WOUND MANAGEMENT FORMULARY - NHS North Somerset
WOUND MANAGEMENT FORMULARY - NHS North Somerset
WOUND MANAGEMENT FORMULARY - NHS North Somerset
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Appendix 4<br />
Specialist Formulary<br />
This template has been posted on every joint nhs.net account and can be used to access a<br />
dressing that might be required for specific named patients. It is expected that formulary<br />
products will be used in the first instance and all requests must demonstrate a sound rationale<br />
for requesting the product.<br />
Alleyyn Heel dressing 10.5 x 13.5cm 5 per box<br />
Acticoat Flex 3 10x10cm 12 per box<br />
10x20cm 12 per box<br />
Mepilex 15cm x16cm 5 per box<br />
20cm x21 cm<br />
Octenaline Wound 300mls 1<br />
Cleaner<br />
Flaminal Forte 50g Tube<br />
Debrisoft 10x10cm 5 pads<br />
Urgo Clean 6x 6cm 10 per box<br />
10x10cm 10 per box<br />
Sorbion S Sachet 7.5 x7.5cm 10 per box<br />
10x10cm<br />
15x15cm<br />
20x20cm<br />
Sorbion Sana 8.5 x8.5cm 10 per box<br />
Biatain IBU 10x12cm 5 per box<br />
15x15cm<br />
Prosheild Plus 115g each<br />
Prosheild Spray cleaner 235mls each<br />
If you wish to request one of these products please complete the request form below<br />
Patients Name………………………………………………<br />
Team requesting item ………………… ……………………… ……………<br />
Wound type<br />
Current<br />
dressing<br />
used and<br />
frequency of<br />
change<br />
Item<br />
requested<br />
Rational for<br />
request<br />
Number of<br />
boxes<br />
requested<br />
( no more<br />
than 2 weeks<br />
supply)<br />
Date approved and ordered……………<br />
Reason for refusal …………………………………………………………………..<br />
…………………………………………………………………………………………
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