request for information under the freedom of information ...this was reviewed during 2014 for bnf...

Chairman David Griffiths Chief Executive Paul Bentley Trust HQ The Oast, Unit D, Hermitage Court, Hermitage Lane, Barming, Nr Maidstone, Kent ME16 9NT

Rating: GOOD

Request for information under the Freedom of Information Act - 7109 Thank you for your letter dated 6 April 2017 requesting information regarding Wound care. Please find detailed below your original request together with our response. Original Request: Please supply me with your most up to date wound care formulary (please indicate if you do not work from a formulary)? Kent Community Health NHS Foundation Trust (KCHFT) does not work from a formulary. It works from a First Choice Dressing List, which is attached as Appendix A. Who has operational responsibility for the formulary including the addition or deletion of products? The First Choice Dressings Formulary Group has operational responsibility for the First Choice Dressing List. However operational responsibility is moving in the near future to the Clinical Commissioning Groups’ Formulary Group. Please provide information on how compliance with your formulary is enforced? Compliance is enforced by monitoring ePACT data and management processes (ePACT is a national electronic system in which all information regarding dispensed FP prescriptions is available. It is part of the NHSBA). Please provide information on how products are evaluated prior to being accepted onto the formulary? If this is part of a clinical evaluation or clinical trial, please provide the results. Products are evaluated against the following criteria: quality factors, health care outcomes, patient factors, healthcare professional factors and economic factors. The information is gathered from literature studies and company information, patient feedback and staff assessment. The information is assessed by the First Choice Formulary Group Please provide information on who is responsible for the cost of wound care in your setting – is it CCG or Acute? The Clinical Commissioning Groups hold the budget for wound care dressings. Please provide information if the wound care products are on prescription FP10? The majority of dressings are supplied to individual patients via FP10s. A small amount of stock is held in clinics, which is obtained via NHS supplies or pharmaceutical suppliers.

Version 5 August 2016

The list will be reviewed on a rolling programme . Review dates for each BNF section are listed in the final column of the tabulated list. The list will be updated after each review (three times a year). Please ensure that you refer to the current version on KCHFT Staff Zone. Approved: KCHFT Medicine Management Goverance Group – October 2014 The original list was compiled by a panel consisting of Tissue Viability Nurse Specialists, Nursing and Podiatry Representatives with the panel being chaired by Medicines Management Representative. This was reviewed during 2014 for BNF sections A5.1.1 to A5.2.4 using a new process. A universal invitation was sent to companies to make submissions and provide evidence against five values of healthcare (quality, health outcomes, patient , healthcare professional and economic factors). Panels were established comprising of Tissue Viability Nurses, CCG Prescribing Advisors, lay representatives, District Nurses, Practice Nurses, Podiatrists, KCHFT medicines management staff and other KCHFT nursing staff. Panel one short-listed from all the submissions. Panel two reviewed the submissions and attended company presentations for the short-listed products. Decisions were made by independent panel member voting against the five values of healthcare. Henceforth the list will be reviewed on a rolling programme using a refined process. Decisions will be taken by a First Choice Dressings Formulary Group using the criteria developed for the five values of healthcare.

Both medical and non medical prescribers are expected to comply with the ‘First Choice Dressings’ list. Non-compliance without appropriate authorisation and supporting evidence will be considered as an issue. Should a product not listed in this document be required; use form ‘Form 2’ on page 15 of this document. Supporting evidence MUST be included. Refer to separately scheduled rota for correct product usage training meetings as approved by Medicines Management and delivered by the manufacturer for those products included in this list . It important these training sessions are accommodated at base level within the stated time frame. Always use dressings as per the manufacture’s instructions and information provided.

FIRST CHOICE DRESSINGS LIST 1st February 2015 and ongoing (version 5)

Kent Community Health NHS Foundation Trust First Choice Dressing List

Version 5 Page 2 of 21 August 2016

Document Tracking Sheet - KCHFT First Choice Dressings List

Version Status Date Issued to/approved by Comments / summary of changes

1.4 Approved January 2013 KCHT Medicines

Management Governance

Group

1 Approved January 2015 KCHT Medicines

Management Governance

Group

Sections A5.1 - A5.2.4 updated

2 Approved June 2015 First Choice Dressings

List Formulary Group

(FCDLFG)

Sections A5.2.5 and A5.2.6 (Foams and

Alginates) updated

3 Approved August 2015 FCDLFG Emollients, skin barriers (moisture

lesion and peri-wound protection) and

washes sections updated. Wound

cleansing products section updated.

4 Approved December

2015

FCDLFG Silver section A5.3.3 updated.

Changes to basic absorbent for

heavily exuding wound and foam

sections. Negative pressure dressings

not included in First Choice List, but

on TVN advice only (requires TVN

referral). Change to A5.8.9 medicated

bandages.

5 Approved August 2016 FCDLFG Iodine A5.3.2, Honey A5.3.1, Other

Antimicrobials A5.3.4, and other

antimicrobials – irrigation fluids,

sections revised. Protease modulating

matrix, Silicone Keloid and Capillary

action sections reviewed, no changes

made. Odour absorbent section review

postponed.



CONTENTS Page Introduction

4

First Choice Dressings List 5

FORM 1 Page 1 Prescription Request for 1st choice Dressings FORM 2 Prescription Request for Non-Formulary / 1st choice Dressings

9

16

Dressing choice 18

Dressing algorithms

Currently under review. BNF table included in interim

19



INTRODUCTION The First Choice Dressings List is available for all practitioners prescribing and/or applying wound care products throughout Kent Community Health NHS Foundation Trust (KCHFT). It aims to provide a clinically effective, appropriate and cost effective choice of products to manage the vast majority of wounds, with a focus on chronic wounds. The list will be evaluated and updated on an ongoing basis to reflect innovations in practice and new, evaluated products. There are some variations between acute and primary care provision and in general products should be selected to maintain a continuum of care for the patient. In most cases, the product list contains in some cases up to three choices to assist in the choice of dressing after a patient assessment. Selection should also be based on frequency of change e.g. planning a change of dressings on a weekly basis would minimise commitment of nursing time. Notes for use The following must be noted:

a. this first choice dressings list is to be used in conjunction with the Wound Care Policy (see principles below) and not in isolation; b. the choice of dressing should not replace sound clinical judgement; c. prescribers should only order a quantity that is clinically required, rather than prescribing whole packs to reduce waste and inefficiencies; d. correct initial and ongoing wound assessment as defined in the wound care policy are essential elements to the selection of appropriate

dressings.

Notes for external organisations and NHS bodies This first choice dressings list has been produced and agreed in accordance with KCHFT’s policies and procedures. It therefore reflects the best practice for KCHFT. This list is available to other organisations and NHS bodies to use at their discretion but they should note that their own policies and procedures may not match KCHFTs. Should any conflicts or discrepancies arise as a consequence all external bodies should refer to their own polices and procedures. KCHFT cannot and would not be responsible for any problems arising from these conflicts.



FIRST CHOICE DRESSING LIST:

First Choice Dressings List for 2015 and ongoing (v5) P=Primary Dressing S=Secondary Dressing Note some dressings may be as primary or secondary dressing Use of relatively expensive First Choice Dressings will be monitored and challenged. Please consider if you have chosen the most cost-effective clinically appropriate option. BNF category

Category Description First Choice Dressing/s Notes

Review date

A5.1.1 Basic Low adherence 1. Atrauman (P) 2. NA-Ultra (P)

2017a

A5.1.2 Basic Absorbent - lightly exuding wounds Mepore 2017a

A5.1.2 Basic Absorbent - moderate to heavily exuding wounds

Zetuvit E (S) Sterile and non- sterile dressings available. Use non-sterile when used as a secondary dressing and not in close contact with wound bed, for significant cost saving.

2017a

A5.1.2 Basic Absorbent - heavily exuding wounds Zetuvit Plus 2017a

Kerramax Care

A5.2.1 Hydrogel dressings Not included in first choice list. On specialist advice only.

2017a

A5.2.2 Vapour-permeable film Tegaderm Film

2017b

A5.2.2 Vapour-permeable film with absorbent pad Mepore Film and pad (P) 2017b

A5.2.2 Vapour-permeable film for iv and sc catheter sites

1. IV3000 2. Tegaderm IV

Use second choice as an alternative for patients with sensitivities or where the securing strips and recording strip are required.

2017b

A5.2.3 Soft polymer without pad Mepitel One (P) AdapticTouch

Use for patients with fragile / sensitive skin only. N.B. Larger sizes are significantly more expensive. - consider 2nd choice if large dressing. Consider if a silicone dressing is a cost-effective alternative.

2018a

A5.2.3 Soft polymer with absorbent pad Mepilex range(P) Mepilex border preferred, but avoid shapes as high cost.

Use for patients with fragile / sensitive skin only. Mepilex border preferred, but avoid shapes as high cost. Mepilex Lite - caution large dressings are relatively expensive. Consider if a silicone dressing is a cost-effective alternative.

2018a



"Mepilex" and "Meplilex Transfer" advised for palliative care and specialist use only.

A5.2.3 Soft polymer cellulose Sorbion sachet extra (P)

Not to be used as a super absorbent pad outside of other dressings as not cost effective. Can be used over low adherent dressings. Consider Mextra Superabsorbent if secondary dressing with fluid handling capacity is required.

2018a

A5.2.4 Hydrocolloid 1.DuoDERM Extra Thin (P/S) 2. DuoDERM Signal (P/S)

Avoid use of shaped dressings. The company can provide a document written by a Muslim Cleric advising on the use of DuoDERM in members of the Muslim faith.

2018b

A5.2.4 Hydrocolloid - fibrous Aquacel Foam and Aquacel Extra including ribbon (P) Evaluate whether Aquacel Foam would be appropriate and more cost-effective when considering using a Foam dressing.

2018b

A5.2.5 Foam (adhesive and non adhesive) 1. Tegaderm – adhesive foam but NOT the flat foam

2. Biatain Silicone 3. ActivHeal Foam –excluding shaped.

ActivHeal Foam- To be included on the FCDL as a lower acquisition cost option for practitioners to try out in practice.

2018c

A5.2.6 Alginate Sorbsan (P) (Sorbsan Flat, Sorbsan Plus, Sorbsan ribbon). Excluding bordered.

2018c

A5.2.7 Capillary-action dressings Under TVN advice only 2019c

A5.2.8 Odour absorbent dressings Clinisorb 2016b

A5.3 Antimicrobial

A5.3.1 Honey Honey -based topical application – 1. Activon Honey 100%. 2. Medihoney 100% (only if applicator spout required). Honey gauze - Actlilte Honey alginate - 1. Medihoney Apinate. 2. Medihoney Gel Sheet (TVN use only). Honey hydrogel - Medihoney HCS without border.

Observe cautions in BNF.

2019c

A5.3.2 Iodine Iodosorb. Iodoflex Paste – Consider as an option for deeper wounds only. Seek TVN advice. Other options may be more cost effective .

Note cautions and contraindications in BNF.

2019c



Povitulle Only to be used for: Bites; vascular issues; necrotic areas which are to remain dry and when directed by a consultant. DO NOT USE TO DRY UP SKIN LACERATIONS.

A5.3.3 Silver - low adherence Not currently included in list 2019b

A5.3.3 Silver - with charcoal Not currently included in list 2019b

A5.3.3 Silver - hydrocolloid Aquacel Ag + Extra and Aquacel Ag + Ribbon

2019b

A5.3.3 Silver - Soft polymer Mepilex Ag. For burns and palliative only. Largest sizes are not included on the First Choice List

A5.3.3 Silver - Foam Not currently included in list 2019b

A5.3.3 Silver - alginate Not currently included in list 2019b

A5.3.4 Other antimicrobials Cutimed Sorbact (swabs and ribbon only)

2019c

A5.3.4 Other antimicrobials - irrigation fluids Octenilin irrigation solution

2019c

A5.4 Specialised dressings

A5.4.1 Protease-modulating matrix Under TVN advice only 2019c

A5.4.2 Silicone keloid dressings Not currently included in First Choice List 2019c

A5.6.1 Topical Negative Pressure Therapy Not currently included in First choice list. Requires referral to TVN.

N/A Adjunct products

Over granulation Haelan Ointment / Haelan Tape For over granulation enteral feeding sites etc. 2016b

A5.7.3 Securing tape

Clinipore / Generic tape Hyperfix 2016b

13.2.2 & DT 1XC

Skin Barrier Films for peri-wound protection

Sorbaderm. Use cream to protect on unbroken skin. Use spray or applicators on broken skin. Avoid using sachets.

2019a

13.2.2 & DT 1XC

For moisture lesions protection from excess moisture and incontinence

Prosheild Cream. Proshield spray cleanser should only be used where there is incontinence related skin damage.

2019a

13.2.1 & DT 1XA Emollients and barrier

Emollients QV and ZERO emollient ranges

Skin products containing paraffin based products, for example White Soft Paraffin, White Soft Paraffin plus 50% Liquid Paraffin or Emulsifying Ointment, in contact with dressings and clothing are easily ignited with a naked flame or a cigarette.

1 Patients should be told to keep away from

fire or flames, and not to smoke when using these preparations. The risks of fire should be considered when using large quantities of any paraffin-based emollient. Care should be taken when washing and drying clothes, as

2019a



residual paraffin may pose a fire risk when in contact with electrical equipment. Patients who require large quantities of emollient (100g or more) should use a water based product (e.g. cream or lotion) rather than a paraffin based one (e.g. ointment) to reduce the fire risk. The First Choice List emollient choices include low paraffin products (please see manufacturer's literature or BNF for paraffin content). Patients on medical oxygen who require an emollient should not use any paraffin based product.

2 Please use a suitable

cost-effective non-formulary product in this situation, completing a non-formulary request form with the rationale documented. 1. NPSA. Rapid Response Report 4. Fire hazard with paraffin-based skin products. November 2007. 2. PrescQIPP Bulletin 49 May 2013. Cost effective emollients with no, or low paraffin content.

13.2.1.1 Washes

LPL 63.4, QV Range (Bath oil and Gentle wash), Zerolatum

These preparations make skin and surfaces slippery. Particular care is needed when bathing.

2019a

13.11.1 & DT- 1XA irrigation solutions

Sodium Chloride Wound Cleansing Products - Aerosol cans

Stericlens 2019a

13.11.1& DT- 1XA irrigation solutions

Sodium Chloride Wound Cleansing Products - Individual sachets

Normasol Staff should read: NHS England Patient Safety Alert 2015/005.

2019a

Drug Tariff 1XA

Compression hosiery Activa range Carolon range

2016b

Medi Uk For any lymphodema patients always discuss with lymphodema service or the local rep prior to application

Bandages 2016c

A5.8.2 Light- weight conforming bandages Knit-Band 2016c

A5.8.3 not all section

Tubular bandages and elasticated viscose stockinette

Generic Elasticated Viscose Stockinette Clinifast

Do not use as a primary layer on limbs unless clinically indicated i.e. reaction to sub-compression wadding padding layer, use of creams to prevent wadding adhering to skin.

2016c

A5.8.4 Support bandages - Knitted Elastomer and viscose bandage

K-lite Profore#2

If compression not required consider using sub-compression wadding padding layer and tubular bandages elasticated viscose stockinette (top layer only) instead of adding knitted elastomer and viscose bandage.

2016c

A5.8.4 Support bandages - K-Plus Profore#3

2016c

A5.8.6 Cohesive bandages K-Four Profore#4

2016c

A5.8.7 Compression bandages - high compression Not included in current first choice list 2016c

A5.8.7 Compression bandages - short stretch Actico short stretch

2016c

A5.8.7 Compression bandages- sub-compression Generic sub compression wadding 2016c



wadding padding K-soft Profore#1

A5.8.8 Multi-layer compression bandaging 4 layer system

K-Four multi-layer compression bandage kit Profore multi-later compression bandage kit

2016c

A5.8.8 Multi-layer compression bandaging 2 layer system

Coban K-Two Pro Two

2016c

A5.8.9 Medicated bandages Viscopaste Ichthopaste

2016c

Healthcare professionals selecting dressings should be familiar with the descriptions of the appropriate use of dressings in the introductory paragraphs to each section of the BNF. The BNF table "Wound contact material for different types of wound" is a useful tool when choosing between dressing types. Manufacturer's literature should be referred to regarding the use of specific products, and in particular their cautions and contraindications. An incident form ("Datix") should be completed if a patient experiences an adverse reaction to a wound care product. PATIENT SAFETY ALERT Potassium Permanganate soaks Should potassium permanganate tablets be prescribed for topical application, care must be taken to ensure that the patient is counselled fully on the use of this product. It should be clearly highlighted that the tablets are to be diluted and applied topically and MUST NOT BE ORALLY INGESTED. The term “potassium permanganate soak” should be used rather than “potassium permanganate tablet” to avoid confusion. Also, receptacles such as plastic cups or jugs should not be used as containers for the diluted solution as this may imply oral ingestion is the intended route. Should accidental ingestion occur this should be treated as a medical emergency and dealt with accordingly. This follows a recent NHS England Patient Safety Alert which highlighted a number of cases of accidental oral ingestion of potassium permanganate tablets. The full alert can be accessed here: http://www.england.nhs.uk/wp-content/uploads/2014/12/psa-potass-prmangant.pdf


Patient wishes the prescription to be:

Left at Surgery for collection by patient or representative

Other information (name and address of Pharmacy chosen by patient):

Forwarded to Pharmacy for collection by patient or representative

Forwarded to Pharmacy for delivery to patient

Date:

Name of Nurse: (Please print)

Nurses Tel No:

Signature: (*To be sent from requesting nurse's or team's nhs.net email if sent electronically)

Patient Name:

DOB:

Patient Address:

Tel No:

NHS No:

Name of dressing

Size and Price (per unit

in pence) (Dec14 DT)

Shaped dressings are not on the First Choice List and require

completion of Form 2 for non-formulary request

Size required

(Write in full)

No. use

d a

t each

change

No. of

chan

ges /

week

Num

ber

of

weeks s

upp

ly

MA

X 4

WE

EK

S

Qty to be

ordered

Rationale e.g. New treatment

/ change of treatment /

wound type/ multiple wounds

A5.1.1 Basic Low adherence

Atrauman 5cm x 5cm 26 7.5cm x 10cm 28 10cm x 20cm 62 20cm x 30cm 171

N-A Ultra 9.5cm x 9.5cm 33 19cm x 9.5cm 63

A5.1.2 Basic Absorbent

Mepore 7cm x 8cm 11 9cm x 20cm 44 9cm x 25cm 61 9cm x 30cm 70 9cm x 76 10cm x 11cm 22 11cm x 15cm 36

Zetuvit E Zetuvit E (Non-Sterile) 10cm x 10cm 7 10cm x 20cm 9 20cm x 20cm 14 20cm x 40cm 27 Zetuvit E (Sterile) 10cm x 10cm 21 10cm x 20cm 24 20cm x 20cm 39 20cm x 40cm 109

Zetuvit Plus 10cm x 10cm 63 10cm x 20cm 87 15cm x 20cm 100 20cm x 25cm 137 20cm x 40cm 211

KerraMax Care Square 5cm x 5cm 100 10cm x 10cm 127 Rectangular 10cm x 22cm 167 20cm x 22cm 295 20cm x 30cm 337 20cm x 50cm 450 KerraMaxCare Border Adhesive Square 16cm x 16cm 429 26cm x 26cm 975 Rectangular 16cm x 26cm 678 KerraMaxCare Multisite 21cm x 23cm 323

FORM 1 Page 1 Prescription Request for 1st choice Dressings 2015 v5 (Form must be completed fully) Please send electronically. If faxing, ensure patients name and NHS number is written on the top of each sheet faxed.

* Where the prescription request form is sent from the nursing team's nhs.net account, there must be an audit trail from the requesting accountable nurse's email account.



A5.2.2 Vapour-permeable film

Tegaderm Film 6cm x 7cm 39 12cm x 12cm 110 15cm x 20cm 239

Mepore Film and pad 4cm x 5cm 24 5cm x 7cm 24 9cm x 62 9cm x 15cm 92 9cm x 20cm 136 9cm x 25cm 150 9cm x 30cm 200 9cm x 35cm 249

IV3000 5cm x 6cm 1-Hand 42 6cm x 7cm Non-winged peripheral 55 7cm x 9cm Ported peripheral 73 9cm x 12cm PICC line 144 10cm x 12cm Central line 139

Tegaderm IV 7cm x 8.5cm peripheral line 59 8.5cm x 10.5cm central line 115 10cm x 15.5cm PICC line 165

A5.2.3 Soft polymer

Mepitel One 6cm x 7cm 159 9cm x 10cm 319 13cm x 15cm 645 24cm x 27.5cm 1738

Adaptic Touch 5cm x 7.6cm 113 7.6cm x 11cm 225 12.7cm x 15cm 465 20cm x 32cm 1250

Mepilex Border Mepilex Border Lite Mepilex Lite

7cm x 7.5cm 139 10cm x 12.5cm 272 10cm x 20cm 369 10cm x 30cm 555 15cm x 17.5cm 474 17cm x 20cm 607 4cm x 5cm 92 5cm x 12.5cm 201 7.5cm x 7.5cm 139 10cm x 10cm 253 15cm x 15cm 413 6cm x 8.5cm 182 10cm x 10cm 217 15cm x 15cm 422 20cm x 50cm 2666 (off List - requires non-formulary form)

Sorbion sachet extra 5cm x 5cm 145 7.5cm x 7.5cm 178 10cm x 10cm 225 20cm x 20cm 700 20cm x 10cm 373 30cm x 20cm 999

A5.2.4 Hydrocolloid

DuoDERM Extra Thin 5cm x 10cm 75 9cm x 15cm 176 9cm x 25cm 281 9cm x 35cm 393 7.5cm x 7.5cm 79 10cm x 10cm 131 15cm x 15cm 284

DuoDERM Signal Square 10cm x 10cm 212 14cm x 14cm 371 20cm x 20cm 738

Aquacel Foam and Aquacel Extra inc ribbon

Aquacel Foam Non-Adhesive 5cm x 5cm 134 10cm x 10cm 253 15cm x 15cm 425 20cm x 20cm 694 15cm x 20cm 581 Aquacel Foam Adhesive 8cm x 8cm 137 10cm x 10cm 214 12.5cm x 12.5cm 265 17.5cm x 17.5cm 530 21cm x 21cm 776 25cm x 30cm 1005 Aquacel Ribbon 1cm x 45cm 183 K 2cm x 45cm 244 Aquacel Extra Square 5cm x 5cm 99 10cm x 10cm 236 15cm x 15cm 444



Rectangular 4cm x 10cm 130 4cm x 20cm 191 4cm x 30cm 287

A5.2.5 Foams

Biatain Silicone 7.5cm x 7.5cm 145 10cm x 10cm 213 12.5cm x 12.5cm 260 15cm x 15cm 386 17.5cm x 17.5cm 513

Tegaderm – adhesive foam

Square 14.3cm x 14.3cm (wound contact pad 10cm x 10cm + border 2cm) 354 Oval 6.9cm x 7.6cm (wound contact pad 3.1cm x 3.8cm + border 0.35cm) 146 10cm x 11cm (wound contact pad 6cm x 7.6cm + border 1.7-2cm) 239 14.3cm x 15.6cm (wound contact pad 10cm x 11cm + border 2cm) 424 19cm x 22.2cm (wound contact pad 14cm x 17.1cm + border 2.5cm) 696 Soft Cloth Border

6.9cm x 6.9cm (wound contact pad 2.5cm x 2.5cm + border 0.95cm) 171

ActivHeal Foam ActivHeal Non-Adhesive Foam Square 5cm x 5cm 75 10cm x 10cm 113 20cm x 20cm 392 Rectangular 10cm x 20cm 234 ActivHeal Foam Adhesive Square 7.5cm x 7.5cm (wound contact pad 5cm x 5cm + border 1.25cm) 118 10cm x 10cm (wound contact pad 6.25cm x 6.25cm + border 1.875cm) 163 12.5cm x 12.5cm (wound contact pad 7.5cm x 7.5cm + border 2.5cm) 168 15cm x 15cm (wound contact pad 11cm x 11cm + border 2cm) 215 20cm x 20cm (wound contact pad 13.5cm x 13.5cm + border 3cm) 450 ActivHeal Foam Contact Square 7.5cm x 7.5cm (wound contact pad 5cm x 5cm + border 1.25cm) 129 10cm x 10cm (wound contact pad 7.5cm x 7.5cm + border 1.25cm) 189 12.5cm x 12.5cm (wound contact pad 10cm x 10cm + border 1.25cm) 218 15cm x 15cm (wound contact pad 12.5cm x 12.5cm + border 1.25cm) 416 20cm x 20cm (wound contact pad 17cm x 17cm + border 1.5cm) 605 Rectangular 10cm x 20cm (wound contact pad 7.5cm x 17.5cm + border 1.25cm) 270



A5.2.6 Alginate

Sorbsan (Sorbsan Flat, Sorbsan Plus, Sorbsan ribbon). Excluding bordered.

Sorbsan Flat 5cm x 5cm 81 10cm x 10cm 171 10cm x 20cm 320 Sorbsan Plus 7.5cm x 10cm 176 10cm x 15cm 310 10cm x 20cm 396 15cm x 20cm 549 Sorbsan Packing (with probe) 30cm/2g 347 Sorbsan Ribbon (with probe) 40cm 204

A5.2.8 Odour absorbent

Clinisorb (Charcoal Odour Control)

A5.3.1 Antimicrobial Honey

Activon Honey 100%. Medihoney 100% - (only when applicator spout req’d). Honey Gauze Actlilte Honey alginate Medihoney Apinate. Medihoney Gel Sheet (TVN use only). Honey Hydrogel Medihoney HCS without border.

Activon Medical Grade Manuka Honey 25g 205

Medihoney Antibacterial Medical Honey 20g 396 5cm x 5cm 57 10cm x 10cm 98 Where not specified by the prescriber, the 5cm size to be supplied 10cm x 20cm 190 20cm x 30cm 536 Medihoney Antibacterial Honey Apinate Square 5cm x 5cm 200 10cm x 10cm 340 Medihoney Gel Sheet 5cm x 5cm 175 10cm x 10cm 420 Medihoney HCS Square 6cm x 6cm 224 11cm x 11cm 447

20cm x 20cm 1805 (off List - requires non-formulary form) Rectangular 20cm x 30cm 2808 (off List - requires non-formulary form)

Not on FCD List. Not on FCD List.

Not on FCD List Not on FCD List

A5.3.2 Antimicrobial Iodine

Iodosorb Ointment 10g tube 456 20g tube 912

Iodoflex paste 5g 413 10g 825 17g 1306

Povitulle 5cm x 5cm 28 9.5cm x 9.5cm 42

A5.3.3 Silver USE FOR A MAXIMUM OF 2weeks Max 2 weeks

Aquacel Ag + Extra and Aquacel Ag + Ribbon ( Silver - hydrocolloid)

Aquacel Ag+ Extra Square 5cm x 5cm 195 10cm x 10cm 464 15cm x 15cm 875 Rectangular 20cm x 30cm 2171 4cm x 10cm 283 4cm x 20cm 369 4cm x 30cm 552 Aquacel Ag+ Ribbon 1cm x 45cm 306 2cm x 45cm 467

Mepilex Ag ( Silver - soft polymer)

10cm x 10cm 612 10cm x 20cm 1009 15cm x 15cm 1136



Note cost and see notes on FCD List regarding restricted use.

------------------------------------- (20cm x 20cm 1684 (off List - requires non-formulary form) 20cm x 50cm 6320 (off List - requires non-formulary form))

------------ Not on FCD List Not on FCD List

------ ------ ------- ------- ---------- Not on FCD List Not on FCD List

A5.3.4 Other antimicrobials

Cutimed Sorbact swabs and ribbon

Cutimed Sorbact Ribbon 2cm x 50cm 403 5cm x 200cm 795 Cutimed Sorbact Round Swab 3cm/5 pieces 330



Date:


Nurses Tel No:

Signature:

Patient Name:

DOB:

Patient Address:

Tel No:

NHS No:


Left at Surgery for collection by patient or representative Other information (name and address of Pharmacy chosen by patient):



Skin protectants’ / Creams / washes / bandages

Type Size Qty to be ordered

Sorbaderm cream / film / foam applicators (avoid using sachets wherever possible) Sorbaderm Barrier Cream 28g 356 92g 719 2g sachet 20 666 Sorbaderm No-Sting Barrier Film Spray 28ml 599 Sorbaderm No-Sting Barrier Film Foam Applicators (Sterile) (1ml) 5 445 (3ml) 5 720

Proshield Cream Proshield Plus skin protective 115g 984

Proshield Spray - should only be used where there is incontinence related skin damage. Proshield Foam & Spray skin cleanser 235ml 651

QV emollient range QV Cream 100g 204, 500g 586, 1050g 1194 QV Intensive Ointment 450g 565 QV Skin Lotion 250ml 314, 500ml 524

ZERO emollient range ZeroAQS Cream 500g 329 Zerobase Cream 50g 104 500g 526 Zerocream 50g 117 500g 408 Zeroderm Ointment 125g 241 500g 410 Zerodouble Gel 100g 225 475g 471 Zeroguent Cream 100g 233 500g 699

LPL 63.4 bath additive and emollient 500ml 310

QV Bath oil QV Bath Oil 250ml 288, 500ml 471

QV Gentle wash QV Gentle Wash 250ml 314, 500ml 524

Zerolatum emollient medicinal bath oil Zerolatum Emollient Bath Additive 500ml 479

Normasol sachets 25 x 25ml 642 10 x 100ml 783

Stericlens Stericlens Aerosol 100ml 207, 240ml 315

Octenilin Irrigation solution Octenilin Bottle 350ml 460

Bandages

Clinipore / Generic tape / Hypafix adhesive tape

FORM 1 Page 6 Prescription Request for 1st choice Dressings 2015 v5 (request

forms must be completed fully)



Date:


Nurses Tel No:

Signature:

Fax No.:

(Please state whether form is to be emailed/faxed back to Community Nurse or direct to GP Surgery.)

Patient Name:

DOB:

Patient Address:

Tel No:

NHS No:


Left at Surgery for collection by patient or representative

Other information (name and address of Pharmacy chosen by patient):



Name of dressing Size Number of dressings

used at each change

Number of changes per week

Number of weeks supply

MAXIMUM FOUR WEEKS

SUPPLY

Quantity to be

ordered

5cm²

2 (x)

3 (x)

4 (x)

(=)

24

YES NO

Has this been discussed with the Tissue Viability Nurse?

Was this discussion prior to ordering the above products?

Was the decision approved by the Tissue Viability Nurse?

THIS FORM SHOULD ONLY BE USED WHEN THERE IS A VALID RATIONLE. THE FORM MUST BE COMPLETED FULLY.

THIS RATIONALE SHOULD BE CLEARLY DOCUMENTED IN THE NURSING NOTES.

FORM 2 Prescription Request for Non-Formulary / 1st choice Dressings v5

RATIONALE FOR USE OF OFF LIST DRESSING:

Please use this box to give rationale for prescribing outside of the formulary and attach a copy of the patients current wound care chart. e.g. What is the problem? Is this a new treatment or change of treatment? If a change, please state what is being stopped. What is the likely duration of treatment (more or less than 4 weeks)?

*Please make sure that you include an email address or Fax number and indicate where the form needs to be sent

(e.g. back to Community Nurse or direct to GP surgery) Patient treatment may be delayed if the fax number is omitted.


The flow chart follows the access, plan, implement and evaluation process (yellow boxes) with expanded points in green that are a ‘must do’ in relation to assessment and treatment of wounds. The blue boxes indicate associated care that may be applicable and should be considered as part of the treatment plan. Refer to Wound Care Policy for further information. Note: Refer to NMC re Accountability / Responsibility, Risk Assess where deemed appropriate.



DRESSING CHOICE

a. Prescribing dressings should take into account: o Personalized Assessment o Wound assessment o wound dressing algorithms; o manufacturers product information; o the current British National Formulary

b. The choice of dressing choice is influenced by: o maximising effectiveness; o minimising a risk; o continuation of treatment between primary and secondary care; o minimising cost; o patient choice;

c. It is expected that the vast majority of wound care products will be selected from the First Choice Dressings List. Should a product be required which is not listed, the rationale for this must be supplied in writing on the exemption form attached. This will influence in the updating process of the First Choice Dressings List;

d. Specialist products listed should only be used following discussion with and where necessary an assessment by Tissue Viability Support Team.

e. Antimicrobial products should only be used where 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;

f. Each practitioner is responsible for ensuring access to and usage of the most recent version of the First Choice Dressing list which can be found on the “Staff Zone” website at http://www.kentcht.nhs.uk

g. Compression systems should only be applied by practitioners trained in their application. Maintenance hosiery can be prescribed in any size, including made to measure;

h. Products which are not on the First Choice Dressings List should not be used routinely, and only used in exceptional circumstances based on clinical need, not preference. The Terms of Reference for The KCHFT First Choice Dressings Formulary Group describe the process for clinicians to use to put forward a new product for consideration.



NB. The flowcharts guiding the choice of dressing for different types of wound bed are currently under review. Please refer to previous versions (substituting the current First Choice products), contact the TVNs for advice, or use the BNF 69 Appendix 5 table "Wound contact material for different types of wounds". www.bnf.org.uk. This table is copied below for your convenience from the electronic BNF.

Wound contact material for different types of wounds

Wound PINK (Epithelialising)

Low Exudate Moderate Exudate

Low adherence A5.1.1

Vapour-permeable film A5.2.2

Soft polymer A.5.2.3

Hydrocolloid A5.2.4

Soft polymer A5.2.3

Foam, low absorbent A5.2.5

Alginate A5.2.6

Wound RED (Granulating)

Symptoms or signs of infection, see Wounds with signs of infection

Low Exudate Moderate Exudate Heavy Exudate

Low adherence A5.1.1

Soft polymer A5.2.3

Hydrocolloid A5.2.4

Foam, low absorbent A5.2.5

Hydrocolloid-fibrous A5.2.4

Foam A5.2.5

Alginate A5.2.6

Foam with extra absorbency A5.2.5


Alginate A5.2.6

https://www.medicinescomplete.com/mc/bnf/current/PHP9492-low-adherence-dressings.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9531-vapour-permeable-films-and-membranes.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9567-soft-polymer-dressings.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9590-hydrocolloid-dressings.htm


https://www.medicinescomplete.com/mc/bnf/current/PHP9616-foam-dressings.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9628-alginate-dressings.htm





https://www.medicinescomplete.com/mc/bnf/current/PHP9611-hydrocolloid-fibrous-dressings.htm








Wound YELLOW (Sloughy)

Symptoms or signs of infection, see Wounds with signs of infection


Hydrogel A5.2.1

Hydrocolloid A5.2.4


Alginate A5.2.6


Alginate A5.2.6

Capillary-action A5.2.7

Wound BLACK (Necrotic/Eschar)

Consider mechanical debridement alongside autolytic debridement

Low Exudate or Dry Moderate Exudate Heavy Exudate

Hydrogel A5.2.1

Hydrocolloid A5.2.4

Hydrocolloid A5.2.4


Foam A5.2.5

Seek advice from wound care specialist

Wounds with signs of infection

Consider systemic antibacterials if appropriate; also consider odour-absorbent dressings (section A5.2.8)

For malodourous wounds with slough or necrotic tissue, consider mechanical or autolytic debridement


Low adherence with honey A5.3.1

Low adherence with iodine A5.3.2

Low adherence with silver A5.3.3

Hydrocolloid with silver A5.3.3

Honey—topical A5.3.1

Hydrocolloid-fibrous with silver A5.3.3

Foam with silver A5.3.3

Alginate with silver A5.3.3

Honey—topical A5.3.1

Cadexomer–iodine A5.3.2

Hydrocolloid-fibrous with silver A5.3.3

Foam, extra absorbent, with silver A5.3.3

Alginate with honey A5.3.1

Alginate with silver A5.3.3

Note In each section of this table the dressings are listed in order of increasing absorbency.

Some wound contact (primary) dressings require a secondary dressing

https://www.medicinescomplete.com/mc/bnf/current/PHP9509-hydrogel-dressings.htm






https://www.medicinescomplete.com/mc/bnf/current/PHP9642-capillary-action-dressings.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9509-hydrogel-dressings.htm





https://www.medicinescomplete.com/mc/bnf/current/PHP9647-odour-absorbent-dressings.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9655-honey.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9670-iodine.htm



https://www.medicinescomplete.com/mc/bnf/current/PHP9664-honey-based-topical-application.htm




https://www.medicinescomplete.com/mc/bnf/current/PHP9664-honey-based-topical-application.htm

https://www.medicinescomplete.com/mc/bnf/current/PHP9670-iodine.htm



https://www.medicinescomplete.com/mc/bnf/current/PHP9655-honey.htm


- 2 -

Please provide a list of the wound care products that you are planning to keep on prescription FP10? The list of wound care products available on prescription are detailed within the First Choice Dressing List attached as Appendix A. Please provide information if you are planning to take wound care products off prescription FP10? At present the Trust is not planning on taking off any of the wound care products detailed in Appendix A. Please provide a list of the wound care products that you are planning to take off prescription FP10? Not applicable, please refer to our response to the previous question. Do you hold information about your patient demographic? If so, please provide information on what is your patient demographic and what are the most commonly treated wounds from your patient demographic Kent Community Health NHS Foundation Trust provides wide-ranging NHS care for people in the community, in a range of settings including people’s own homes; nursing homes; health clinics; community hospitals; minor injury units and in mobile units. We are one of the largest NHS community health providers in England, serving a population of about 1.4 million across Kent and 600,000 in East Sussex and London. The most commonly treated wounds are trauma (skin tears), leg ulcers and pressure wounds (pressure ulcers). Please provide any information that you have relating to the average monthly usage of each product in the formulary? The Trust does not record the monthly usage of each product in the First Choice Dressing List. Please provide information on the number of wound care products used that are not currently on the formulary? Please see the table on the next page which shows the number of items procured via FP10 Non-Medical prescribing that are not on the First Choice Dressing List (FCDL):

Number of items supplied that are not on FCDL

Number of different products that are not on FCDL

4th Quarter of 2015-16 393 90

1st Quarter of 2016-17 289 94

2nd Quarter of 2016-17 205 74

3rd Quarter of 2016-17 156 52

Total 1,043 310

Please provide any information on the monthly usage levels for non-formulary wound care products in the last twelve months?

- 3 -

The Trust does not record the monthly usage of wound care products not listed in the First Choice Dressing List. How often do you review your wound care formulary and when was this last undertaken? A rolling review is carried out over two years. The last review was carried out in August 2016 Please provide information about the procedure that you use of the information you assess when reviewing your formulary? Reviews of the First Choice Dressings List are conducted using the following criteria: quality factors, health care outcomes, patient factors, healthcare professional factors and economic factors. The information is gathered from literature studies and company information, patient feedback and staff assessment. The revised First Choice Dressings List is assessed and approved by the First Choice Formulary Group Please provide a list of the suppliers that are currently on your formulary? The list below shows all the suppliers that were on our formulary for wound management products during the financial year 2015/16: 365 HEALTHCARE 3M UNITED KINGDOM PLC ACTIVA HEALTHCARE ADVANCED MEDICAL SOLUTIONS (PLYMOUTH) LTD ADVANCIS MEDICAL AERO HEALTHCARE AQUILANT SURGICAL ASPEN MEDICAL EUROPE LTD (EX UNOMEDICAL) B BRAUN MEDICAL LTD BARD LTD (BLUE DIAMOND) BASTOS VIEGAS BLUE BOX MEDICAL LTD BSN MEDICAL LTD CLINIMED LTD. CLINISUPPLIES LTD COLOPLAST LIMITED CONVATEC LTD COVIDIEN UK CRAWFORD PHARMACEUTICALS CREST MEDICAL LTD DENTAL DIR. BILLERICAY DENTAL SUPP. DERMA SCIENCES EUROPE LTD H&R HEALTHCARE LTD JOHNSON & JOHNSON MEDICAL LTD KCI MEDICAL LTD M & A PHARMACHEM MEDLOCK MEDICAL LIMITED (MOLNLYCKE H/C) MEDTRONIC MITG MEGLIO LIMITED

- 4 -

MOLNLYCKE HEALTH CARE LTD PAUL HARTMANN LTD RELIANCE MEDICAL LTD RICHARDSON HEALTHCARE LTD ROBINSON HEALTHCARE LIMITED SALLIS HEALTHCARE LTD SHERMOND (DIV BUNZL RET SUP) SMITH & NEPHEW HEALTHCARE LTD SSL INTERNATIONAL STEROPLAST LTD SYNERGY HEALTHCARE (UK) LTD SYSTAGENIX WOUND MANAGEMENT UNISURGE INTERNATIONAL LTD UNOMEDICAL (CONVATEC) URGO LTD VYGON UK LTD Please provide figures for your total spend on wound care products in 2015 and 2016? The table below shows the total spend on wound care products in 2015 and 2016:

Total Dressings Spend on FP10 in 2015 £395,422.91

On First Choice Dressings List £342,177.33

Non-First Choice Dressings List £53,245.58

Total Dressings Spend on FP10 in 2016 £354,358.04

On first Choice Dressings List £301, 396.84

Non-First Choice Dressings List £52,961.20

Please provide figures for your total spend on Compression bandages in 2015 and 2016? Please provide figures for your total spend on Foam dressings in 2015 and 2016? Please provide figures for your total spend on Anti-Microbial wound care products in 2015 and 2016? Please provide figures for your total spend on Alginate (Silver) wound care products in 2015 and 2016? Please provide figures for your total spend on Hydrocolloid wound care products in 2015 and 2016? Please provide figures for your total spend on Wound contact products in 2015 and 2016? Please provide figures for your total spend on Exudate Absorber (Super Absorber) Dressings products in 2015 and 2016? Please provide figures for your total spend on Acute Wound Care products - Post Op Film Dressing Plus Pads, Steri-Strips, Stockinette and Semi Permeable Film Dressings in 2015 and 2016? Please provide figures for your total spend on Skin Integrity wound products – Barrier Films and Barrier Creams in 2015 and 2016? Please provide figures for your total spend on Vascular Access wound products – Semi Permeable Film Dressings and IV Dressings in 2015 and 2016?

- 5 -

Please provide figures for your total spend on hosiery products in 2015 and 2016? The Trust is not able to run reports broken down by the categories you have requested. To provide the breakdown you have requested would require the extraction, review and manipulation of data in each individual invoice. This would exceed the appropriate cost limit as set out in Section 12 (1) of the Freedom of Information Act 2000 and is therefore exempt. I have detailed below the relevant excerpts of the act for Section 12. Are you planning on collaborating with another healthcare entity to provide wound care services? The Trust already works collaboratively with the Clinical Commissioning Groups. Please provide information on your current supply route – DHL, wholesaler or vendor direct? The Trust’s supply route is via FP10 and community pharmacies. Do you currently have a contract in place for supply of wound care products? If so when does it expire? The Trust does not have a contract in place for the supply of wound care products. Please provide information on how many delivery points do you have for wound care deliveries? The Trust had 252 delivery points receiving deliveries of wound management products during the financial year 2015/16. Please provide information on how many community locations are holding stock of wound care and prescribing to the community? Please refer to our answer to the previous question (252 delivery points). Kent Community Health NHS Foundation Trust provides wide-ranging NHS care for people in the community, in a range of settings including people’s own homes; nursing homes; health clinics; community hospitals; minor injury units and in mobile units. Therefore all our locations are community locations. Please provide information on what software platform do you use for ordering wound care products? The Trust does not have a software platform for ordering wound care products.

Section 12 12. — (1) Section 1(1) does not oblige a public authority to comply with a request for information if the authority estimates that the cost of complying with the request

would exceed the appropriate limit.

- 6 -

Do you have a wound care clinic in place for your local demographic and where do your referrals come from? The Trust has wound medicine centres in South Kent Coast; Ashford and Canterbury localities with proposals in place for Thanet. West Kent will have an operational centre opening in May. Referrals are from KCHFT services primarily but this is being extended to general practice in some localities.

request for information under the freedom of information ...this was reviewed during 2014 for bnf...

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