WOUND HEALING PRODUCTS Formulary and sWoundHealingFormulWOUND HEALING PRODUCTS Formulary and Guidelines ... Dressings listed in Table 2 are only available if authorised by the CNS

WOUNDHEALINGPRODUCTSFormularyandGuidelines2012WoundHealingGroupAneurinBevanUniversityHealthBoardThisGuidelines/Formularyisavailableonlineat:www.gpmtc.wales.nhs.uk

TheuseofwoundhealingproductsinbolditalicsarerestrictedandrequireauthorizationseeTABLES1to3AneurinBevanUniversityHealthBoardWoundHealingGuidelines&FormularyFOURTHEDITIONMay2012(RevisedNov2013)Reviewdate:2015 2

Contents

A.IntroductionPage3B.WoundManagementGuidelinesPage46C.FormularyPage714D.GuidanceontheuseofSilverDressingsPage15E.GuidanceontheuseofSiliconedressingsPage16F.GuidanceontheuseofTNPPage17G.ReferencesandFurtherGuidancePage18H.WoundHealingProductsPage19I.CNSTissueViabilitycontactdetailsPage20

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A.INTRODUCTIONThis formulary provides information on a definitive list of dressings which will beavailablewithin theAneurinBevanUniversityHealthBoardandprovidesguidanceontheiruse.ThisisacollaborativedocumentacrossPrimaryandSecondaryCare.The information has been collated by themembers of theWound FormularyGroupwhosemembersincludethefollowing:DrRichardGoodwin ChairConsultantDermatologistJayneWarren CNSTissueViabilityTraceyMorgan CNSTissueViabilityAlisonChandler CNSTissueViabilityLizJeffreys FootandAnkleNurseSpecialistTrevorBatt PrincipalPharmacistFormulary/InterfaceCharmaineJuniper PrescribingSupportPharmacistCaerphillyLocalityTraceyHutchings CNSVascularSurgeryTheresaMaclean PharmacistRGHGaynorSlocombe PodiatristLizFreeman CNSDermatologyThereareawiderangeofproducts included intheformularywhichareappropriatefor specific stagesofwoundhealing. Inexceptional circumstanceswhere a suitabledressing cannot be found on the Formulary an application for dressings orwoundproductsnot listedcanbemadevia thechairmanof theWoundHealingGroup,Dr.RichardGoodwinConsultantDermatologist,orinhisabsenceaCNSinTissueViability.N.B.Dressings listed inTable2areonlyavailable ifauthorisedbytheCNSTissueViabilityor Community Band 7+. All woundsmust be assessed and an authorisation formcompletedpriortoapplicationandplacedinpatientsnotes.DressingslistedinTable3areonlyavailableifauthorisedbyCNSinTissueViabilityandanauthorisationformiscompletedpriortoapplicationandplacedinpatientsnotes

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B.WOUNDMANAGEMENTGUIDELINESTheseguidelineshavebeenwrittentoassiststaffinthemanagementofwounds.Itisfundamentaltowoundmanagementthatathoroughassessmentofeachpatientisundertakenpriortodevelopingamanagementplanforanywound.Theaimsandobjectivesoftheseguidelinesare:

Patientassessment

Woundassessment

Treatment/DressingSelection

Patientadvocate

Recordinginformation

Reviewdate

Patientdischargeinformation

PatientAssessment

Thisshouldcomprise:

Chronicdisease

Nutritionalstatus

Immunestatus

Age

Psychologicalstatus

Smoking

Currentandrelevantpreviousmedication

Relevantbloods

SocialFactors

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WoundAssessment

Thisshouldinclude: Previoushistoryand treatmentobtained from thepatient ifnot recorded in

thenotesorreferralletter Wound aetiology Vascular assessment including Ankle Brachial Pressure

Index.Neurological assessmentwhere possible to establish the presence ofneuropathy.Itisparamountthatallpossiblecausativefactorsareinvestigatedandifnecessaryanappropriatereferralismadetotherelevantspecialism

Number,sizeandlocationofallwounds. PressureUlcerGradeEPUAP(2009) Typeandappearanceofwound,e.g.colour,tissue,exudateetc Patientsnormalrestingpositioninrelationtothewounde.g.legelevation Pain The alleviation of pain should be promptly addressed and carefully

monitored. AppearanceofsurroundingskinSkinCareEmollients(suchasemulsifying

ointmentBP)areusedtoincreaseskinhydrationandtohelppreventthedevelopmentofeczemaanddrycracksandfissuresonfeet.SeeABHBMedicinesFormularyforfurtherinformationonspecificemollientchoices.

WaterlowAssessment. SkinBundleimplementedifindicated. WoundChartcompleted.

Treatment/DressingSelection

ReferencetotheWoundHealingGroupFormularyisessential.Forproductsintable2and3pleasecontactappropriatepersonnel

To optimise healing in the majority of wounds a moist environment is

desirable. This encourages the breakdown of fibrin and dead tissue andpreventstissuedehydration.Italsopromotestheinteractionofgrowthfactorswhich results in formation of new capillaries and new granulation tissue.However patients with Peripheral Vascular Disease with wounds on theirextremities should not be treated with autolytic debriding agents. THESEWOUNDSSHOULDBEKEPTDRY

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There is no such thing as an ideal dressing. Dressing selected should include thefollowingcharacteristics:

Maintainamoistenvironment

Adequatelymanageexcessexudate

Allowgaseousexchange

Providethermalinsulationandmechanicalprotection

Nonallergicandnonsensitising

Impermeabletomicroorganisms

Acceptabletopatientandpainminimising

Clinically/costeffective

Noninflammable

Nonadherent

Patientengagementandcommunication

Thisisakeyroleforanyhealthprofessionaltreatingapatient.Anexplanationofthenatureandtypeofwound,andtheexpectedactionsoftheselecteddressingshouldbe conveyed to the patient. It is essential to obtain informed consent from thepatientor their legalrepresentativeprior toany intervention.Thismustbeclearlydocumented in thepatients records. Itmustbe clear that the treatmentoptions,expectedoutcomes,anypossibleadverseeventsandalternativestothesuggestedtreatmentareexplainedandunderstoodbythepatientortheirlegalrepresentative.It is essential that the level of concordance of the patient to a proposedtreatment/managementplanisestablishedasthiswillinfluencetheeffectivenessoftheplan.

RecordingInformation

TheABHBWoundManagementChartshouldbecompletedtorecordallinformationrelating towoundmanagement. It isa legal requirement thatall interventionsarefullydocumentedinthepatientstreatmentrecorde.g.medicalnotes,nursingnotesorpatientrecords.

ReviewDateAdateforreassessmentshouldbeagreedwiththenurse/doctor.

PatientDischargeInformation

Ifapatientisadmittedtoordischargedfromhospitalwithawound,instructionsshouldbeprovidedontheplanofcareandawoundchartcompleted.

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C.FORMULARYToassist in thecorrectselectionofwounddressing this formularyhasbeendesignedaroundthetypeofwoundratherthan individualdressings.Afterreadingthe WoundManagementGuidelinestheclinicianshouldconsulttheformularysection.Note:Productslistedinbolditalicsareforrestricteduseonly.Woundtypeclassifications:

1.InflamedFoot

2.EpithelialisingWounds

2.1Superficial,clean,lowexudate2.2Clean,withmediumexudate

3.GranulatingWounds

3.1Clean,surgicalwoundswithtissueloss3.2Chronicwoundswithlow/moderateexudate3.3Chronicopenwoundswithmoderate/highexudate3.4Chroniccavitywounds

4.Woundswithslough

4.1Dry4.2Moist4.3Cavities

5.BlackNecroticWounds

5.1Superficial4.2Extensiveanddeep

6.InfectedandMalodorousWounds

6.1Shallow6.2Cavities6.3Heavyexudate6.4Malodorous

7.Miscellaneous

7.1Miscellaneousforgeneraluse7.2Miscellaneousforrestricteduse

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1.InflamedFootListedbelowareseveralcommonlyseencausesofthiscondition: Cellulitis(Infection) Eczema can cause a similar appearance (i.e. from venous stasisor contact

sensitivitytodressings) Venoushypertension Ischaemia

Cellulitis is usually preceded 6 to 12 hours by a feeling ofmalaise and flulikesymptoms,withorwithoutpyrexia.Therednesswilloftenspreadvisiblyover24hours.BloodtestsforelevatedCRP,ESRandWhiteCellcountshouldbetaken.Treatmentrequiressystemicantibioticsandlegelevation.Thisconditionisrarelybilateralandotherconditionsshouldbeconsidered.

Eczemaonthefootorlowerlegmaysometimeslookverysimilartocellulitis,butdoes not cause symptoms of malaise or pyrexia. It is commonly caused byvenous stasis. Occasionally an allergic contact dermatitis to topically appliedmedications,dressingsorbandagesmaybe responsible.Treatmentofeczemarequires leg elevation and or compression bandaging as well as topicalemollients and topical steroid. If allergic contact dermatitis is suspected thenpatchtestswillberequiredtodetermineexactlywhichproductisresponsible.

VenousHypertensionmayhaveasimilarpresentationtocellulitisandcanpresentbilaterally. If the patients general medical condition permits, compressiontherapyshouldbeconsidered.

Ischaemiaclassicallypresentsasverypainful(RestPainonelevation)andabsentfootpulses.

Theuseofwoundhealingproductsinbolditalicsare