelled and may cause indentation. Suitable for moderate to highly exuding wounds BIATAIN SOFTHOLD 5 1.21 5cm x 7cm 5 2.41 10cm x 10cm 5 4.00 15cm x 15cm 5 3.66 10cm x 20cm 9
Allevyn compression: polyurethane foam dressing 4mm thick bonded onto semi permeable film. Suitable under compression ALLEVYN COMPRESSION Smith & Nephew 10 1.17 5cm x 6cm 5 2.41 10cm x 10cm 3 4.09 15cm x 15cm 3 4.58 15cm x 20cm Allevyn Gentle Bordered: Polyurethane foam dressing with silicone contact layer. Foam dressings for moderate to highly exuding wounds only to be used for fragile skin types or where pain on dressing removal problematic. ALLEVYN GENTLE BORDERED Smith & Nephew 10 1.43 7.5cm x 7.5cm 10 2.44 10cm x 10cm 10 3.14 12.5cm x 12.5cm 10 6.11 17.5cm x 17.5cm HONEY Medical grade Manuka honey. Has an antimicrobial action and creates an environment to promote autolytic debridement. May reduce wound malodour. ACTIVON Advancis Medical ACTIVON TULLE 5 1.78 5cm x 5cm 5 3.01 10cm x 10cm ACTIVON TUBE 12 1.99 25g ALGIVON alginate 5 2.09 5cm x 5cm impregnated with honey 5 3.53 10cm x 10cm 10
HYDROCOLLOID Occlusive hydrocolloid dressings are suitable for low to moderately exuding wounds. Not suitable for infected wounds or those requiring frequent dressing changes. In contact with exudate forms gel to provide healing environment and by rehydrating dry slough or necrosis aids autolysis. TEGADERM HYDROCOLLOID 3M Health Care TEGADERM OVAL 5 2.26 10cm x 12cm with adhesive border 5 4.22 13cm x 15cm TEGADERM SACRAL with adhesive border 6 4.71 17.1cm x 16.1cm TEGADERM THIN 10 1.50 10cm x 12cm OVAL with adhesive border 10 2.81 13cm x 15cm Granuflex hydrocolloid: Due to its flexible and conformable nature it is particularly useful in bordering wounds to support the application of Larvae (maggot) therapy or TNP GRANUFLEX ConvaTec DuoDERM 5 71p 5cm x 10cm EXTRA THIN 10 1.63 9cm x 15cm 10 75p 7.5cm x 7.5cm 10 1.23 10cm x 10cm 10 2.68 15cm x 15cm GRANUFLEX 10 2.62 10 x 10cm 10 4.96 15cm x 15cm 10 5.38 15cm x 20cm 11
HYDROFIBRE Hydrofibre dressings absorb and retain exudate, forming a conformable gel and prevent lateral wicking. Suitable for moderate to highly exuding wound. AQUACEL 10 1.09 5cm x 5cm ConvaTec 10 2.59 10cm x 10cm 5 4.88 15cm x 15cm 10 1.38 4cm x 10cm 10 2.04 4cm x 20cm 10 3.05 4cm x 30cm AQUACEL RIBBON 5 2.59 2cm x 45cm HYDROGEL Hydrogels have high water content (95%) to rehydrate any slough / necrosis at the wound bed and provide moist wound healing environment. Limited fluid absorption ability. Not to be used in conjunction with foam dressing which will limit ability to donate water molecules to wound. PURILON GEL Coloplast 10 1.62 8g 10 2.12 15g LOW ADHERENT NA Ultra has a coating of Silicone Urgotul is impregnated with hydrocolloid particles NA ULTRA Systagenix URGOTUL Urgo 40 33p 9.5cm x 9.5cm 25 63p 9.5cm x 19cm 25 3.00 11cm x 11cm 16 8.49 16cm x 21cm 12
Low adherent Island adhesive dressing. For low exuding wounds minor abrasions, not a suitable post operative surgical dressing SOFTPORE Richardson Health care 60 6p 6cm x 7cm 50 13p 10cm x 10cm 50 20p 10cm x 15cm 30 35p 10cm x 20cm ODOUR ABSORBING For use on malodorous wounds. Carboflex is a multi component absorbent primary dressing, whilst Clinisorb is a secondary dressing only. Both products odour absorbing ability deactivated once the charcoal component becomes wet. CARBOFLEX ConvaTec CLINISORB CliniMed 10 2.95 10cm x 10cm 5 3.55 8cm x 15cm 5 6.72 15cm x 20cm 10 1.77 10cm x 10cm 10 2.35 10cm x 20cm 10 3.78 15cm x 25cm PROTEASE MODULATOR Indicated for chronic / compromised wounds that have failed to progress. Inactivates harmful proteases and protects growth factors. Wound bed needs to be free of necrotic tissue or thick slough to be effective. PROMOGRAN PRISMA Systagenix Wound Management 10 5.19 28cm2 13
RETENTION DRESSING CLINIFAST Clinisupplies RED LINE (small limb) GREEN LINE (medium limb) BLUE LINE (large Limb) YELLOW LINE (child trunk) BEIGE LINE (adult trunk) 1 56p 3.5cm x 1m 1 58p 5cm x 1m 1 1.62 5cm x 3m 1 2.81 5cm x 5m 1 77p 7.5cm x 1m 1 2.13 7.5cm x 3m 1 3.74 7.5cm x 5m 1 1.20 10.75cm x 1m 1 3.49 10.75cm x 3m 1 6.04 10.75cm x 5m 1 1.83 17.5cm x 1m TAPES CLINIPORE Clinisupplies 1 35p 1.25cm x 5m 1 59p 2.5cm x 5m 14
TOPICAL SKIN BARRIER A highly concentrated barrier product to protect skin against body fluids. Barrier film provides up to 72 hours protection Cream apply sparingly after every 3rd / 4th incontinence episode. CAVILON NO STING BARRIER FILM 3M Health Care FOAM APPLICATOR 5 4.98 1ml 5 7.99 3ml PUMP SPRAY 1 6.67 28ml CAVILON DURABLE BARRIER CREAM 3M Health Care TUBE 1 4.00 28g 1 8.15 92g SACHET 20 7.58 2g 15
VAPOUR PERMEABLE FILM Semi permeable transparent film for superficial wounds with a low exudate level. Tegaderm and pad suitable occlusive post operative dressing. Refer to manufacturer s guidance to ensure non traumatic method of removal. TEGADERM 100 38p 6cm x 7cm 3M Health Care 10 1.08 12cm x 12cm 10 2.34 15cm x 20cm TEGADERM 50 25p 5cm x 7cm AND PAD 25 62p 9cm x 10cm 25 92p 9cm x 15cm 25 1.34 9cm x 20cm 25 1.51 9cm x 25cm TEGADERM IV Peripheral line 100 57p 7cm x 8.5cm Central line 50 1.11 8.5cm x 10.5cm PICC line 25 1.60 10cm x 15.5cm 16
Wound Management Guide EPITHELIALISING GRANULATING SLOUGHY/NECROTIC INFECTED AIM: Promote Final stage of healing AIM: Promote Granulation AIM: Debride slough, necrotic tissue AIM: Treat infection Low Exudate NA Ultra Tegaderm Duoderm / Tegaderm hydrocolloid Tegaderm and Pad Low Exudate NA Ultra Duoderm / Tegaderm hydrocolloid Low Exudate Sumar and Tegaderm Algivon and Tegaderm Urgotul - and secondary dressing Tegaderm hydrocolloid Action Take full holistic assessment identify criteria e.g. localised heat, pain, erythema, pus Take swab Systemic antibiotics first line treatment for identified wound infection Moderate / High Exudate Moderate / High Exudate Moderate / High Exudate Wound Management Biatain Adhesive / Non Adhesive Biatain Adhesive / Non Adhesive Aquacel and Biatain Aquacel / Sorbsan/ Iodoflex and secondary dressing Biatain Adhesive/ Non Adhesive Eclypse (high exudate) Consider antimicrobial dressing according to wound characteristics e.g. exudate level, tissue type, wound location: Iodoflex (check thyroid function) Algivon Aquacel Ag Biatain Ag Foam Silvercel If wound malodourous without indications of infection use: Clinisorb- low exudate Carboflex - moderate/high exudate Urgotul SSD Refer to: A Practical Guide to the Management & Treatment of Wounds in Primary Care
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