All dressings on the formulary are for general use with the exception of those indicated for specialist prescribing

Transcription

1 Wound Management Formulary Introduction Notes for using the formulary The wound care formulary aims to provide a clinically effective, appropriate and cost effective choice of products to manage the vast majority of wounds. All dressings on the formulary are for general use with the exception of those indicated for specialist prescribing It must be emphasised that an holistic wound assessment must take place prior to choosing a dressing (see wound care guidelines) The formulary should not be used in isolation and should not replace sound clinical judgement Tissue viability nurses should be referred to as necessary ( see wound care guidelines) Dry black heels should not be re hydrated, necrosis due to arterial insufficiency should not be re-hydrated seek further advice from tissue viability team Specialist products should only be used following discussion with\assessment by tissue viability nurses It is expected that the vast majority of wound care products will be selected from this formulary. Should a product be required that is not listed the rationale for this must be supplied in writing on the exception reporting form (see appendix 1). This will aid in the updating process of the formulary. Antimicrobial products should only be used where there is an increased risk of infection or clinical signs of infection are apparent. Once an infection has resolved, treatment with an antimicrobial dressing should be stopped. Only tissue viability link nurses\district nursing sister should initiate the use of an anti-microbial or silicone dressing When prescribing dressings a maximum of 1weeks supply should be prescribed ensuring that there are sufficient dressings to last until the next evaluation regardless of the pack size. Choosing the ideal dressing There are two different categories of dressings: 1 Primary- This is in contact with the wound 2 Secondary- This is not in contact with the wound but it covers the primary dressing. When choosing a secondary dressing ensure its compatibility with the primary wound contact layer. There are many hundreds of wound products available, all having slightly different properties. The ideal wound management choice is dependent on the type, depth and colour of the wound in conjunction with the stage of healing and what the main objective of treatment is: e.g. debridement or protection. Dressing choice should be influenced by the level and type of exudates. The ideal dressing is considered to be, one that ensures optimal healing and addresses the following Maintain high humidity Removes excess wound exudates Permits thermal insulation Impermeability Gaseous exchange Non fibre shedding/nontoxic Non adhesive, comfortable and conforming Page 1 of 12

2 Care of ischemic wounds The toes and sometimes the foot can be affected by so called dry gangrene in chronic arterial insufficiency. The tissues are black shrivelled and dry. Whilst it is traditionally called gangrene there is no infective process. The tissues are undergoing spontaneous breakdown and drying. It is important that these areas, unlike other wounds, are kept dry Introducing moisture carries the risk of infection. Ideally the areas should be left exposed to the air. If a dressing is required it should be light, dry and allow circulation of air. Guidelines for Good Practice in the management of wounds Always employ an holistic approach to wound management: e.g. investigate any underlying problems (see wound care guidelines) Wounds should not be routinely cleansed (with the exception of exuding non-healing chronic wounds) Good hand hygiene must be practised at all times (see hand hygiene policy) MUST(Malnutrition Universal Screening tool) assessment must be completed and acted upon It is essential that a date be set for reassessment of the wound and that any changes in treatment following reassessment are recorded (see wound care guidelines Wounds should not be left exposed or wrapped in a dressing towel. The action of dehydration and reduction in wound temperature is detrimental to wound healing A multi-disciplinary approach must be taken in wound care A clear explanation of the action of certain types of dressing treatment must be explained to the patient Avoid layering of dressings, most products are designed as a primary dressing, use of more products only reduces the effectiveness of the product All dressings should be disposed of in accordance with clinical waste guidelines All dressings must be prescribed (with the exception of total purchase of dressings pilot sites) For any wound not progressing as anticipated consider referral to the tissue viability team (see wound care guidelines) Information and practice guidelines for the products included in the formulary Hydrocolloids Hydrocolloids can be used on a variety of wounds, including pressure ulcers, leg ulcers, surgical wounds and minor burns. They can also be used on granulating, sloughy or necrotic wounds and they can aid in the rehydration and debridement of dry sloughy and necrotic wounds. Refer to wound classification chart for wound exudates levels. Duoderm extra thin Comfeel plus transparent 5cm x 10cm 7.5cm x 7.5cm 5cm x 7cm 5cm x 15cm 5cm x 25cm 10cm x10cm 9cm x14cm 9cm x 25cm 9cm x15cm 9cm x 25cm 9cm x 35cm 15cm x15cm 15cm x 20cm 20cm x 20cm 17cm x17cm sacral Page 2 of 12

3 Hydrofibre technology Absorbs and locks away large amounts of exudate, forming a gel. Aquacel can be moistened prior to application on dry wounds. Aquacel Versiva XC (adhesive) Versiva XC (non adhesive) 5cm x 5cm 14cm x 14cm 19cm x 19cm 7.5cm x 7.5cm 11cm x 11cm 20cm x 20cm Ribbon 2cm x 45cm 4cm x 10cm 4cm x 20cm 4cm x 30cm 22cm x 22cm (heel) 18.5cm x 20.5cm (sacral) Foam Dressings Foam dressings can be used on a variety of wounds including pressure ulcers, leg ulcers, burns and surgical wounds Foams are best suited to exuding wounds and are not recommended for dry superficial wounds Saturated foam dressings can cause maceration of healthy skin if left in contact with the wound Biatain adhesive 12.5cm x 12.5cm 18cm x 18cm 18cm x 28cm 21.5cm x 12.5cm 5cm x 7cm Biatain Non-adhesive 10cm x 20cm 20cm x 20cm Mepilex should only be used when: 19cm x 20cm (heel) 23cm x 23cm (sacral) 1. Biatain, the PCT formulary first line foam dressing has been used first and for sufficient time has elapsed to determine its effectiveness. 2. Biatain is not suitable if the patient has compromised, fragile skin or experiences pain at dressing change. 3. Biatain has been used in line with manufacturer s recommendations for use, including approved methods for application and removal. Page 3 of 12 Mepilex border Mepilex border lite 7cm x 7.5cm 10cm x 12.5cm 10cm x 20cm 10cm x 30cm 4cm x 5cm 7.5cm x 7.5cm 5cm x 12.5cm 15cm x 17.5cm 17cm x 20cm 18cm x 18cm 23cm x 23cm (sacrum)

4 Alginate dressings Highly absorbent and suitable for use on exuding wounds and suitable for the promotion of autolytic debridement of debris in very moist wounds. Alginates act as a haemostatic but caution is needed because blood clots can cause the dressing to adhere to the wounds surface. Alginates should not be used if the bleeding is heavy and extreme caution is needed if used with tumours with friable tissue. Hydrogel Urgosorb 5cm x 5cm 10cm x 20cm 30cm x 30cm (Rope) Used to donate liquid to dry, sloughy wounds and to facilitate autolytic debridement of dry necrotic tissue. A secondary non-absorbent dressing is required. Cutimed 8G 15G Vapour permeable film dressing Suitable for partial thickness wounds with minimal exudate Most commonly used as a secondary dressing over an alginate or hydrogel Can also be used to protect the skin in patients at risk from developing minor skin damage as a result of friction C-View 6cm x 7cm 10cm x 12cm 15cm x 20cm Island dressing with integral absorbent pad Usually indicated in the management of a secondary dressing over a primary dressing or as a primary dressing. Soft Pore Low/non adherent dressings 6cm x 7cm 10cm x 15cm 10cm x 20cm 10cm x 25cm 10cm x 30cm 10cm x 35cm Tricotex 9.5cm x 9.5cm Solvaline N 5cm x 5cm 10cm x 20cm Page 4 of 12

5 Urgotul 11cm x 11cm 10cm x 40cm 16cm x 21cm Mepitel 5cm x 7cm 8cm x 10cm 12cm x 15cm 20cm x 32cm Absorbant dressings Highly exuding difficult to manage wounds Eclypse (not to be used under compression) 20cm x 30cm 40cm x 60cm Skin Protectant The Cavilon range of products provides a barrier in various presentations. Cavilon cream has the added benefit of being not only a barrier but also a moisturiser, and if used sparingly adhesive dressings can be applied over the top of it Cavilon no sting barrier cream (can increase adherence of some adhesive products therefore avoid under adhesive products in people with fragile skin) Cavilon no sting barrier film 2g sachet (20 sachets) 28g tube 92g tube 1ml foam applicator 3ml foam applicator 28ml pump action spray. Page 5 of 12

6 Anti-microbial dressings Anti-microbial dressings should be used in conjunction with wound care guidelines and MUST be reviewed after 2 weeks. Silver based products Aquacel Ag Biatain ag non adhesive Biatain ag adhesive Urgotul SSD 5cm x 5cm 20cm x 30cm 5cm x 7cm 5cm x 8cm cavity 10cm x 20cm 20cm x 20cm 12.5cmx12.5cm 18cmx18cm 23cmx23cm sacral 19cmx20cm Heel 11cm x 11cm 16cm x 21cm Ribbon 2cm x 45cm 4cm x 10cm 4cm x 20cm 4cm x 30cm Iodine based products Before using products with an iodine base refer to BNF for guidance Iodoflex (paste) Should not be used for more than 12 weeks. Inadine 5g 10g 17g 5cm x 5cm 9.5cm x 9.5cm Honey based products Have a wide variety of supporting benefits including the management of chronic wounds including the reduction of malodour (anti microbial activity) anti-inflammatory activity and the stimulation of healing. Activon Tulle Activon tube Algivon Actilite 5cm x 5cm 10cm x10cm 25g 5cm x 5cm 10cm x 20cm 20cm x 20cm Page 6 of 12

7 Tape Clinipore tape 1.25cm x 5m 2.5cm x 5m 5cm x 5m Retention bandage K-band 5cm x 4m 7cm x 4m 10cm x 4m 15cm x 4m K-lite 10cm x 4.5m Acti-Fast Elasticated Viscose Stockinette Red Green Blue Yellow Beige 1m x 3.5cm 10m x 3.5cm 1m x 5cm 3m x 5cm 5m x 5cm 10m x 5cm 1m x 7.5cm 3m x 7.5cm 5m x 7.5cm 10m x 7.5cm 1m x 10.75cm 3m x 10.75cm 5m x 10.75cm 10m x 10.75cm 1m x 17.5cm 10m x 17.5cm Compression therapy MUST NOT be used without a full leg ulcer assessment including Doppler assessment (see leg ulcer guidelines K-four K-soft K-lite 10cm x 3.5m 10cm x 4.5m 10cm x 4.5m 15cm x 4.5m Page 7 of 12

8 K-plus Ko-flex cohesive bandage Actico cohesive short stretch bandage system 10cm x 8.7m 10cm x 10.25m 10cm x 6m 10cm x 7m 10cm x 6m For initiation by Tissue Viability Specialist only Sorbion S, Promogram prisma Cutimed Sorbact Acticoat absorbant K2 compression bandage system Larvae E VAC Non Formulary Exception Reporting Form To be completed when a non-formulary product is to be used. This will help monitor the appropriateness of the present formulary and influence future decision-making. Patient ID Number:.. Organisation: GP Practice Tick all that apply Type of Wound Wound bed Wound depth Exudate levels Aim of treatment description Skin Tear/ Epithelialising Superficial Dry Protection Laceration Surgical Granulating Shallow Minimal Warm moist Environment Pressure Sloughy Cavity Moderate Rehydration Ulcer Venous Ulcer Critically Colonised Deep cavity Heavy Desloughing Arterial Ulcer Infected Sinus Absorption Diabetic Necrotic Odour control Ulcer Other Fungating Anti-microbial effect Page 8 of 12

9 Current s in use Formulary s Used Duration used Reasons discontinued/not suitable (Continued overleaf) Information relating to non-formulary products use Name of product chosen Time used Rationale for choice Did this product achieve the aims that were highlighted in the rationale for choice? Yes No If no please give reasons Page 9 of 12

10 Name of person submitting this report Base/Hospital Contact number Date.. Signature and Designation Please return completed forms to Tissue Viability Nurses Page 10 of 12

11 Treatment choice without a cavity Treatment choice with a cavity Necrotic Sloughy Granulating Epithelialising Infected Fungating Malodorous Debride Remove Eschar Remove slough Provide clean base for granulation tissue Promote granulation Provide healthy base for epithelialisation Promote epithelialisation and wound maturation Manage infection Manage complex wound e.g. bleeding, exudates, malodour, size, site Primary & Secondary dressing Primary & Secondary dressing Primary & Secondary dressing Primary & Secondary dressing Primary & Secodary dressing Primary & Secondary dressing Low exudate Hydrogel Moistened hydrofibre Hydrocolloid Island dressing\film Primary dressing, hydrogel moistened hydrofibre hydrocolloid, foam (not with gel) island dressing Hydrofibre Hydrocolloid, foam Take a wound swab to determine sensitivity Anti-microbial Urgotul, Island dressing\ foam, Versiva xc Medium exudate Hydrofibre, alginate hydrocolloid or foam Versiva Xc Hydrofibre, alginate hydrocolloid, foam, Versiva xc Foam, Versiva Xc Anti-microbial Hydrofibre, skin protectant, foam Versiva xc High exudate Low exudate Medium exudate High exudate Hydrofibre, alginate. Secondary dressing Foam Versiva Xc Hydrogel Moistened hydrofibre Hydrocolloid, island dressing\film Hydrofibre, alginate, hydrocolloid, foam, Versiva xc Hydrofibre,, alginate, Foam, versiva Xc Hydrofibre, alginate Foam, Versiva Xc Hydrocolloid, Hydrogel moistened hydrofibre, foam, film dressing \island dressing (not with gel) Hydrofibre, alginate, foam, hydrocolloid (depending upon exudate) foam, Versiva Xc Primary dressing Hydrofibre, foam (depending upon exudate) Versiva Xc Hydrofibre, alginate Foam, Versiva Xc Anti-microbial Hydrocolloid, Foam foam Anti-microbial foam, may require Hydrofibre, alginate depending upon exudate Should not occur in clean granulating wounds Foam island, dressing Should not occur in clean epithelialising wounds Anti-microbial Anti-microbial Hydrofibre, foam, Versiva xc absorbant Consider anti-microbial or charcoal dressing if malodorous Urgotul foam Island dressing dressing Hydrofibre, alginate, foam. Versiva Xc Consider anti-microbial /charcoal dressing if malodorous Primary Hydrofibre alginate Foam, Versiva xc Consider anti-microbial or charcoal dressing if malodorous Page 11 of 12

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