Lancashire Care NHS Foundation Trust Wound Care Formulary ... · Wound contact Hydrocolloid or...
Transcript of Lancashire Care NHS Foundation Trust Wound Care Formulary ... · Wound contact Hydrocolloid or...
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Lancashire Care NHS Foundation Trust Wound Care Formulary
Version 5.0 (July 2019)
Wound Bed Example Depth Aim Choice Low - mod
exudate Mod - High
exudate
Post op wound or sutures / strips
Superficial
Protect
Simple post op island dressing
Consider cause - ? refer
Pink (Epithelialising)
Superficial
Protect
Wound contact layer or Hydrocolloid or Island dressing
Foam Dressing / Wound Contact + Absorbent pad
Red (Granulating)
Superficial Absorb / Protect
Foam or Wound Contact layer + Absorbent Pad
Wound Contact layer + Absorbent Pad
Red (Granulating)
Deep / Cavity
Absorb / Protect
Alginate / gelling fibre as filler + Foam or Absorbent Pad
Alginate / gelling fibre as filler + Foam or Absorbent Pad
Yellow (Sloughy)
Superficial Remove slough
Honey + Foam or Absorbent Pad
Alginate / gelling fibre + Foam or Absorbent Pad
Yellow (Sloughy)
Deep / Cavity
Remove slough
Alginate / honey as filler + Foam or Absorbent Pad
Alginate / gelling fibre as filler + Foam or Absorbent Pad
Black (Necrotic / Eschar)
Caution –not suitable to debride. Never debride black stable eschar from lower limb without seeking specialist advice. In heel / foot pressure ulcers, this may serve as the body’s natural protection and should not be removed. Consider use of Inadine strips around the wound edge to protect healthy skin from non-viable tissue
If appropriate wound for debridement consider speed of debridement (to reduce risk of infection). Conservative sharp (by trained Podiatrist / TVN; Autolytic (hydrogel / hydrocolloid) or Larvae (via TVN)
Clinically Infected
Superficial or deep
Reduce bacteria in wound
Wound swab + Oral antibiotics + antimicrobial dressing. Change to alternative antimicrobial if no improvement. Ensure observations for sepsis are in place
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Previous formulary changes
Version Date Additions Deletions Amendments
4 March 2017
4.1 July 2017 Zetuvit Plus
4.2 October 2017 Urgo K Two (Southport & Formby trained staff)
Promogran Cast re-lining Kerralite Cool (18x12.5cm)
Corrections to sizes Zetuvit Plus (red)
4.3 December 2017
Premier Pad Zetuvit E Sterile
Povitulle (replacing Inadine)
Inadine (replaced by Povitulle)
Iodosorb Powder (for cavities)
4.3a (amended)
January 2018 Inadine
Povitulle
Supply issue with Povitulle
4.4 May 2018
Kytocel Suprasorb x +PHMB Change of
antimicrobial
Melolite (Sterile) Advazorb Silfix
Liquiband flow control
Liquiband Optima
Prontosan 350ml
Code for Supply Chain added
4.5 July 2018
Juzo ACS wrap Mediven harmony arm sleeve
Juzo Expert MTM Jobst Bella Light
Dressings packs EHC 2883, 2884, 2885, EHC2913
Mediven Elegance
Mediven for men
4.6 September 2018 Xupad dressings Premier Pad dressings
4.7 January 2019 Liquiband Optima Liquiband flow control
Kendall AMD 20x20 FP10 only
Liquiband Optima code updated
5.0 June 2019
365 wound closure strips Activheal Silicone Contact Layer Opsite film and Opsite film + pad Medihoney apinate ProDerma Foam (FP10 only) ProDerma Ointment (FP10 only)
Steristrips Kendall AMD Adaptic touch silicone contact layer Hydrofilm Leukomed T Algivon Proshield spray (FP10 only) Proshield Ointment (FP10 only)
Multiple changes to product groups to align to National
groups of products. Some products &
product sizes (rarely used) have
been removed
Urgo KTwo now available via Supply
Chain
Originally Produced by the Tissue Viability Team & Non-Medical Prescribing Lead
of Lancashire Care Foundation Trust.
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Contents
New - Colour Guide to Wound Dressing Selection Introduction 4
Section 1– Dressing Packs 5 Dressing Packs 5
Section 2 – Dressings and Irrigation 5 Irrigation Simple Adhesive Island Dressings / Films (+pads) 5 Securing Cannulae / lines 6 Wound Closure Strips 6 Wound Contact Layers / Low Adherence Dressings 6 Absorbent / Superabsorbent dressings 7 Film dressings 7 Foams: non adhesive 8 Foams: Adhesive 8 Foams: Silicone Adhesive 8 Hydrogels 9 Hydrocolloids 9
Alginates / Gelling fibres 9 Antimicrobial Dressings 10 Odour Absorbing Dressings 10
Section 3 – Other Wound Care Products 11 Barrier Films & Creams - for peri-wound management only (Community) 11
Tapes 11 Medicated Bandaging 11 Tubular Bandages 12 Simple Bandages 12 Stockinette 12 Compression Bandages (40mmHg compression) 13 Hosiery Kits (40mmHg compression) for treating leg ulcers 13
Section 4 – Compression Hosiery & Applicators 14 Maintenance Hosiery for prevention of leg ulcers 14 Applicators 14
Section 5– Specialist Products 15 Specialist products (only via TVN referral) 15
Index 16
Exception Reporting form 17
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Introduction
This wound care formulary is your guide to information regarding management of wounds in daily practice. The Trust has a statutory obligation to provide clinical and cost-effective wound care treatments for the population covered by LCFT. By adhering to products contained within the formulary, practitioners will provide clinically and cost effective treatment to manage the vast majority of wounds. Products represent 1st choice in terms of clinical and cost effectiveness. Practitioners are encouraged to consider these products first and provide rationale for using alternatives. The formulary products have been RAG rated, as follows:
Green – Universally available to appropriately trained staff
Amber- should not be stocked routinely but are available on request
Red- highly specialist / high cost products.
When a non-formulary item is prescribed an exception form must be completed and returned (see page 16). Please also refer to the following LCFT guidelines:
Clinical Wound Management guidelines
Pressure Ulcer guidelines
Lower Limb guidelines Ordering Key: Prices shown are from NHS Supply Chain catalogue
Green Universally available
to appropriately trained staff
Amber Available but not routinely stocked
Red highly specialist / high cost products
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Section 1: Dressing Packs ** Please order Dressing Packs from usual supplies Requisition Point
not from community dressings requisition point **
Product Size NHS Code Unit Cost Pack Size
365 Healthcare 365 Wound Dressing Pack With small gloves EHC3256 £0.40 80
365 Wound Dressing Pack With medium gloves EHC3257 £0.40 80
365 Wound Dressing Pack With large gloves EHC3258 £0.40 80
365 Supplementary/minor procedure pack (swabs, gloves and bag)
With medium gloves EHC2913 £0.29 80
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Section 2: Dressings
NB: All remaining products to be ordered from
Community Dressings Requisition Point for Central Lancs / BwD/ Southport (other than FP10 only products)
Irrigation Use warm saline for irrigation
Product Size NHS Code Unit Cost Pack Size
Crest
Saline Pod 20mls MRB1140 £0.11 25
Simple Adhesive Island Dressing Use as a protective primary dressing for surgical closed wounds or minor wounds
Product Size NHS Code Unit Cost Pack Size
Richardson
Softpore 6cm x 7cm EIJ023 £0.04 60
Softpore 10cm x 10cm EIJ013 £0.06 50
Softpore 10cm x 15cm EIJ014 £0.09 50
Softpore 10cm x 20cm EIJ024 £0.12 30
Softpore 10cm x 30cm EIJ026 £0.18 30
Smith and Nephew
Opsite Post op 5cm x 6.5cm (wcp 2.5cm x 4cm)
ELW052 0.06 100
Opsite Post op 8.5cm x 9.5cm (wcp 3.5cm x 7.5cm)
ELW051 0.14 20
Opsite Post op 10cm x 25cm (wcp 5.5cm x 20cm)
ELW092 0.35 20
Opsite Post op 10cm x 30cm (wcp 5.5cm x 25cm)
ELW045 0.45 20
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Products for Securing Cannula/Lines
Product Size NHS Code Unit Cost Pack Size
To secure subcutaneous lines for syringe drivers
Smith and Nephew
Opsite flexigrid 10cm x 12cm ELW325 £0.16 50
To secure central lines, PICC lines etc
Aquilant
IV3000 Central Line 10cm x 12cm ELW054 £1.24 50
To secure IV peripheral lines
3M
Tegaderm IV Peripheral Line
7cm x 8.5cm ELW056 £0.14 100
Wound Closure Strips
Product Size NHS Code Unit Cost Pack Size
365 Healthcare
Wound Closure Strip 6 x 38mm x 6 strips EIR125 £0.09 50
Wound Closure strip 3 x 75mm x 5 strips EIR126 £0.08 50
Wound Contact Layers / Low-Adherence Indicated for use as a wound contact layer for low exuding and granulating wounds
Product Size NHS Code
Unit Cost
Pack Size
Hartmann
Atrauman 7.5cm x 10cm EKA032 £0.19 10 Basic first line low adherence Atrauman 10cm x 20cm EKA036 £0.38 30
Systagenix
N-A dressing 9.5cm x 9.5cm EKG011 £0.25 40 Suitable for wounds which should be kept
dry N-A dressing 19cm x 9.5cm EKG013 £0.60 25
Advanced Medical Solutions
Activheal silicone wound contact layer
5cm x 7cm ELA849 £0.84 10 For use under Topical Negative Pressure and
for a non adherent dressing in painful
wounds
Activheal silicone wound contact layer
10cm x 10cm ELA835 £1.50 10
Activheal silicone wound contact layer
10cm x 20cm ELA836 £3.94 10
Simple non-adhesive: Podiatry use H&R Healthcare
Melolite 5cm x 7.5cm EJE171 £0.06 100
Melolin 5cm x 5cm EJE011 £0.12 100
Melolin 10cm x 10cm EJE013 £0.29 100
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Absorbent Dressings / Superabsorbent Dressings For use on exuding wounds.
For highly exuding wounds where exudate is not contained with absorbent dressing Then step up to use super-absorbent. Step down as exudate reduces.
Product Size NHS Code
Unit Cost
Pack Size
1st line – use Xupad
Xupad 10cm x 12cm EJA092 £0.07 25 Low to moderate absorbency Xupad 10cm x 20cm EJA093 £0.09 25
Xupad 20cm x 20cm EJA094 £0.12 15
Xupad 20cm x 40cm EJA095 £0.24 8
If Xupad not suitable and regular absorbent pad required use Zetuvit E via FP10
Zetuvit E Sterile 10cm x 12cm
FP10 only
Low to Moderate
absorbency Zetuvit E Sterile 10cm x 20cm
Zetuvit E Sterile 20cm x 20cm
Zetuvit E Sterile 20cm x 40cm
If Xupad / Zetuvit E not absorbent enough then step up to Kliniderm Super Absorbent
Kliniderm Super Absorbent
7.5cm x 7.5cm EKH071 £0.28 50 For managing high to very highly
exuding wounds Kliniderm Super Absorbent
10cm x 10cm EKH072 £0.39 50
Kliniderm Super Absorbent
10cm x 20cm EKH073 £0.56 50
Use Zetuvit Plus (for larger wounds or where greater conformability is required)
Zetuvit Plus 10cm x 20cm EME047 £0.79 10 For very high exuding wounds –
step down as exudate reduces
Zetuvit Plus 15cm x 20cm EME048 £0.85 10
Zetuvit Plus 20cm x 25cm EME049 £1.92 10
Zetuvit Plus 20cm x 40cm EME128 £1.92 10
Films Films are non-absorbent wound contact layers which can also be used to retain some
dressings
Product Size NHS Code
Unit Cost
Pack Size
Smith and Nephew For use as a primary dressing on very low exudate wound or as a secondary dressing
to secure
Opsite Flexigrid 6cm x 7cm ELW322 £0.07 100
Opsite Flexigrid 10cm x 12cm ELW325 £0.16 50
Opsite Flexigrid 15cm x 20cm ELW327 £0.48 10
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Foams: Non-Adhesive
Product Size NHS Code
Unit Cost
Pack Size
Advanced Medical Solutions (1st line)
ActivHeal Foam Non-Adhesive
5cm x 5cm ELA214 £0.77 10 Foams are best suited to wounds with a medium
level of exudate. Use of shaped
foams is discouraged
ActivHeal Foam Non-Adhesive
10cm x 10cm ELA216 £1.41 10
ActivHeal Foam Non-Adhesive
10cm x 20cm ELA246 £2.06 10
ActivHeal Foam Non-Adhesive
20cm x 20cm ELA218 £3.62 10
ActivHeal Foam Heel
18cm x 12cm (Heel)
ELM160 £3.94 5
Foams: Adhesive
Product Size NHS Code
Unit Cost
Pack Size
Advanced Medical Solutions
ActivHeal Foam Adhesive 7.5cm x 7.5cm ELM161 £1.07 10 Foams are best suited to wounds
with a medium level of exudate.
Use of shaped foams is
discouraged.
ActivHeal Foam Adhesive 10cm x 10cm ELA210 £1.19 10
ActivHeal Foam Adhesive 12.5cm x 12.5cm ELA211 £1.52 10
ActivHeal Foam Adhesive 15cm x 15cm ELA212 £1.92 10
ActivHeal Foam Adhesive 20cm x 20cm ELA213 £3.05 10
Foams: Silicone Adhesive
Product Size NHS Code
Unit Cost
Pack Size
Aria
Kliniderm Silicone Foam Adhesive
7.5cm x 7.5cm ELA741 £1.30 5 Use of a silicone foam will reduce
absorbency. This should be reserved for those patients
with fragile skin and /or those who
experience pain from removal of adhesive foams.
Kliniderm Silicone Foam Adhesive
10cm x 10cm ELA742 £1.79 5
Kliniderm Silicone Foam Adhesive
15cm x 15cm ELA744 £3.61 5
Kliniderm Silicone Foam Adhesive
10cm x 20cm ELA745 £3.37 5
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Hydrogels Note: Patients with wounds to the lower limb must have their vascular status assessed
by obtaining an ABPI/TBPI using a Doppler, prior to any dressing regime involving debridement.
Product Size NHS Code
Unit Cost
Pack Size Indications
Advanced Medical Solutions Use on dry and necrotic wounds to
rehydrate the necrosis and aid
autolysis if aim is to remove necrosis
ActivHeal Hydrogel 8g ELA639 £1.05 10
Crawford Health
Kerralite Cool 6cm x 6cm EME081 £1.91 5
Kerralite Cool 12cm x 8.5cm EME082 £2.80 5
Hydrocolloids
Note: Patients with wounds to the lower limb must have their vascular status assessed by obtaining an ABPI/TBPI using a Doppler, prior to any dressing regime involving
debridement.
Product Size NHS Code
Unit Cost
Pack Size Indications
Convatec Wounds with low to medium exudate levels. They should NOT be used on diabetic foot ulcers without seeking specialist advice.
DuoDerm Extra Thin 7.5cm x 7.5cm ELM311 £0.74 5
DuoDerm Extra Thin 10cm x 10cm ELM050 £1.21 10
DuoDerm Extra Thin 15cm x 15cm ELM051 £2.64 10
3M Healthcare Ltd
Tegaderm Hydrocolloid 10cm x 10cm ELM087 £2.21 5
Tegaderm Hydrocolloid 10cm x 12cm – Oval
ELM084 £2.07 5
Tegaderm Hydrocolloid 13cm x 15cm – Oval
ELM373 £4.08 5
Alginates / Gelling Fibre
Product Size NHS Code
Unit Cost
Pack Size Indications
Advanced Medical Solutions for review Use as a filler in medium to high
exuding wounds to absorb exudate.
Gelling fibre are more suitable for
high exudate wound
ActivHeal Alginate 5cm x 5cm ELS139 £0.57 10
ActivHeal Alginate 10cm x 10cm ELS140 £1.08 10
ActivHeal Alginate 10cm x 20cm ELS141 £2.77 5
ActivHeal Alginate 2cm x 30cm (rope)
ELS142 £1.75 5
Convatec
Aquacel Extra 5cm x 5cm ELY377 £0.92 10
Aquacel Extra 10cm x 10cm ELY378 £2.21 10
Aquacel Extra 15cm x 15cm ELY379 £4.07 5
Aquacel Ribbon 1cm x 45cm (rope)
ELY368 £1.82 5
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Antimicrobial Dressings Limit use to 2 weeks treatment and then review.
Product Size NHS Code
Unit Cost
Pack Size Indications
Advancis (1st line)
Actilite 5cm x 5cm EJE079 £0.61 10 Mild antimicrobial –
low exudate Actilite 10cm x 10cm EJE042 £1.04 10
Actilite 10cm x 20cm EJE040 £2.03 10
Dermasciences
Medihoney apinate 5cm x 5cm EJE076 £1.80 5 Suitable for moderate to high
exudate Medihoney apinate 10cm x 10cm EJE000 £3.18 5
Advanced Medical Solutions Activon Tube 25g ELZ069 £1.85 12 Low exudate
(tube can be used for up to 28 days when open - for individual patient use) BSN Medical
Cutimed Sorbact Ribbon 2cm x 50cm ELY218 £4.20 20 Traps bacteria within dressing Cutimed Sorbact Swabs 4cm x 6cm ELY212 £1.93 5
Cutimed Sorbact Swabs 7cm x 9cm ELY213 £3.13 5
Aspen Medical
Kytocel 5cm x 5cm ELY712 £0.85 10 Mild antimicrobial Kytocel 10cm x 10cm ELY707 £2.06 10
Kytocel 15cm x 15cm ELY708 £3.80 10
Kytocel 4cm x 20cm ELY710 £1.45 10
Kytocel Ribbon 2.5cm x 45cm ELY774 £1.94 10
Inadine - First 48hrs post trauma or Podiatry recommendations only: Note: 1 – 3 days max wear time
Acelity
Inadine 5cm x 5cm EKB501 £0.41 25 1-3 days maximum wear time- short
acting Inadine 10cm x 10cm EKB095 £0.59 10
S & N Health
Iodosorb Ointment 10g EKB012 £5.38 4 Effective treatment of bacteria &
biofilms
Iodosorb Powder 3g Sachet EKB010 £2.49 7
Odour Absorbing
Product Size NHS Code Unit Cost
Pack Size
Indications
CliniMed For use as a deodoriser for a
variety of wounds Clinisorb 10cm x 10cm ELV051 £2.12 10
Clinisorb 10cm x 20cm ELV053 £2.72 10
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Section 3: Other Wound Care Products
Barrier Films and Creams Only for use on peri-wound skin and management of moisture lesions in community. Can be ordered for moisture associated skin damage in in-patients (Mental Health and Longridge Community) For ongoing prevention of Moisture Associated Skin Damage in patients in the community, use FP10 route for supply
Product Size NHS Code Unit Cost
Pack Size
Indications
Medicare Plus International
Mediderma S Barrier Cream 28g ELY563 £3.12 1 Cream for protection of intact
skin Mediderma S Barrier Cream
90g ELY538 £9.43 1
Mediderma S Barrier Film 1ml ELY532 £0.61 5 For management of superficial broken skin
Mediderma S Barrier Film 3ml ELY533 £0.92 5
Mediderma S Barrier Film Spray
30ml ELY562 £5.65 1
Tapes
Product Size NHS Code Unit Cost
Pack Size
Clinisupplies
Clinipore 1.25cm x 9.14m EHU019 £0.14 24 Paper tape Clinipore 2.5cm x 9.14m EHU020 £0.28 12
Clinipore 5cm x 9.14m EHU021 £0.44 6
3M Healthcare Ltd
Transpore 1.25cm x 5m EHA051 £0.30 24 Plastic perforated Transpore 2.5cm x 5m EHA053 £0.54 12
Transpore 5cm x 5m EHA055 £1.20 6
Transpore 7.5cm x 10m EHA057 £1.80 4
BSN Medical
Hypafix 5cm x 10m EHR111 £1.61 1 Fabric – caution with fragile skin Hypafix 10cm x 10m EHR113 £2.45 1
Hypafix 15cm x 10m EHR031 £4.48 1
Hypafix 20cm x 10m EHR117 £4.74 1
Medicated Bandages-Available on a named patient basis only
Product Size NHS Code Unit Cost
Pack Size
S & N Health
Ichthopaste 6m x 7.5cm EFA051 £5.78 1
Viscopaste 6m x 7.5cm EFA011 £5.22 1
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Simple Bandages for Securing and Retaining dressings
Tubular Bandage To be used for the retention of dressings under bandaging and to prevent wool bandage
from causing skin irritation
Product Size NHS Code Unit Cost
Pack Size
Indications
Synergy Healthcare
Comfitube Size 1 (20m roll) EGJ055 £0.98 1 toes
Comfitube Size 12 (20m roll) EGJ056 £1.60 1 hands
Comfitube Size 56 (20m roll) EGJ058 £4.51 1 arms
Comfitube Size 78 (20m roll) EGJ039 £4.17 1 legs
Simple Bandages
Suitable for use in mental health (following risk assessment) and other settings
Product Size NHS Code Unit Cost Pack Size Indications
Urgo
K-Band 5cm x 4m
EDB034 £0.12 20 Simple retention bandage
K-Soft #1 10cm x 3.5m
EPA028 £0.56 24 Soft wool bandage for absorbency and
protection
K-Lite #2 5cm x 4.5m
ECA100 £0.76 16 Light conformable bandage for leg
wounds (used as part of compression) or
where compression is not suitable
Stockinettes
To be used for the retention of dressings/ bandages where appropriate – care should be taken to use the appropriate size for the limb
Product Size NHS Code
Unit Cost Pack Size Indications
Synergy Healthcare
Comfifast Green 5cm x 10m EGP006 £2.20 1 digits
Comfifast Blue 7.5cm x 10m EGP007 £2.35 1 Small limbs
Comfifast Yellow 10.75cm x 10m EGP008 £3.45 1 Larger limbs
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Compression Systems Ensure that holistic leg ulcer assessment has been performed and ABPI/TBPI within
normal range prior to implementing compression therapy
Product Size NHS Code
1st line for small / low exudate venous leg ulcers
Urgo
For patients without Oedema Altipress Hosiery Kit - Beige Small Size Short Length FP10 Only
Altipress Hosiery Kit - Beige Small Regular FP10 Only
Altipress Hosiery Kit - Beige Medium Short FP10 Only
Altipress Hosiery Kit - Beige Medium Regular FP10 Only
Altipress Hosiery Kit - Beige Large Short FP10 Only
Altipress Hosiery Kit - Beige Large Regular FP10 Only
BSN Medical
For patients with Oedema
Jobst Hosiery Kit Small FP10 Only
Jobst Hosiery Kit Medium FP10 Only
Jobst Hosiery Kit Large FP10 Only
Product
Size NHS Code
Unit Cost Pack Size
Activa Healthcare (Short Stretch for ankle circumference 18cm – 25cm)
Short stretch compression. Use wool bandage as Layer #1
Actico Cohesive (short stretch) toe to knee
6m EBA016 £4.25 1
For ankle circumference > 25cm use a second Actico from ankle to below knee in reverse direction
Urgo (Traditional Four Layer Compression for ankle circumference 18 – 25cm)
K-Soft #1 10cm x 3.5m EPA028 £0.56 24 Layer #1
K-Soft Long 10cm x 4.5m ECA174 £0.71 24
K-Lite #2 5cm x 4.5m ECA100 £0.76 16 Layer #2
K-Lite Long 10cm x 5.25m
ECA173 £1.30 16
K-Plus #3 10cm x 8.7m ECA162 £2.03 24 Layer #3
K-Plus Long 10cm x 10.25m
ECA172 £3.07 24
Ko-Flex #4 10cm x 6m ECD018 £3.48 18 Layer #4
Ko-Flex Long 10cm x 7m ECD028 £3.98 18
K-Three C 10cm x 3m EBA060 £3.12 24 Use K-Three C in place of layers #2
& #3 for ankle circumference >
25cm
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Product Size NHS Code Unit Cost Pack Size
URGO Two Layer Compression Systems
Also on FP10
Urgo K Two Kit 18-25cm ankle ECA152 £9.36 1
Urgo K Two Latex Free Kit 18-25cm ankle ECA236 £9.36 1
Urgo K Two Reduced Kit 18-25cm ankle ECA205 £9.14 1
Urgo K Two Reduced Latex Free 18-25cm ECA234 £9.36 1
3M Healthcare Ltd Coban 2 Comfort foam layer 10cm x 3.5m roll ECA210 £8.32 18
Coban 2 Comfort foam layer 15cm x 3.5m roll ECA211 £12.65 10
Coban 2 Compression layer 10cm x 4.5m roll ECA214 £5.36 32
Coban 2 Compression layer 15cm x 4.5m roll ECA215 £7.98 15
Coban 2 Lite Comfort foam layer 10cm x 2.7m roll ECA218 £6.49 18
Coban 2 Lite Comfort foam layer 15cm x 2.7m roll ECA219 £9.80 10
Coban 2 Lite Compression layer 10cm x 3.5m roll ECA222 £5.13 32
Coban 2 Lite Compression layer 15cm x 3.5m roll ECA223 £6.95 15
ONLY FOR USE FOLLOWING SPECIALIST ADVICE FROM LYMPHOEDEMA
Product
Sigvaris Advance – Arm sleeve FP10 Only
Haddenham Heathcare
Haddenham Microfine Toe Caps FP10 Only
Haddenham Microfibre Gloves FP10 Only
Ready Made: Sigvaris
Sigvaris Comfort Range FP10 Only
BSN Medical
Jobst Farrow Wrap FP10 Only
Made to Measure: BSN Medical Jobst Elvarex Custom Fit Range FP10 Only
Juzo Juzo ACS wrap FP10 Only
Juzo Expert MTM
Section 4: Hosiery & Applicators
Maintenance Hosiery for patients who have healed to prevent re-ulceration
Product
Ready Made: Activa hosiery – Ready made FP10 Only
Actilymph hosiery Ready made FP10 Only
Made to Measure: Actilymph hosiery– Made to measure lower limb hosiery when standard not appropriate
FP10 Only
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Applicators
Product Size NHS Code Unit Cost Pack Size
Activa Health Care
Acti-Glide Stocking Applicator One size EUE049 £16.28 1
Moore UK Ltd
Ezy-As Stocking Applicator Various FP10 Only
Section 5: Specialist Products
ONLY FOR USE FOLLOWING SPECIALIST ADVICE FROM:
Tissue Viability, Lymphoedema, Diabetic Foot MDT & “HOT FOOT” TEAM Lymphoedema/Vascular Services Only
Product Size NHS Code
Unit Cost
Pack Size
Indications
Ark Therapeutics
Flaminal Forte Gel 15g FP10 Only Sinus management
Various Suppliers
Topical Negative Pressure
Order through Tissue Viability Service/Vascular Team/Hot Foot Team only:
Eg. Renasys / Pico etc
LarvE (Zoobiotic): Order through Tissue Viability Service/Vascular Team/Hot Foot Team only
For rapid debridement
Braun
Prontosan 40ml ELY424 £0.76 4 Soak for 20 minutes
Prontosan 350ml ELY248 £4.66 10
Activa Healthcare
Debrisoft-debridement pad (not for descaling)
10cm x 10cm ELZ354 £7.11 5 Only for debridement of
wounds
For Severe Incontinence Associated Dermatitis only:
Medihoney Barrier Cream FP10 Only Where there is infection present
H & R Healthcare
Medi Derma-Pro Plus Skin Protectant
115g FP10 Only Step down to Medi Derma S when skin
recovers Medi Derma-Pro Foam & Spray Cleanser
250ml FP10 Only
For Appropriately Trained Staff in BwD Treatment Rooms & Mental Health Units Only
Advanced Medical Solutions
Liquiband optima tissue adhesive
0.5g FVF009 £6.06 10
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INDEX
Product Page Product Page Actico Cohesive 13 Kliniderm Silicone Foam Adhesive 8
Acti-Glide Stocking Applicator 15 Kliniderm Super Absorbent 7
ActivHeal Alginate 9 Kytocel 10
ActivHeal Foam products 8 LarvE (Zoobiotic) 15
ActivHeal Hydrogel Gel 9 Liquiband 15
Activheal Silicone Wound Contact Layer 6 Medi Derma-S Barrier products 11
Actilite 10 Medi Derma-Pro products 15
Actilymph hosiery 14 Medihoney apinate 10
Activa Hosiery – Ready made 14 Medihoney barrier cream 15
Activon Tube 10 Melolin 6
Altipress Hosiery Kit 13 Melolite 6
Aquacel Extra 9 NA dressing 6
Atrauman 6 Opsite Flexigrid 6,7
Clinipore 11 Opsite Post op 5
Clinisorb 10 Prontosan 15
Coban 2 Products 14 ProDerma products 15
Comfifast 12 Sigvaris Advance – Arm Sleeve 14
Comfitube 12 Sigvaris Comfort Range 14
Cutimed Sorbact 10 Softpore 5
Debrisoft 15 Tegaderm Hydrocolloid 9
Dressing packs 5 Tegaderm IV Peripheral Line 6
DuoDerm Extra Thin 9 Transpore 11
Ezy-as stocking applicator 15 Urgo K Two 14
Flaminal Forte Gel 15 Viscopaste 11
Haddenham Microfibre/Mircrofine 14 Wound Closure Strips -365 6
Hypafix 11 Xupad 7
Ichthopaste 11 Zetuvit Plus/E 7
Idosorb Ointment & Powder 10
Irrigation 5
Inadine 10
IV3000 6
Jobst Hosiery Kit 13
Jobst Elvarex Custom Fit Range 14
Jobst Farrow Wrap 14 K-Bandages (all) 12, 13
Juzo products 14
Kerralite Cool 9
17
Wound Care Formulary Exception Reporting Form
Name of formulary product not suitable
Reason
Non formulary item prescribed
Rationale for selection
Was this an acute trust request? YES NO Name of prescriber Date
Contact number
PLEASE NOTE: All Exception forms to be completed electronically and returned
to