WOUND MANAGEMENT PRODUCTS FORMULARY

Tissue Viability Service WOUND MANAGEMENT PRODUCTS FORMULARY West Essex Version: November 2014 (prices based on August 2014 Drug Tariff) Tissue Viability Service: Cathy Malone, Tracy Dale, Veronica Rice, Jody Davey Lead Pharmacist: Louise Crowley Podiatry Service: Linda Walsh Leg Ulcer Service (PAH): Winnie Furlong

INTRODUCTION This Wound Formulary is intended to be used by any healthcare professional prescribing or requesting dressings to be prescribed for the management of wounds in primary care in West Essex. It has been produced in collaboration with the SEPT Tissue Viability Service in West Essex, SEPT Community and Inpatient multidisciplinary teams in West Essex, Infection Control, Podiatry Service, PAH Leg Ulcer Service, and West Essex Clinical Commissioning Group. The management of Burns and Plastics is outside of the scope of this Formulary and requires specialist advice. Dermatology products are not included in this Formulary. Users are directed to The West Essex Dermatology Formulary, available on the website of West Essex Clinical Commissioning Group. Adherence to the Wound Formulary will be audited and monitored. Deviation from recommended products will require clinical justification. KEY MESSAGES Start the appropriate level of management for the wound type and stage of healing in accordance with the Trust Wound Care Guidelines using the EWMA Wound Bed Preparation acronym TIME. (T = Tissue, I = Inflammation/Infection, M = Moisture, E = Edges) Review the wound at each dressing change documenting the TIME observations on the wound assessment form (WAF) In accordance to the Wound Bed Preparation process the wound classification and size should change over time. Use measuring grids and depth probes at least every four weeks to evidence the progress or non progress of a wound. Do not over prescribe excessive quantities or issue long term repeats. A maximum of 14 days supply should be sufficient. This avoids wastage and prompts the opportunity for formal review of the wound. Antimicrobial dressings should only be used where there are clinical signs and symptoms of infection, and discontinued if there is no improvement after 14 days. They should not be routinely used for management of uncomplicated leg ulcers. The BNF advises against the use of silver dressings for acute wounds as there is some evidence that they may delay wound healing. Dressings prescribed on FP10 for individual patients must not be used for any other patient or for stock. Notes for Use 1. The Formulary has been split into two parts Which Dressing?, intended to guide the clinician to the appropriate type of dressing for the wound, and Which Product?, intended to be used once the type of dressing required has been determined 2. The Formulary also contains specific sections dedicated to dressings for Podiatry and to Leg Ulcers. 3. Where there is a choice, the most cost-effective product which is suitable should be selected. 4. If in doubt as to which product is appropriate, advice should be sought from the Tissue Viability Service or where applicable from Podiatry or the Leg Ulcer service. 2

Exudate Curve + Healing Aims Super Absorbents Hydrofiber with Foam Antimicrobials (DACC/Silver/Iodine) Increased Moisture Exudate Level Moist Dry Hydrogel Hydrocolloid Honey Rehydrate Foam Hydrofiber with Hydrocolloid/Foam Larvae Absorb Foam Hydrocolloid Light Absorbent Dressings Hydrate / Protect Hydrocolloid Film Honey Tissue Type Necrotic Sloughy Granulating Epithelialising Infected Wound Progression Model WOUND MANAGEMENT PRODUCTS FORMULARY 3

4 WHICH DRESSING? TISSUE TYPE AIM RECOMMENDED DRESSING TYPE Necrotic Removal necrotic tissue by rehydration * Hydrocolloid; Hydrogel; Larvae Tulles; Cadexomer / Povidone Iodines Infected Treat infection and promote healing Tulles; Cadexomer Iodines; Povidone iodine; alginates; alginate gels; Foams; hydrocolloid fiber; Honey; PHMB (TVS supervision only); Gels; Silver Dressings Malodourous To de-odorise wound and manage infection if present Honey Sloughy Remove sloughy tissue by autolysis and provide a clean base for granulation tissue Alginate Flat Sheet; Alginate Rope; Hydrocolloid Fiber; Hydrocolloid Sheet; Larvae; Hydrogels; Hydrogel Sheet; Debridement product (TVS approval required) Granulating Promotion of healing by encouraging granulation Adhesive Foam; Non-adhesive Foam; Hydrocolloid Sheet; Silicone nonadherent; Adhesive non-adherent; Protease Modulating Epithelialising Protection of new tissue and to encourage healing Non-adhesive non-adherent; Semi-occlusive film; Adhesive; Foam; nonadhesive Foam; Hydrocolloid Leg Ulcers To identify the aetiology of the ulcer Topical dressing will depend on the presentation of the wound bed. Venous ulcers compression (4-layer, 2-layer, short stretch); Mixed aetiology reduced compression; Arterial ulcers no compression Lymphoedema Control and reduction of chronic oedema and lymphoedema in the lower limbs and arms. Short-stretch bandaging FUNCTION AIM RECOMMENDED DRESSING TYPE Barrier/peri-wound To protect intact and damaged skin against urinary and Barrier Film, Skin Protectant protection faecal excoriation, frictional forces, adhesive trauma Negative Pressure Wound Therapy Designed to assist in kick-starting the healing process in complex wounds such as trauma and burn wounds, some surgical wounds and specific chronic wounds Wound Cleansing To remove particles and debris For Infected or chronic wounds only Retention and support To retain dressings and support limbs NPWT systems Sterile Dressing Packs, Saline Antimicrobial cleansing and irrigation solutions and gels Surgical Adhesive Tapes, Retention Bandages Support Bandage *Consult TVS/Podiatry for Necrotic wounds below the ankle

CONTENTS page ALGINATES 6 HYDROFIBER 7 HYDROGELS 7 HYDROCOLLOIDS 8 FOAMS 9-10 LOW ADHERENT DRESSINGS 11 SKIN BARRIER PRODUCTS 12 ODOUR ABSORBENT AND DEODORISING DRESSINGS 12 WOUND INFECTION 13-16 IODINE IMPREGNATED DRESSINGS 13 HONEY DRESSINGS (DO NOT USE IF ALLERGIC TO BEE VENOM) 14 PHMB IMPREGNATED DRESSINGS 15 ALGINATE GEL 15 SILVER IMPREGNATED DRESSINGS / PRODUCT 16 NEGATIVE PRESSURE WOUND THERAPY 17 SHORT-STRETCH BANDAGING 18 LEG ULCER DRESSINGS & BANDAGES 19-22 MISCELLANEOUS 23-25 DRESSING PACKS 23 WOUND CLEANSING 23 OTHER 24-26 PODIATRY 27 WOUND MANAGEMENT PRODUCTS FORMULARY 5

WOUND MANAGEMENT PRODUCTS FORMULARY Prices are based on August 2014 Drug Tariff Prices Drug Tariff Prices The clinician should read all product literature and manufacturers guides prior to use. ALGINATES Activheal Flat Sheet Alginate AMS 10cm x 20cm Kaltostat Flat Sheet Alginate ConvaTec 5cm x 5cm 7.5cm x 12cm 10cm x 20cm 15cm x 25cm 1.15 2.83 0.94 2.05 4.03 6.92 Use to contain exudates and clean wound debris Use only if haemostatic properties are required, for bleeding minor wounds. Not for heavily bleeding wounds Flaminal Hydro Gel Flaminal Forte Gel Alginate Gel Crawford Healthcare Alginate Gel Crawford Healthcare 15g tube 50g 15g tube 50g 7.61 25.18 7.61 25.18 Alginate gel containing two antimicrobial enzymes, glucose oxidase and lactoperoxidase, which exert their effect without damaging healthy skin cells Flaminal Hydro contains less alginate than Flaminal Forte For use on infected wounds with moderate to heavy exudate where assistance in debridement of slough or necrotic tissue is required Consider when management with Iodine or silver based products has failed or is contraindicated For use under TVS Instruction only Sorbsan Packing Alginate Rope Aspen Medical 30cm/2g 3.47 For cavities Use to contain exudates and clean wound debris Kaltostat Ribbon Alginate Rope ConvaTec 2g 3.77 For cavities Use only if haemostatic properties are required, for bleeding minor wounds. Not for heavily bleeding wounds 6

HYDROFIBER Aquacel EXTRA Aquacel Ribbon Hydrocolloid Fiber Hydrocolloid Fiber ConvaTec ConvaTec 5cm x 5cm 15cm x 15cm 1cm x 45cm 2cm x 45cm 0.99 2.36 4.44 1.81 2.42 Absorbs wound fluid and transforms into a soft gel Avoid packing cavity tightly Use if wound is very productive For use as Protease Modulating Therapy (PMT), only on Team Leader or TVS advice HYDROGELS (NOT INDICATED FOR USE ON DIABETIC FOOT WOUNDS) Activheal Hydrogel Hydrogel AMS 8g tube 15g tube 1.23 1.41 To hydrate necrotic tissue and further enhance autolytic debridement Can be used with non-woven gauze when support structure is required Actiform Cool Hydrogel Sheet Activa 5cm x 6.5cm 1.78 2.61 Enhances autolytic debridement Reduces pain in leg ulcers only Can be left in place for up to 7 days Should not be placed into deep cavities or sinuses Do not apply to a bleeding wound Keep within 5 C-35 C temperature range WOUND MANAGEMENT PRODUCTS FORMULARY 7

HYDROCOLLOIDS (NOT INDICATED FOR USE ON DIABETIC FOOT WOUNDS) DuoDERM Extra Thin Hydrocolloid Sheet ConvaTec 5cm x 10cm 7.5cm x 7.5cm 15cm x 15cm 0.75 0.79 1.30 2.81 To promote autolytic debridement in a necrotic wounds For use on simple granulation wounds with minimal exudate Wear time 3-7 days Can be cut to size Acitvheal Hydrocolloid Hydrocolloid Sheet AMS 5cm x 7.5cm 15cm x 15cm 0.78 1.58 3.43 Appropriate if greater support for autolytic debridement is required or if Duoderm has not met patient s need Useful if a thicker pad is required 8

FOAMS Activheal Foam Adhesive Activheal Foam Non- Adhesive Adhesive Foam Non-Adhesive Foam AMS AMS 7.5cm x 7.5cm 12.5cm x 12.5cm 15cm x 15cm 20cm x 20cm 5cm x 7.5cm 15cm x 15cm 15cm x 18cm sacral 1.18 1.63 1.68 2.15 4.50 0.97 1.55 2.91 3.36 For moderately exudating wounds For moderately exudating wounds or overgranulation Do not use films to secure foams as this prevents evaporation of exudate Allevyn Gentle Border (Adhesive) Adhesive non-adherent Foam Smith & Nephew 7.5cm x 7.5cm 10cm x 20cm 12.5cm x 12.5cm 15cm x 15cm 17.5cm x 17.5cm 1.48 2.18 3.51 2.67 3.93 5.26 Use if ActivHeal is unsuitable for patient Allevyn Gentle (Non- Adhesive) Silicone nonadherent Foam Smith & Nephew 5cm x 5cm 10cm x 20cm 15cm x 15cm 20cm x 20cm 1.26 2.49 4.01 4.18 6.68 Use if ActivHeal is unsuitable for patient Do not use films to secure foams as this prevents evaporation of exudate WOUND MANAGEMENT PRODUCTS FORMULARY 9

FOAMS Tegaderm Foam Adhesive Adhesive Foam 3M 14.3cm x 15.6cm oval 4.21 Use only where surfaces are difficult to fit around e.g. elbows, anal/rectal areas Aquacel Foam Adhesive Adhesive non-adherent Foam ConvaTec 8cm x 8cm 12.5cm x 12.5cm 17.5cm x 17.5cm 21cm x 21cm 25cm x 30cm 19.8cm x 14cm Heel 20cm x 16.9cm Sacral 24cm x 21.5cm Sacral 1.37 2.12 2.63 5.26 7.70 9.96 5.38 4.82 5.50 For use on sloughy and productive flat wounds Aquacel Foam Non- Adhesive Non-Adhesive Foam ConvaTec 5cm x 5cm 15cm x 15cm 20cm x 20cm 15cm x 20cm 1.33 2.51 4.22 6.88 5.77 For use on sloughy and productive flat wounds For use as a Protease Modulating Therapy (PMT) on apparently clean wounds which fail to progress, Under Team Leader or TVS advice only Lyofoam Max Non- Adhesive Non-Adhesive Foam Molnlycke 15cm x 15cm 20cm x 20cm 1.13 2.13 3.95 Can be used on over-granulating wounds Apply smooth shiny side to wound bed Indicated for use on diabetic foot wounds Do not use films to secure foams as this prevents evaporation of exudate 10

LOW ADHERENT DRESSINGS Atrauman NA Tulle Hartmann 5cm x 5cm 7.5cm x 10cm 10cm x 20cm 20cm x 30cm Physiotulle Tulle Coloplast 15cm x 20cm Softpore Tulle Richardson Healthcare 6cm x 7cm 10cm x 15cm 10cm x 20cm 10cm x 25cm 10cm x 30cm 10cm x 35cm 0.26 0.28 0.62 1.71 2.23 6.80 0.06 0.13 0.20 0.35 0.40 0.49 0.58 Silicone, non-adherent Use to protect low exuding wounds or as a liner in NPWT Use if Atrauman NA is ineffective For increased non-adherence on advice from Team Leader or TVS only Adhesive, non-adherent Waterproof Use to protect low exudating wounds and promote new tissue WOUND MANAGEMENT PRODUCTS FORMULARY 11

SKIN BARRIER PRODUCTS Conotrane Cream Barrier Cream Generic 100g 0.88 For use as a basic barrier cream Vasogen Cream Barrier Cream Generic 100g 0.88 For use as a basic barrier cream Cutimed Protect Cream Barrier Cream BSN 92g tube 28g tube Cutimed Foam Barrier Film 28ml Spray Applicator (Non alcohol 1ml Swab based) 3ml Swab 6.05 3.18 5.11 4.30 6.93 To care for intact skin To protect skin from urine and faeces To care for damaged or fragile skin around wounds To protect urine and faecally excoriated skin around pressures ulcers or moisture lesions Proshield Plus Barrier Cream h&r Healthcare 115g 9.78 For use as a skin protectant for both intact and injured skin associated with incontinence, under TVS advice only Proshield Foam & Spray Cleanser Skin Protectant h&r Healthcare 235ml 6.45 For use as a skin protectant for both intact and injured skin associated with incontinence, under TVS advice only ODOUR ABSORBENT AND DEODORISING DRESSINGS Algivon Honey Advancis 5cm x 5cm 1.98 3.40 Suitable for malodourous wounds where exudate is high and the additional benefits of alginates for exudate management is required Activon Tube Honey Advancis 25g 2.05 Suitable for malodourous wounds where exudate is low Clinisorb Odour Control Dressing Activated Charcoal CliniMed 10cm x 20cm 1.86 2.48 Use only as a deodorizing dressing Use to contain odour as part of a detailed care plan to manage wound bed Do not place in direct contact with the wound - place over a suitable primary dressing Once the charcoal comes into contact with exudate, its odour adsorbing properties are reduced and a change is required 12

WOUND INFECTION Antimicrobial Dressings (Only for heavily colonized wounds or infected wounds as an adjunct to systemic antibiotic treatment) Antimicrobial products should only be used where an increased risk of infection or clinical signs of critical colonisation/ infection are apparent. Once an infection has resolved, treatment with an antimicrobial product should be stopped There is no robust clinical evidence that dressings containing antimicrobials (e.g. silver, iodine or honey) are more effective than unmedicated dressings for the treatment or prevention of wound infection. However, experience and anecdotal case studies indicate they have a place in the management of infected wounds and may prevent progression to systemic antibiotics. Long term use of antimicrobial dressings must be avoided e.g. stop using silver dressings if there are no improvements after 2 weeks and replace with a nonsilver dressing Indiscriminate use of topical antimicrobial dressings should also be discouraged because of concerns over bacterial resistance and toxicity. They should only be used where critical colonisation, an increased risk of clinical infection or clinical signs of infection are apparent Antimicrobial dressings should not be used as routine for non-infected acute wounds, diabetic foot ulcers or uncomplicated leg ulcers Evidence for use in infected burns is weak Review each product use after two weeks IODINE IMPREGNATED DRESSINGS Iodoflex Paste Iodosorb Ointment Cadexomer Iodine Cadexomer Iodine Smith & Nephew Smith & Nephew 5g 10g 4.06 8.12 10g 4.49 As above First-line for use on infected wounds where an antimicrobial is required, unless contraindicated For use on infected wounds where an antimicrobial is required in conjunction with debridement and exudate management Single use Do not use in renal impairment, thyroid disorders, children, pregnancy & lactating women Inadine Povidone Iodine Acelity 5cm x 5cm 9.5cm x 9.5cm 0.33 0.49 For use on superficial wounds where there is a likelihood of infection WOUND MANAGEMENT PRODUCTS FORMULARY 13

WOUND INFECTION HONEY DRESSINGS (DO NOT USE IF ALLERGIC TO BEE VENOM) Actilite Honey Advancis 5cm x 5cm 10cm x 20cm Algivon Honey Advancis 5cm x 5cm 0.98 1.90 1.98 3.40 A non-adherent light viscose net dressing coated with antibacterial Manuka honey & Manuka oil. The dressing is designed to protect a wound, promote healing and allow the passage of exudate Use on contaminated skin tears or other superficial contaminated trauma injury Can be used prophylactically to prevent infection in patients at increased risk of infection Honey may solidify at cold temperatures or become more liquid in very warm condition. Warm between hands to soften, or place in fridge for a few minutes if too liquid A soft alginate dressing impregnated with 100% medical grade Manuka honey. The alginate fibers enable a sustained, slower release of honey Suitable for malodorous, sloughy or necrotic wounds where exudate is high, where the additional benefits of exudate management through an alginate is required Honey may solidify at cold temperatures or become more liquid in very warm condition. Warm between hands to soften, or place in fridge for a few minutes if too liquid Activon Tube Honey Advancis 25g 2.05 For infected wounds which are sloughy, necrotic, and low exudate 14

WOUND INFECTION PHMB IMPREGNATED DRESSINGS Subrasorb X + PHMB PHMB h&r Healthcare 5cm x 5cm 9cm x 9cm 14cm x 20cm 2.53 5.03 11.45 For light to moderately exudating, critically colonised and infected wounds where antimicrobial dressings have failed to control bacterial burden For use under Team Leaders or TVS instruction only ALGINATE GEL Flaminal Hydro Gel Alginate Gel Crawford Healthcare 15g tube 50g 7.61 25.18 For use on infected wounds with moderate to heavy exudate where assistance in debridement of slough or necrotic tissue is required Consider when management where antimicrobial dressings have failed or is contraindicated For use under Team Leaders or TVS instruction only Flaminal Forte Gel Alginate Gel Crawford Healthcare 15g tube 50g 7.61 25.18 For use on infected wounds with moderate to heavy exudate where assistance in debridement of slough or necrotic tissue is required Consider when management where antimicrobial dressings have failed or is contraindicated For use under Team Leaders or TVS instruction only WOUND MANAGEMENT PRODUCTS FORMULARY 15

WOUND INFECTION SILVER IMPREGNATED DRESSINGS / PRODUCT Sorbsan Silver Flat Silver Alginate Aspen Medical 5cm x 5cm 10cm x 20cm 1.57 3.97 7.26 For use on infected wounds which are exudating moderately but require assistance with autolytic debidement in addition to exudate management It should be the subsequent product to be considered when management with Iodine or Honey based products have failed or are contraindicated Sorbsan Silver Packing Silver Alginate Aspen Medical 30cm/2g 5.76 For use on infected wounds which are exudating moderately but require assistance with autolytic debidement in addition to exudate management It should be the subsequent product to be considered when management with Iodine or Honey based products have failed or are contraindicated Aquacel Ag+ EXTRA Silver Hydrocolloid Fiber ConvaTec 5cm x 5cm 15cm x 15cm 1.95 4.64 8.75 Allow a 1 cm overlap over the edge of the wound Aquacel Ag+ Ribbon Cavity dressing Silver Hydrocolloid Fiber ConvaTec 1cm x 45cm 2cm x 45cm 3.06 4.67 For use on infected sloughy or necrotic cavity or sinus wounds where exudate is heavy. It should be held in situ with an absorbent adhesive dressing such as Softpore. The secondary dressing can be upgraded to foam if exudate is copious. Use under instruction of TVS or Team Leader Physiotulle AG Silver Tulle Coloplast 2.24 For clinical infection in leg ulcers only 16

NEGATIVE PRESSURE WOUND THERAPY* FOR USE ONLY ON ADVICE FROM TVS OR ON DISCHARGE FROM ACUTE TRUST KCI Activac Avance NPWT NPWT KCI Molnlycke 300ml 300ml 28.18 19.61 FOR USE ONLY ON ADVICE FROM TVS or on discharge from ACUTE TRUST Each area should have available at all times: KCI Activac Disposable s 5 x 300ml canisters for KCI Activac 5 KCI small Simplace dressing packs, 2 medium Simplace dressing packs 10 Vac gel strips Molnlycke Avance Disposables Renasys NPWT Smith & Nephew PICO System NPWT Smith & Nephew 250ml 19.15 10cm x 30cm (Other sizes available) 124.55 5 x 300ml canisters for Molnlycke Avance systems 5 Avance small gauze dressing kits, 2 medium gauze dressing kits 5 mepiseals 5 flat drains Renasys Disposables Continuity of care when initiated in Acute Trust only Various Sizes Disposables for other manufacturers systems need to be ordered. The discharging Acute Trust concerned will need to supply 3 dressings * For NPWT products not listed on this formulary, please contact the TVS for authorisation to order. WOUND MANAGEMENT PRODUCTS FORMULARY 17

SHORT-STRETCH BANDAGING Actico Short-stretch bandaging Activa 4cm x 6m 6cm x 6m 8cm x 6m 10cm x 6m 12cm x 6m 2.38 2.79 3.21 3.33 4.24 Short stretch cohesive bandage Rosidal K Short-stretch bandaging Activa 6cm x 5m 8cm x 5m 10cm x 5m 10cm x 10m 12cm x 5m 2.61 3.12 3.41 5.93 4.13 Short Stretch cotton bandage for patients with sensitivities Mollelast Short-stretch bandaging Activa 4cm x 4m 0.30 Cotton Toe bandage Cellona Padding and Shaping layer Activa 5cm x 2.75m 7.5cm x 2.75m 10cm x 2.75m 15cm x 2.75m 0.31 0.37 0.46 0.60 Required for shaping- high density wool for shaping larger limbs 18

LEG ULCER DRESSINGS & BANDAGES Mepore Ultra Adhesive Dressing Molnlycke 7cm x 8cm 9cm x 20cm 9cm x 25cm 9cm x 30cm Acitvheal Hydrocolloid Hydrocolloid Sheet AMS 5cm x 7.5cm 15cm x 15cm Alione (Biatain Super) Foam Coloplast 12.5cm x 12.5cm 15cm x 15cm 20cm x 20cm 12cm x 20cm 0.40 1.51 1.67 2.75 0.78 1.58 3.83 2.15 3.55 4.28 6.67 3.56 Will contain low exudates where adhesive dressing needed (waterproof) When greater support for autolytic debridement is required or exudate is low To contain high exudate Aquacel EXTRA Hydrocolloid ConvaTec 5cm x 5cm 1.01 To contain very high exudate Fiber 15cm x 15cm 2.39 4.49 Atrauman NA Tulle Hartmann 5cm x 5cm 0.26 To protect new tissue 7.5cm x 10cm 10cm x 20cm 20cm x 30cm 0.28 0.62 1.71 Physiotulle Tulle Coloplast 2.23 For resistant ulcers 15cm x 20cm 6.80 Physiotulle AG Silver Tulle Coloplast 2.24 For clinical infection Actiform Cool Hydrogel Sheet Activa 5cm x 6.5cm 1.78 2.61 For added pain control in leg ulcers WOUND MANAGEMENT PRODUCTS FORMULARY 19

LEG ULCER DRESSINGS & BANDAGES Iodoflex Paste Cadexomer Iodine Smith & Nephew 5g 10g 4.06 8.12 For mixed aetiology infected leg ulcers K-Soft Padding Urgo 10cm x 3.5m 0.45 Where extra padding required for shaping, absorption, protection Allevyn Cavity Foam Smith & Nephew 12cm x 4cm 7.16 For pressure padding for wounds in concavities as advised by CNS Leg Ulceration only Viscopaste Zinc Paste Bandage Smith & Nephew 7.5cm x 6m 3.63 For dry eczema ZipZoc Zinc Oxide Stocking Smith & Nephew 7.5cm x 6m 3.63 When easy application of paste bandage is required Icthopaste Zinc Paste and Icthammol Bandage Smith & Nephew 7.5cm x 6m 3.67 For wet eczema only K-Four 4-Layer Compression Urgo <18cm 18cm - 25cm 25cm - 30cm >30cm Ultra Four 4-Layer Compression Robinson Healthcare <18cm 18cm - 25cm K-Two 2-Layer Compression Urgo 18cm x 25cm 25cm x 32cm 7.11 6.80 6.80 9.36 6.41 5.67 7.99 8.72 4-layer bandaging system 4 layer bandaging system - Latex Allergy Alternative 2-layer system 20

LEG ULCER DRESSINGS & BANDAGES Actico Short-stretch bandaging Activa 4cm x 6m 6cm x 6m 8cm x 6m 10cm x 6m 12cm x 6m 2.38 2.79 3.21 3.33 4.24 Short stretch cotton for sensitive patients Rosidal K Short-stretch bandaging Activa 6cm x 5m 8cm x 5m 10cm x 5m 10cm x 10m 12cm x 5m 2.61 3.12 3.41 5.93 4.13 For patients with sensitivities Actifast Multistretch Tubular Bandage Activa Red Line (Small Limb) 1m Green Line (Medium Limb) 1m Green Line (Medium Limb) 3m Green Line (Medium Limb) 5m Blue Line (Large Limb) 1m Blue Line (Large Limb) 3m Blue Line (Large Limb) 5m Yellow Line (Child Trunk) 1m Yellow Line (Child Trunk) 3m Yellow Line (Child Trunk) 5m 0.58 0.60 1.67 2.89 0.79 2.19 3.85 1.24 3.59 6.22 Where a Cotton Liner is required WOUND MANAGEMENT PRODUCTS FORMULARY 21

LEG ULCER DRESSINGS & BANDAGES Comfinette Tubular Bandage Synergy NHSSC Only NHSSC Only For patients who prefer a lighter liner for an existing skin condition Vascular Access Clinic Only Activa Leg Ulcer Kit Stocking & Compression Liner Compresson Liner Pack (Closed Toe) Compression Liner Pack (Open Toe) Leg Ulcer Kit Activa S, M, L, XL, XXL S, M, L, XL, XXL S, M, L, XL, XXL 22.56 16.92 16.59 Alternative to compression bandage for small low level exudate wounds For made to measure & smaller sizes only Where there is a clinical need for higher pressures Liner gives 10mm Hg and outer stocking gives 30mm Hg Mediven Leg Ulcer Kit Leg Ulcer Kit I, II, III, IV, V, VI, VII 32.50 Alternative to compression bandages for low to medium exudate wounds. Liner gives 20 mm Hg and outer stocking gives 20 mm Hg 22

MISCELLANEOUS DRESSING PACKS Nurse It Sterile Dressing Pack Medicare Plus International small/medium medium/large 0.52 0.52 Includes: tray, forceps, apron, latex free gloves, disposable bag, paper towel, 7 swabs, absorbent dressing pad, sterile field, wound measurement ruler Soft Drape Sterile Dressing Pack Richardson Medium Large Order via NHSSC Includes: tray, apron, latex free gloves, disposable bag, paper towel, 7 swabs, absorbent dressing pad, sterile field, wound measurement ruler WOUND CLEANSING Irripod Saline C D Medical 25 x 20ml 5.84 For general wound cleansing May be warmed in luke-warm water Octenilin Wound Irrigation Solution Octenilin Wound Gel Antimicrobial Cleansing and Irrigation Solution Schulke & Mayr UK Ltd Antimicrobial Schulke & Cleansing Gel Mayr UK Ltd 350ml 4.60 For critically colonised and infected wounds 20ml 4.78 Gel for cleansing, moistening and decontamination of encrusted, contaminated and chronic skin wounds ADHESIVE REMOVER Appeel Adhesive remover Clinimed 30 Wipes 50ml Aerosol 15.26 9.20 For use on patients with fragile skin WOUND MANAGEMENT PRODUCTS FORMULARY 23

MISCELLANEOUS OTHER Haelan Tape Steroid Tape Typharm 7.5cm x 50cm 9.27 For management of over-granulation, under TVS advice only Mesorb Super Absorbent Molnlycke 10cm x 15cm 10cm x 20cm 15cm x 20cm 20cm x 25cm 0.62 0.81 1.00 1.42 2.24 Absorbent dressing for use when extra absorbency is required Flivasorb Super Absorbent Activa 10cm x 20cm 20cm x 20cm 20cm x 30cm Hydrofilm Film Dressing Hartmann 6cm x 7cm 10cm x 12.5cm 10cm x 15cm 10cm x 25cm 12cm x 25cm 15cm x 20cm 20cm x 30cm 0.88 1.05 1.86 2.35 0.22 0.42 0.52 0.81 0.85 0.96 1.59 For use only under advice of TVS or Team Leader Semi-occlusive Film dressing - allows oxygen transmission, moist wound environment Protects newly formed epithelialised tissue Bacterial barrier Water resistant Remove dressings in the direction of the hair growth IV 3000 IV Film Dressing Smith & Nephew 5cm x 6cm 6cm x 7cm non winged peripheral 7cm x 9cm ported peripheral 9cm x 12cm PICC Line 10cm x 12cm Central Line 0.42 0.55 0.73 1.43 1.39 For use on IV/subcutaneous therapy sites 24

MISCELLANEOUS OTHER Debrisoft LarvE Biobag dressing kit Debridement Product Larvae in a mesh bag Activa 6.35 For immediate debridement of devitalised tissue TVS advice or Team leader only BioMonde 2.5cm x 4cm 4cm x 5cm 5cm x 6cm 6cm x 12cm 199.50 229.50 249.50 279.50 299.50 A zoobiotic for accelerated debridement of slough, only on advice from TVS. NB needs to be prescribed on FP10 Unique FP10 pack code is required on prescription Decide which day larvae is to be applied. Take into consideration orders for larvae must be placed by 2pm at the latest on the day before required To cancel an order contact BioMonde before 12pm on the day before delivery. All cancellations received after this time will incur full charge State when you require delivery (application date) Time frame of delivery (am or Saturday) Pharmacists should liaise with prescriber to ensure timely delivery and viability of product Caution with patients who take Warfarin Maxitrol Eye Ointment Alcon 5ml 1.42 For topical application to over granulating wounds. Unlicensed use, approved by SEPT MMC provided it has been initiated by Acute Trust Specialists Sorbsan Depth Measuring Probe Aspen Medical Single NHSSC Only Wound Measuring Grids ConvaTec 100 NHSSC Only For measuring depth/undermining of cavity wounds Measure depth at a minimum of 4 weekly intervals For measuring of chronic wounds at minimum of 4 weekly intervals WOUND MANAGEMENT PRODUCTS FORMULARY 25

MISCELLANEOUS OTHER KerraPro Pressure Reducing Pads (Under TVS Advice) Silicone Pad Crawford x 0.3cm Sheet x 1.2cm Sheet 4.20 12.64 Silicone pads that help protect the skin of at-risk patients as part of a pressure ulcer prevention programme Can be reused on the same patient (simply wash with soap and water) Must be completely dry before re-application Heel 14.83 For use under the heel or at the back of the heel Can also be used on elbows, shoulders and knees Sacrum/Ankle 16.69 For comfort and protection in particularly bony body areas such as shoulder, shoulder blades, hips and ankles 50cm x 2.5cm x 0.3cm Strip 50cm x 5cm x 0.3cm Strip 5.26 6.32 May be cut to the required length to provide protection when using healthcare equipment such as facemasks and tubes Can also be used as hand, finger, wrist, foot, toe and ankle wraps 26

PODIATRY Melolin Non-Adherent Molnlycke 5cm x 5cm 20cm x 10cm 0.10 0.27 0.53 Non-adherent Standard dressing for non-complex wounds Biatain Foam Foam Coloplast 5cm x 5cm 1.29 2.35 Exuding plantar ulcers. Sustains thickness on compression and cushioning effect Allevyn Foam Smith & Nephew 5cm x 5cm 1.25 2.48 Exudating plantar ulcers use if Biatain is unsuitable for patient Allevyn Heel Foam Smith & Nephew 10.5cm x 13.5cm 5.08 Ischaemic heel ulcers where adhesive strapping is contraindicated Sorbsan Alginate Aspen 5cm x 5cm Sorbsan Plus Alginate Aspen 7.5cm x 10cm 10cm x 15cm Cutimed Sorbact Swab Antimicrobial BSN 4cm x 6cm 7cm x 9cm Kerramax Care Superabsorbent Crawford 10cm x 20cm 0.81 1.71 1.76 3.10 1.62 2.70 1.27 1.67 Removal of adherent slough Reduction of maceration Removal of adherent slough on plantar ulceration with excessive exudate For use within Foot Protection Team and on TVS services recommendation only For Management of moderate to heavily exuding wounds. May be used under moderate compression bandaging. Soft, conformable and stackable. WOUND MANAGEMENT PRODUCTS FORMULARY 27

Other Useful Sources of Information: 1. BNF http://www.bnf.org 2. Drug Tariff http://www.ppa.org.uk/ppa/edt_intro.htm 3. Mims for District Nurse Formulary http://www.mims.co.uk 4. EWMA Position Document: Management of Wound Infection: http://ewma.org/fileadmin/user_upload/ewma/pdf/position_documents/2006/english_pos_doc_2006.pdf 5. Wound Care Handbook: http://www.woundcarehandbook.com/products CONTACTS Tissue Viability Service: 01279 827477 Leg Ulcer Service: 0208 2724649 Podiatry Service: 01279 698719 Pharmacist: 01279 827479 Referral forms available upon request