Wounds - what should a dressings formulary include?
The purpose of this part of the special feature is to describe the range of wound care products which is available in hospitals. Similar products are described in groups with reference to their ideal characteristics, advantages, disadvantages, effectiveness and use. Emphasis is given to newer groups of wound care products. This information will be of particular interest to those who are involved in compiling wound care formularies in hospitals. It should be noted that decisions about the contents of a hospital formulary have to be made locally and for this reason no recommendations are made about the addition of particular products.
In the early 1980s, few wound care products were available apart from traditional dressings and paste bandages. The first representatives of modern wound care products, such as Inadine, Granuflex, Kaltostat and Sorbsan, were introduced into hospitals during the mid 1980s. As can be seen in Table 1, few products were added to the Drug Tariff in the late 80s and early 90s. During the mid 1990s, the range slowly expanded into the well recognised groups of products as such as vapour-permeable adhesive films, hydrogels, hydrocolloids, alginates and foam dressings, and newer groups of products were marketed, such as silicone, silver and collagen dressings, tissue adhesives, barrier films and skin substitutes (tissue-engineered products).
From 1996, however, this overly cautious approach appears to have been abandoned as an avalanche of new products was added both to the Drug Tariff and to the list of preparations which can be prescribed by nurses, Part XVIIB of the Drug Tariff.1
Precise details of sizes, shapes and prices of products can be found in the approved list of appliances, Part IXA of the Drug Tariff.1 General information about individual products is available in the British National Formulary,2 in the ‘Formulary of wound management products’3 and from the Surgical Materials Testing Laboratory website (see Panel 8, p266). A general assessment can be made about an individual product by comparing it with the characteristics of an ideal dressing (Panel 1, p262). However, there is a paucity of information on the evidence of effectiveness of individual products or of comparative effectiveness; evidence-based practice in wound care has not kept pace with the vast number of products marketed.
When developing a hospital formulary, it is easier to consider products having similar characteristics in groups. Generally, it is only necessary to use one product from each group. Products should have as many ideal characteristics as possible, should have some research evidence supporting their use and be competitive on price. Often, products are chosen to treat particular kinds of wounds. These are colour-coded, eg, epithelialising (pink), granulating (red), infected (green), sloughy (yellow) and necrotic (black). The range of wound care products available is described below in groups, starting with some of the newest products.
Skin substitutes are tissue-engineered products using living cells (fibroblasts, keratinocytes) in a scaffold of natural or synthetic extracellular matrices which provide mechanical stability and a three-dimensional framework for subsequent tissue infiltration and development.4,5 Often, biodegradable scaffold materials are used that are resorbed as new tissue is laid down. Natural scaffolds are derived from human or animal tissues, such as collagen and hyaluronan. Synthetic scaffolds, such as polyglycolic acid and polylactic acid, can be manufactured on a large scale.
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Citation: Hospital Pharmacist URI: 10976442
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