COMMUNITY PREFERRED DRESSINGS LIST - Integrated Local Services - Including: Wound Management Guide
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Integrated
Local Services
COMMUNITY
PREFERRED DRESSINGS
LIST
Including:
Wound Management Guide
Pressure Ulcer Prevention Pathway
Moisture Associated Skin Damage Pathway
Tissue Viability Nurse contact details:
02030498855 or Gst-tr.TVNreferrals@nhs.net
Community Wound
Management Guide and
Preferred Dressing List
Key Messages
• Start at appropriate level of management depending on wound type, stage of healing and level of
exudate. Review the wound regularly and prescribe the most suitable dressing as required.
• It is expected that generally the TYPE of wound and SIZE will change over time; do not prescribe excessive
quantities or issue as long term repeats to avoid wastage and facilitate prompt review of wound.
• The sizes on the PDL are a guide and list the most commonly used dressing and sizes, Staff should use
their clinical judgment to decide when other sizes or dressing products are needed.
• To prevent excessive quantities being prescribed, it is recommended that a “dose” is written for each
dressing e.g. Granuflex 10x10cm change every 5-7 days x10
• Dressings on FP10 prescriptions should be prescribed for individual patients and not to be used as stock
items.
* Note that Silver and Honey dressings are not recommended for routine use in chronic venous leg ulcers
(SIGN guideline 120. 2010). Also the BNF (77) and NICE Key Therapeutic Topic 14 (KTT14) 2015 do not
recommend the routine use of silver for uncomplicated ulcers and acute wounds. Consult Tissue Viability
Nurses (TVNs).
WHICH Dressing?
Wound Type Aim Recommended dressing Recommended dressing
No or low exudate Moderate to high exudate
Epithelialising wound To protect area and • Low adherent dressings • Foam Non Adhesive
encourage healing. • Vapour-permeable film
• Hydrocolloid
Granulating wound To promote healing by • Hydrocolloid • Foam adhesive
encouraging • Foam adhesive • Hydrocolloid-fibrous
granulation.
Sloughy wounds To remove sloughy NO INFECTION PRESENT • Honey
tissue by autolysis and • Hydrogel • Cadexomer – Iodine
provide a clean base • Hydrocolloid
for granulation tissue. Not on diabetic/or Ischaemic feet
Necrotic wounds
To remove necrotic • Hydrogel • Cadexomer – Iodine
tissue by rehydration. • Hydrocolloid • Hydrocolloid-fibrous
Infected wounds (only if To treat infection and • Honey* • Honey*
there are clinical signs of promote wound • Cadexomer – Iodine • Cadexomer – Iodine products
infection) healing. products • Silver Dressing* (Do not use if
on antibiotics. Max 2 weeks)
Malodorous and To de-odorise wound • Low adherent dressings • Metronidazole gel**
Fungating wounds and manage infection • Metronidazole gel ** • Odour absorbent dressings
if present. • Odour absorbent dressings • Honey products
• Honey products • Hydrocolloid-fibrous
• Alginate (Kaltostat for
bleeding wound only)
**Metronidazole gel is not in
community nurses formulary.
Leg Ulcers Please refer to Treat wound type and VENOUS LEG ULCER (confirmed by Doppler reading)
Leg Ulcer Pathway stage of healing. • Compression bandaging
• Compression hosiery
ARTERIAL LEG ULCER
• Treat according to individual need
Written May 2019. Review Date: May 2022
Will only be updated in interim if there are major changes in practice or prices. For more information about the PDL,
contact Pharmacy Team CHSPharmacy2@gstt.nhs.uk) or TissueViabilityNurseSpecialists@gstt.nhs.uk
For other wound management queries visit http://gti/clinical/directorates/inpatientsservices/tissueviability/TissueViability.aspx
1 of 4
** Costs are based on Drug Tariff March 2019.
WHICH Product?
Product Size PIP Cost Prescribing Points
Codes per
dressing
Absorbent or Zetuvit E Non 10 x 10cm 328-6085 £0.07 • Non-sterile pads should be used in most
cases.
Surgical Sterile Pads 20 x 20cm 328-6101 £0.15
• Do not use Zetuvit and Xupad under
20 x 40cm 328-6119 £0.28 compression bandaging.
Pads
XuPad Sterile 10 x 12cm 360-9401 £0.15
Pads 20 x 20cm 329-1663 £0.28
20 x 40cm 329-1689 £0.40
Kliniderm 10 x 10cm 394-7132 £0.49 • Kliniderm should only be used in highly
SuperAbsorbent 10 x 15cm 394-7124 £0.69 exudating wounds.
Padding 20 x 20cm 394-7157 £1.49 Kliniderm is thin, so suitable for use
•
20 x 30cm 394-7165 £1.99 under compression bandaging.
Zetuvit Plus 10 x 10cm 356-7351 £0.83
15 x 20cm 356-7369 £1.32
Alginates Kaltostat 5 x 5cm 007-0789 £0.98 • Kaltostat is haemostatic and useful for
bleeding wounds.
7.5 x 12cm 022-7033 £2.13 Remove when bleeding stops.
•
10 x 20cm 022-7058 £4.19 • Can be used to pack cavities rather than
using KeraCel.
Antibacterial Iodosorb 10g 036-6658 £4.62 • Avoid iodine in those patients with
thyroid disorders.
and ointment 20g 033-3906 £9.25
• Cadexomer iodine – Max single
Antimicrobial Iodoflex paste 5g 073-1547 £4.19 application 50g; Max weekly application
10g 014-9617 £8.37 150g. Duration up to 3 months in any
Activon Tube 25g 319-3729 £2.77 single course treatment.
Only if there are • Honey is useful for application to
localised clinical (Honey) deep/cavity wounds.
signs of infection Activon Tulle 5 x 5cm 304-0631 £2.25 • Tulle dressings impregnated with honey
(Honey) 10 x 10cm 304-0623 £3.71 are suitable for shallow wounds. Tulle
Use for 2 weeks only dressings can be extended out to 5x15,
and revise need Algivon Plus 5 x 5cm 374-9496 £2.45 10x30.
(Honey) 10 x 10cm 374-9512 £4.20 • Algivon Plus is an alginate dressing
impregnated with honey. Do not use for
dry wounds.
.
Barrier Cavilon cream 28g 301-7480 £3.28 • Use the appropriate formulation to suit
the patient’s skin.
Cream/Skin 92g 277-1079 £6.55 Refer to GSTT moisture lesion pathway
Cavilon film 28ml 252-8966 £5.79 http://gti/resources/inpatient_services/tissueviability/
Protection
spray pressure%20ulcer%20and%20moisture%20lesion
/moisture%20lesion%20flow%20chart%20commu
Cavilon film 1ml 1ml (5’s) 252-8941 £4.05 nity%20version.pdf
stick
Compression Actico – 8cm 314-0886 £3.31 • Confirm ABPI Doppler reading before
Inelastic applying compression therapy.
bandaging 10cm 271-5431 £3.43 • Actico is a short stretch bandage suitable
12cm 314-0894 £4.38 for patients with chronic oedema and
Actico 2c kit (2 10cm 376-5203 £8.14 lymphoedema.
layer system) (18-25cm) • Application technique is more important
in achieving healing.
10cm 376-5211 £9.16 • K-Two reduced kit is for where ABPI is
(25-32cm) 30cm.
Profore #3 8.7m 258-5768 £4.03
Profore #4 2.5m 246-1671 £3.33
Written May 2019. Review Date:May 2022
Will only be updated in interim if there are major changes in practice or prices. For more information about the PDL,
contact Pharmacy Team CHSPharmacy2@gstt.nhs.uk) or TissueViabilityNurseSpecialists@gstt.nhs.uk
For other wound management queries visit http://gti/clinical/directorates/inpatientsservices/tissueviability/TissueViability.aspx
2 of 4
WHICH Product?
Product Size PIP Codes Cost Prescribing Points
per
dressing
Foams Tegaderm 10 x 11cm 304-1589 £2.39 • For light to moderately exuding wounds.
Foam • Do not cover foams with occlusive
14.3 x 304-1605 £4.28 dressings.
Adhesive 15.6cm • Tegaderm may be preferred for wounds
Kliniderm 10 x 10cm 394-7249 £1.63 in awkward areas.
Silicone with 12.5 x 12.5cm 394-7256 £2.33 • Kliniderm Silicone for patients with frail
and sensitive skin that are liable to tear.
Border 15 x 15cm 394-7264 £3.95
15 x 20cm 394-7280 £5.00
Kliniderm 5 x 5cm 394-7215 £0.95
silicone Non 10 x 10cm 394-7223 £1.95
Adhesive
Kliniderm 6 x 8.5cm 399-4126 £1.27
Foam Silicone 10 x 10cm 399-4134 £1.57
Lite 15 x 15cm 399-4142 £3.70
Hydrocolloids Granuflex 10 x 10cm 004-6359 £2.87 • Allow 2.5cm over wound edge.
• Granuflex – may smell when dressing is
15 x 15cm 004-6367 £5.45 removed.
Duoderm – 7.5 x 7.5cm 027-7798 £0.82 • Can be warmed before use to make
Extra thin 10 x 10cm 027-7897 £1.36 more malleable.
15 x 15cm 027-8036 £2.93 • Can be left in place for up to 7 days.
• Do not use on diabetic or ischemic feet.
Hydrocolloid- KerraCel 5 x 5cm 402-0517 £0.60 • For moderate to highly exuding wounds.
• Will require a secondary dressing.
fibrous 10 x 10cm 402-0525 £1.44
• Ribbons for sinus/cavity wounds – do not
15 x 15cm 402-0533 £2.71 pack too tightly.
KerraCel 2.5 x 45cm 402-0541 £1.91
Ribbon
Hydrogels Intrasite gel – 8g 210-2929 £1.85 • Hydrogels are NOT suitable for ischemic
with applicator and diabetic feet, infected or heavily
15g 004-2895 £2.48 exuding wounds.
Intrasite 10 x 10cm 267-8043 £1.85 • If a hydrogel has been used in the
conformable - (7.5g) wound prior to application or larvae,
sheet 10 x 20cm 267-8084 £2.50 ensure the wound is thoroughly
cleansed prior to larvae application.
(15g) • Hydrogel sheets – for shallow wounds
Purilon – 8g 270-1753 £1.79 and where gels may be difficult to keep
alginate 15g 242-9801 £2.33 in place.
hydrogel
Irrigating Tap Water • Tap water is preferred to soak leg ulcers
and irrigate clean wounds.
solutions Irripod 25 x 20ml 313-7155 £5.84 Prontosan is a soak, pay attention to
•
Prontosan 350ml 324-8572 £4.90 instructions for use.
solution • Prontosan to be used to remove biofilm
layer on chronic wounds and only after
discussion with the TVN.
• Review after 2 weeks.
Low adherent N-A Ultra – 9.5 x 9.5cm 230-4095 £0.34 • N-A ultra is silicone coated dressing.
contact • For use as primary dressing under
dressings 19 x 9.5cm 259-0990 £0.67 compression bandaging.
dressing • Non-adherent polyester mesh wound
Atrauman 7.5 x 10cm 369-7547 £0.35 contact layer. Suitable for fragile skin
20 x 30cm 324-8697 £2.20 that is likely to tear easily.
Moisturisers Hydromol 500g 294-1391 £4.96 • For soaking leg ulcers.
ointment • Dermol – To soak and wash infected
and soap legs for a limited time of 6 weeks, then
Hydromol Bath 500ml 317-2780 £4.46 revert to Hydromol emollient if needed.
substitutes & Shower Refer to Joint Emollient Guideline
•
http://www.lambethccg.nhs.uk/news-and-
emollient publications/meeting-papers/south-east-london-area-
Dermol 500 500ml 232-2808 prescribing-
committee/Documents/Clinical%20guidelines%20and
lotion %20pathways/1.%20SEL%20Emollient%20Guide%20
Adults%20and%20children%20June%202018.pdf
ZeroAQS 500g 362-6447 £3.29
cream
Written May 2019. Review Date:May 2022
Will only be updated in interim if there are major changes in practice or prices. For more information about the PDL,
contact Pharmacy Team CHSPharmacy2@gstt.nhs.uk) or TissueViabilityNurseSpecialists@gstt.nhs.uk
For other wound management queries visit http://gti/clinical/directorates/inpatientsservices/tissueviability/TissueViability.aspx
3 of 4
WHICH Product?
Product Size PIP Cost Prescribing Points
Codes per
dressing
Odour Clinisorb 10 x 10cm 018-2667 £1.94 • Clinisorb can be cut to size.
absorbing 10 x 20cm 018-2857 £2.58
dressings
Paste Ichtopaste 7.5cm x 6m 033-2668 £3.78 • Patch test before use.
• Do not use for cavity wounds.
bandages Viscopaste 7.5cm x 6m 033-2734 £3.74
Retention K-Band 10cm x 4m 034-4358 £0.29 • For tubular bandages 5m and 3m
lengths are less wasteful than 1m and
bandages Actifast or clinifast – Tubular can accommodate various limb sizes.
Blue Line 7.5cm x 3m 327-6433 £2.13 • Consider if blue (7.5cm) line size will
7.5cm x 5m 327-6441 £3.74 suffice before prescribing a yellow
Yellow Line 10.75cm x 3m 327-6466 £3.49 (10cm) line bandage. In practice blue
line is generally sufficient for
10.75cm x 5m 327-6474 £6.04 medium sized limbs and yellow line
for large oedematous limbs.
• 6m per month should be enough for
most patients.
Silver Aquacel Ag+ 5 x 5cm 386-2703 £1.95 • Aquacel Ag ribbon for cavity wounds.
Extra • Use silver dressings for a maximum of
dressings 10 x 10cm 386-2695 £4.64 2 weeks, then contact TVN if no
(Only if there are Aquacel Ag+ 1cm x 45cm 386-2729 £3.10 improvement.
localised clinical signs Ribbon 2cm x 45cm 386-2737 £4.74 • Generally is expected that no more than
of infection)
Atrauman Ag 5 x 5cm 321-4533 £0.53 5 dressings will be needed for each
Use for 2 weeks only and wound.
10 x 10cm 321 4541 £1.28
review need.
Sterile Nurse-It S/M 351-2407 £0.55 • Contains apron, paper sterile field,
gloves, swabs, forceps, paper towel,
dressing M/L 336-9170 £0.55 disposable bag and compartment tray.
Sterile Gauze 7.5cm 325-3234 £0.42
packs and (Pack of 5)
Swabs
gauze swabs Non Sterile 10cm (Pack 325-3236 £1.48
Gauze Swabs of 100)
Surgical Scanpor tape 2.5cm x 013-6077 £0.92 • Some patients are allergic to adhesive
tapes.
adhesive 10m
• Hypafix is more suited for securing
5cm x 10m 014-8155 £1.76 dressings, catheters and draining tubes
tapes
7.5cm x 281-3036 £2.58 in position where contact to the skin is
10m needed. It is useful for sacral sores,
joints or awkward body contours.
Hypafix 5cm x 10m 035-2047 £2.75 • Hypafix may be left in position for
10cm x 038-6326 £4.80 prolonged periods.
10m
Topical V.A.C. Small 346-8543 £22.95 • Community nurses to use only if
discussed with TVN or referred from
Negative Granufoam Medium 346-8576 £27.32 hospital.
Dressing Kit Order 5 at a time for kits (box size).
Pressure NPWT Gauze 377-9600 £18.21
•
• Reassess after 1 month.
Dressing Kit • If more adhesive film is needed e.g. in
case of leakage, use Tegaderm film
with Sensa
dressing.
Trac
ActiVAC 300ml 346-7883 £28.85
Canister with
Gel
Vapour Tegaderm 12 x 12cm 242-8951 £1.11 • Stretch opposite corners for easy
Transparent removal.
permeable 15 x 20cm 003-8703 £2.41 Can be left in place up to 7 days.
•
Film Dressing For clean surgical wounds.
dressings Hydrofilm Plus 5 x 7.5cm 342-4322 £0.18
•
with absorbent
9 x 15cm 342-4348 £0.31
pad
10 x 20cm 342-4355 £0.47
Written May 2019. Review Date:May 2022
Will only be updated in interim if there are major changes in practice or prices. For more information about the PDL,
contact Pharmacy Team CHSPharmacy2@gstt.nhs.uk) or TissueViabilityNurseSpecialists@gstt.nhs.uk
For other wound management queries visit http://gti/clinical/directorates/inpatientsservices/tissueviability/TissueViability.aspx
4 of 4
PRESSURE ULCER AND PREVENTION MADE EASY PATHWAY
The use of reposi�oning as a preventa�ve strategy should be considered for all pa�ents at risk of pressure ulcera�on and depends upon
clinical assessment. This includes the pa�ent’s general condi�on, comfort, skin condi�on / assessment and level of mobility. An
assessment of the pa�ent’s skin over all the pressure points should be conducted and a Pressure ulcer risk assessment
Category 1 Category 2 Category 3 Category 4 Unstageable/DTI
Non-blanchable Par�al thickness skin Full thickness skin loss Extensive destruc�on, Full thickness skin or
erythema of intact skin. loss involving involving damage to or �ssue necrosis,or �ssue loss in which the
Discoloura�on of the epidermis, dermis, or necrosis of damage to muscle, true depth of the ulcer
skin, warmth, oedema, both. subcutaneous bone, is completely obscured
indura�on or hardness The ulcer is superficial �ssue that may extend or suppor�ng by slough and / or
may also be indicators, and presents clinically down to, but not structures with or eschar in the wound
par�cularly on those as an abrasion or through underlying without full thickness bed. Purple or maroon
with darker skin. blister. fascia. skin loss. localized area of
discoloured intact skin
or blood- filled blister
due to damage of
underlying so� �ssue
from pressure and / or
shear
Inform TVN Refer to TVN
Complete Da�x Complete Da�x
& RCA if acquired
Reposi�on every 2 – 4 hourly
IN ADDITION TO CATEGORY 1
U�lise 30o �lt & side lying HARD NECROTIC
posi�on Reposi�on every 2-4 hours depending on assessment of
pa�ent’s skin ESCHAR:
Document on turning / Refer to Foot Health if
reposi�oning chart Consider anatomical loca�on of ulcer when si�ng pa�ent for heels / ankles
meals
Restrict chair si�ng to less than 2 Leave dry and intact
hrs for at risk pa�ents (sacral, Restrict si�ng to 45 minutes where possible for grades 3 Consider offloading with
Ischial, spinal, bu�ock pressure & 4 (including profiling bed frame) boots
damage) BLISTERS:
Refer all pa�ents to die�cian
Consider pressure relieving Apply protec�ve dressing
Educate pa�ents and carers on reposi�oning regime Refer to Foot health if
cushion
If mul�ple category 2 -4 / DTI or Unstageable pressure ulcers, heels and ankles
U�lise pillow under calves or heel
consider Safeguarding adults Consider offloading
protec�on devices to protect
heels. Base dressing selec�on on �ssue type present and treatment
-Document on carenotes
aim ( u�lise preferred dressing list for guidance )
Complete nutri�onal assessment, -Inform GP
refer to die�cian as appropriate Document on carenotes -Inform TVN
Document ulcer in pa�ent’s notes and Inform GP -Educate carers and
Document in pa�ent’s care plan &
Ensure wound assessment completed if PU present pa�ents
educate carers & pa�ents
Low Risk Medium Risk High Risk Very High Risk
(10-15, with intact skin) (15-22, with intact skin (>22, with intact skin (>22, with or without PU
or 10-15 if PU present) or 15-22 if PU present) present)
May need assistance
/encouragement to mobilise Regular turning Regular turning Regular turning
Observe pressure areas Observe pressure areas Observe pressure areas Observe pressure areas
Reassess weekly or if Reassess weekly or if Reassess weekly or if Reassess weekly or if
condi�on changes. condi�on changes. condi�on changes. condi�on changes.
Complete Care Plan Complete Care Plan Complete Care Plan Complete Care Plan
Pressure relieving equipment should be selected using the
PRESSURE RELIEVING EQUIPMENT COMMUNITY GUIDANCE DOCUMENT
Any altera�on in wound characteris�cs may indicate a change in status and as such, wound management should be reassessed as necessary.
Tissue Viability Nurses contact details - Tel: 0203 049 8855. Email: gst-tr.tvnreferrals@nhs.net
PREVENTION AND MANAGEMENT OF
MOISTURE ASSOCIATED SKIN DAMAGE
ASSESS PATIENT’S SKIN
Features of MASD
PREVENTION MANAGEMENT
Moisture must be present.
No moisture lesion BUT Linear shaped , between anal cleft, skin Moisture lesion present
incontinence folds, peri-wound and peri-stomal areas.
Can be present as blanching redness
Continence management as per Continence management as
Local Policy with or without skin irritation.
per Local Policy
Single or multiple areas of skin break-
Use soap free emollient (e.g. down, irregular shaped or spots or a Use soap free emollient (e.g.
Hydromol or Zero AQS kissing lesion. Hydromol or Zero AQS
cream) to cleanse skin + pat Typically superficial but depth of lesion cream) to cleanse skin + pat
dry gently can extend with infection or unrelieved dry gently
pressure.
Apply Cavilon Cream to wet Apply Cavilon cream to wet
areas after every 3rd areas after every 3rd episode
episode of Reposition frequently of incontinence
incontinence 3-4 hourly if skin is intact. to prevent
for Protection 2 hourly if skin is compromised. further skin
breakdown
Assess skin integrity every shift or
each visit & document Protect skin with
Proshield Plus cream.
If no improvement after 2 weeks OR Gently apply thin layer to
if skin is severely excoriated due to intact and irritated skin.
Moisture Associated Skin Damage Apply liberally
STOP use of Cavilon Cream to broken skin
REFER TO TVN FOR ADVICE if wound and top up as
bed sloughy/necrotic or concerned. required. (2-3
times per day)
Tissue Viability Contact details
Phone: 0203 049 8855
Email: gst-tr.TVNreferrals
@nhs.net
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