Tissue Viability Service WOUND CARE FORMULARY. Version: April Tissue Viability Nursing Service

Transcription

1 Tissue Viability Service WOUND CARE FORMULARY Version: April 2014 Tissue Viability Nursing Service

2 For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required 2 Tissue Viability Service

3 CONTENTS page INTRODUCTION 4 EXUDATE CURVE + HEALING AIMS 5 HYDROFIBER 6 HYDROGELS 6 FILM DRESSING 7 WOUND CONTACT LAYER 7 ODOUR CONTROL 8 SKIN PROTECTIVES 8 FOAMS 9 HYDROCOLLOIDS 10 LIGHT ABSORBENT DRESSINGS 10 WOUND CLEANSING AGENTS 11 SUPER-ABSORBENT DRESSINGS 11 MISCELLANEOUS 12 BANDAGES ANTIMICROBIALS WOUND MANAGEMENT PRODUCTS FORMULARY 3

4 Introduction The formulary will be available across Leicestershire NHS Partnership Trust and associated Clinical Commissioning Groups. Within LPT community areas, online wound dressing is the preferred supply route, within in-patient areas via e-prescribing. The formulary has been devised by an expert clinical group in consultation with staff. It aims to provide a clinically effective, appropriate and cost effective choice of products to manage the vast majority of wounds. The product list contains alternatives within each category, to assist the choice of dressing following patient assessment. The formulary should be seen as an active document that will be continually assessed, evaluated and updated to reflect innovation in practice. Selection of dressing product should also be based upon clinical presentation of the wound and frequency of dressing change. For items usage beyond formulary please refer to the Tissue Viability Nursing team. The following must be noted: 1. The choice of dressing should be based on sound clinical judgment. 2. Clinicians should provide the patient with a quantity that is clinically required, rather than supplying whole packs that produce waste and inefficiencies. 3. Correct initial and ongoing wound assessment must inform selection of dressing product. Dressing Choice The choice of dressings is influenced by Maximising effectiveness Minimising risk Continuation of care between primary and secondary care Minimising cost Patient concordance Specialist products e.g. NPWT & Larvae therapy should only be used following discussion and where necessary assessment by the TVN Compression products should only be applied by practitioners trained in their application. Maintenance hosiery can be prescribed in any size, including made to measure. 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. Long term use of antimicrobial dressings should be avoided: if there are no improvements after 2-4 weeks alternative options must be considered, as well as referral to TVN. Silver dressings should not be used routinely for acute wounds, diabetic foot ulcers or uncomplicated leg ulcers. 4 Tissue Viability Service

5 Exudate Curve + Healing Aims Super Absorbents Hydrofibre with Foam Antimocrobials (DACC/Silver/Iodine) Exudate Level Wet Moist Hydrogel Hydrocolloid Honey Foam Hydrofibre with Hydrocolloid/Foam Larvae Foam Hydrocolloid Light Absorbent Dressings Hydrocolloid Film Honey Dry Rehydrate Absorb Hydrate / Protect Tissue Type Necrotic Sloughy Granulating Epithelialising Infected Wound Progression Model WOUND MANAGEMENT PRODUCTS FORMULARY 5

6 Leicestershire Formulary & Price List (April 2014 Drug Tariff Prices) The clinician should read all product literature and manufacturers guide prior to use. HYDROFIBER Aquacel EXTRA TM ConvaTec 5cm x 5cm 10cm x 10cm 15cm x 15cm Made to absorb exudate Wear time depends on exudate level, but should be changed when saturated HYDROGELS Activheal Hydrogel Advanced Medical Solutions 8g Tube 1.23 Do not use on full thickness burns or surgical implantations Use on necrotic/sloughy wounds with nil-low exudate Hydrosorb Gel Sheet Paul Hartmann 5cm x 7.5cm 10cm x 10cm Do not use on infected wounds or full thickness burns For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required 6 Tissue Viability Service Tier 1 Tier 2

7 FILM DRESSING Hydrofilm Paul Hartmann 6cm x 7cm 10cm x 12.5cm 10cm x 15cm Should not be used on clinically infected, bleeding or highly exuding wounds Maximum wear time 7 days Corner of the dressing lifted carefully from the skin then stretched horizontally away from the wound WOUND CONTACT LAYER Atrauman Paul Hartmann 5cm x 5cm 7.5cm x 10cm 10cm x 20cm Maximum 7 day usage Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 7

8 ODOUR CONTROL Clinisorb CliniMed 10cm x 10cm 10cm x 20cm Use only as a deodorising dressing Once the charcoal comes into contact with exudate, its odour adsorbing properties are reduced and a change is required SKIN PROTECTIVES Cavilon Durable Barrier Cream 3M Healthcare 2g Sachet (20) 7.47 Apply sparingly do not use on infected/broken skin Cavilon No Sting Barrier Film 3M Healthcare 1ml Foam Applicator (5) 4.96 Can be used on broken skin 72 Hour protection Allow product to dry completely before applying pads or clothing For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required 8 Tissue Viability Service Tier 1 Tier 2

9 FOAMS Tielle Plus Systagenix 11cm x 11cm 15cm x 15cm 15cm x 20cm 20cm x 26.5cm (Heel) Maximum 7 days usage Not to be used on full thickness burns Allevyn Adhesive Smith & Nephew 7.5cm x 7.5cm 10cm x 10cm 12.5cm x 12.5cm 12.5cm x 22.5cm 17.5cm x 17.5cm 22.5cm x 22.5cm Maximum 7 days usage Not for use with oxidizing agents such as hypochlorite solutions as it can break down the absorbency of the dressing Allevyn Gentle Border Smith & Nephew 7.5cm x 7.5cm 10cm x 10cm 10cm x 20cm 12.5cm x 12.5cm 15cm x 15cm 17.5cm x 17.5cm Maximum 7 days usage Not for use with oxidizing agents such as hypochlorite solutions as it can break down the absorbency of the dressing Allevyn Non-Adhesive Smith & Nephew 5cm x 5cm 10cm x 10cm Maximum 7 days usage Tielle Xtra Systagenix 11cm x 11cm 15cm x 15cm Maximum 7 day wear Not to be used on full thickness burns Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 9

10 HYDROCOLLOIDS DuoDERM Extra Thin ConvaTec 7.5cm x 7.5cm 10cm x 10cm 9cm x 15cm Tegaderm Hydrocolloid 3M Healthcare 10cm x 12cm 13cm x 15cm days Can be cut to size Ensure border extends at least 3cm past wound margins Maximum 7 days usage Remove by pulling parallel to skin to release adhesive LIGHT ABSORBENT DRESSINGS Softpore Richardson Healthcare 6cm x 7cm 10cm x 10cm Not for use on fragile skin Change when required Clearpore Richardson Healthcare 6cm x 7cm 10cm x 10cm Not for use on fragile skin Change when required For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required 10 Tissue Viability Service Tier 1 Tier 2

11 WOUND CLEANSING AGENTS Irripods CD Medical 20ml ampoules x Avoid splashes to face Can be warmed in luke warm water Prontosan Solution B Braun 350ml Bottle 4.71 Use on wounds contaminated with bio film, soak the wound for minutes to ensure effectiveness Do not rinse Prontosan Wound Gel B Braun 30ml Tube 6.30 Apply 3-5mm directly to wound bed Can be warmed to body temperature before use For use to moisten and cleanse wounds SUPER-ABSORBENT DRESSINGS Kerramax Care Crawford Healthcare 10cm x 10cm 10cm x 22cm 20cm x 22cm Super absorbent dressing Can be used under moderate compression Maximum of 7 Days Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 11

12 MISCELLANEOUS Sterile Gauze Swabs Premier 7.5cm x 7.5cm 10cm x 10cm Softdrape Richardson Healthcare Small Medium Large Do not apply directly to wound bed Sterile dressing pack for use when cleansing and handling wounds Single use Appeel Sterile Clinimed 5ml Straw Sachet 1.12 Single use wipes Use to remove adhesive remnants from skin Do not use if there is a known sensitivity to silicone Mefix adhesive tape Molnlycke Healthcare 2.5cm x 5m 5cm x 5m Use as indicated Micropore 3M 2.5cm x 9.14m 0.38 Use as directed First line product for bandage fixation Aderma Smith & Nephew Sheet 10cm x 10cm x 0.3cm 10cm x 10cm x 1.2cm Strip 30cm x 5cm x 0.3cm Heel Standard Extra Large Only apply to unbroken skin, should be washed with warm soapy water 12 Tissue Viability Service Tier 1 Tier 2

13 BANDAGES COMPRESSION BANDAGES - MULTILAYER K-Plus - Layer 3 Urgo 10cm x 8.7m 2.24 Third layer of 4 layer compression bandage Ensure patient is suitably assessed to have compression therapy Compression bandage to be applied by a competent Health Care Professional 50% overlap 50% stretch figure of 8 application Ko-flex - Layer 4 Urgo 10cm x 6m 2.97 Top layer of 4 layer bandage or option for use as top layer of 3 layer bandage (reduced compression) 50% overlap 50% stretch in spiral application K Two Urgo Two Layer Kit 18cm - 25cm 25cm - 32cm Maximum 1 week wear time 2 layer compression system Not to be used in arterial disease (ABPI <0.8) For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 13

14 BANDAGES COMPRESSION BANDAGES SHORT STRETCH Actico Short Stretch Padding Bandage Activa Healthcare 10cm x 6m 3.30 Must not be applied to patients of an ABPI <0.8 Under STRICT supervision with patients with diabetes K-Soft - Layer 1 Urgo 10cm x 3.5m 0.45 Apply toe to knee in a spiral application 50% over lap without any tension For ankles measuring 18cm or less apply two layers/additional pieces to protect boney prominences Conforming Bandage K-Lite - Layer 2 Urgo 10cm x 4.5m 0.98 Apply toe to knee in a spiral application 50% overlap 50% stretch (Compression therapy) Retention Bandage Comfifast Synergy Health Blue Line 7.5cm x 10m Yellow Line 10.75cm x 10m Beige 17.5cm x 10m Red 3.5cm x 1m Green 5cm x 5m Easifix BSN Medical 5cm x 4m 10cm x 4m Depending on individual patient assessment Cut required length from roll Apply joint to joint i.e. Toe to knee Apply in spiral application Retention bandage 14 Tissue Viability Service Tier 1 Tier 2

15 BANDAGES PASTE BANDAGES PB7 Viscopaste Smith & Nephew 7.5cm x 6m 3.60 Depends on individual patient Maximum 1 week Observe for contact sensitivity Icthopaste Smith & Nephew 7.5cm x 6m 3.64 Depends on individual patient Maximum 1 week Observe for contact sensitivity For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 15

16 ANTIMICROBIALS SILVER ABSORBENT DRESSING Silvercel Non adherent Systagenix 5cm x 5cm 11cm x 11cm 10cm x 20cm 2.5cm x 30cm Do not use on patients with a known sensitivity to silver, alginate or ethylene Do not use on full thickness burns or to control heavy bleeding ANTIMICROBIALS NON SILVER: Povidone iodine impregnated viscose dressing, Cadexomer paste in a protective gauze and Cadexomer powder and an antimicrobial gauze dressing coated with (DACC) dialkylcarbamoyl chloride Inadine Systagenix Wound Management 5cm x 5cm 9.5cm x 9.5cm Change 1-3 days, depending on level of exudate Do not use more than 4 dressings at the same time Do not use on pregnant and lactating women or with patients where iodine is contra-indicated Review use after one week Cutimed Sorbact BSN Medical Ltd Gauze Swab 4cm x 6cm 7cm x 9cm Pad 10cm x 10cm 10cm x 20cm Do not use in combination with ointments and creams as binding effect is impaired Antimicrobial wound layer can be used, folded or unfolded Iodoflex Smith & Nephew 5g 4.01 Should not be used on patients with known sensitivity to any of the ingredients Do not use on lactating women, people with thyroid disorders, or renal impairment Review use after 1 week Flaminal Forte Crawford Healthcare 15g 7.61 Should not be used on full thickness burns Can be used on a wide range of wound types 16 Tissue Viability Service Tier 1 Tier 2

17 ANTIMICROBIALS HONEY Activon Tube Advancis Medical 25g 2.05 Maximum of 3 days For LPT Community Staff: Tier 1 - Routinely accessible via Online Ordering Tier 2 - Link Nurse / District Nurse assessment and ordering required Tier 1 Tier 2 WOUND MANAGEMENT PRODUCTS FORMULARY 17

18 Classification of Pressure Ulceration (Adapted from EPUAP 2009 with recognition to North West Tissue Viability group) CATEGORY 1 CATEGORY 2 CATEGORY 3 Blanching redness Non blanching redness Superficial skin loss Clear blister Non blanching redness Non blanching redness Superficial skin loss Partially de- roofed blister Intact skin. Non blanching redness Usually occurs over bony prominence Individuals with dark skin, observe for additional signs e.g. warmth, oedema, pain, hardness Superficial skin loss. Pink/Red wound bed May be minimal superficial slough with healthy tissue evident May present as a clear filled blister with no discoloration underneath Full thickness tissue loss: Subcutaneous fat may be visible but bone/tendon/muscle is not exposed Depth may vary depending on anatomical location 18 Tissue Viability Service

19 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 eirf as cat 4 downgrade if appropriate once debrided. WOUND MANAGEMENT PRODUCTS FORMULARY 19

20 Notes 20 Tissue Viability Service

21 Notes WOUND MANAGEMENT PRODUCTS FORMULARY 21

22 Notes 22 Tissue Viability Service

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24 Other Useful Sources of Information: 1. BNF 2. Drug Tariff Mims for District Nurse Formulary An Educational Resource Supported by