THE ROYAL CORNWALL HOSPITALS NHS TRUST RESPONSE TO INFORMATION REQUEST

Transcription

1 FREEDOM OF INFORMATION ACT 2000 THE ROYAL CORNWALL HOSPITALS NHS TRUST RESPONSE TO INFORMATION REQUEST Date Request Received: 19 th September 2016 FOI Ref: 1519 Requested Information 1) Please supply me with your most up to date wound care formulary (please indicate if you do not work from a formulary). 2) Please can you outline how compliance with your formulary is enforced? 3) Please indicate where possible what your average monthly usage of each product is. 4) Can you list the number of wound care products used that are not currently on the formulary? 5) Can you provide usage levels for non-formulary wound care products in each of the last twelve months? 6) How often do you review your wound care formulary and when was this last undertaken? 7) Can you provide an overview of the information you assess when reviewing your formulary? 8) Can you supply the number of tissue viability nurses employed in a b c d ) Can you supply the number of leg ulcer nurses employed in a b c d ) What percentage of your practice nurses received specialist training in wound management in: a b c d ) Can you supply us with the figures for your total spend on wound care products in Page 1 of 5

2 12) Can you supply us with the figures for your total spend on compression bandages in 13) Can you supply us with the figures for your total spend on Anti-Microbial wound care products in 14) Can you supply us with the figures for your total spend hosiery products in 15) Do you have a strategy in place to implement NICE Guideline 179- Pressure ulcers: prevention and management of pressure ulcers. 16) Can you provide details on how the NICE Guidelines is implemented and how you monitor compliance? 17) Can you supply the total number of patients in each of the last five calendar years that had d. Cate gory 4 pressure ulcers Page 2 of 5

3 2016 to date Response 1) The Royal Cornwall Hospitals Trust works from the Cornwall Health Community formulary, it also works from a Royal Cornwall Hospitals Trust formulary that is based on the county wide formulary. Please refer to appendix 1 Cornwall and Isles of Scilly Joint Formulary 2) The Royal Cornwall Hospitals NHS Trust does not have a specific process in place to enforce the formulary, however items are supplied via a ward top up system and ward stock is based on the current formulary. Any items requested outside of the formulary are blocked from being ordered by NHS supplies and Tissue Viability advice sought as to the alternatives. 3) Please be advised that this information is not recoded on our electronic systems, to provide the information it would require visiting every clinical area; however, I have estimated that it would exceed the appropriate limit¹ to complete a manual trawl of the monthly products used to determine what is being asked. 4) The wound care products that the Royal Cornwall Hospitals NHS Trust use that are not currently included in the formulary are as follows: Opsite post-op (some surgeons request not to change to Hydrofilm Plus. Mepitel (some surgeons request not to change to Adaptic touch) The use of all non-formulary items have been agreed by clinical divisions 5) Please be advised that this information is not recoded on our electronic systems, to provide the information it would require visiting every clinical area; however, I have estimated that it would exceed the appropriate limit¹ to complete a manual trawl of the monthly products used to determine what is being asked. 6) The Royal Cornwall Hospitals Trust reviews the formulary annually; the last review was conducted in Page 3 of 5

4 7) The Royal Cornwall Hospitals Trust can confirm that when reviewing the formulary that a number of meetings are held with the community tissue viability team, the Clinical Commissioning Group, Pharmacy leads and the Royal Cornwall Hospitals NHS Trust tissue viability team. All items included in the formulary are discussed and alternatives reviewed where required. Throughout the year some products may be evaluated in readiness for inclusion in the formulary. The outcomes of the review meetings are discussed along with financial appraisal, if required the appropriate changes are made. Clinical evidence is also reviewed as part of the formulary meetings and discussions. Consideration is also given to the levels of education and support provided to introduce a change in wound dressing. It is made very clear by the clinicians that there must be a cost vs clinical efficacy discussion to ensure that using the least expensive products is actually the best cost effective solution. Sometimes the cheapest dressing may not be the most cost effective in relation to the length of time it can stay in place or its clinical benefits. We are also very aware of the need to ensure there is continuity between providers in relation to the formulary however in some cases the wound dressing costs on FP10 are more expensive than through supply chain and vice versa. This therefore is taken into consideration and an alternative may be sought. 8) Can you supply the number of tissue viability nurses employed in f wte (whole time equivalent) g wte h wte i wte j wte 9) The Royal Cornwall Hospitals NHS Trust does not employ leg ulcer nurses. 10) The Royal Cornwall Hospitals NHS Trust is an Acute Hospital therefore does not employ any Practice Nurses. 11) Unfortunately due to the way the information is recorded electronically we are unable to break the costs down to product category for questions as requested, however I have estimated that it would exceed the appropriate limit¹. 12) The Royal Cornwall Hospitals Trust have a Pressure Ulcer Prevention Policy, this was updated in 2016 and reflects NICE guideline 179 Pressure Ulcers: Prevention and Management of Pressure Ulcers 13) The Royal Cornwall Hospitals Trust implements guidelines as these are embedded into Trust policy, patient records and education and training. Toolbox training is a method where a large number of staff are educated and the pressure ulcer prevention toolbox has been delivered in 2014 and There are also study days provided on a regular basis and pressure ulcer prevention also forms part of the HCA, Assistant practitioner and Excellence in practice days. The key elements are monitored through monthly quality nursing indicators. These are then produced on a monthly Performance assurance framework and reviewed by Senior Nursing teams. Monthly pressure ulcer incident reports are produced and shared with the clinical directorates, and exception reporting occurs via the Governance Collaborative Committee meeting. The Trust also reports through the Safety Thermometer monthly. Page 4 of 5

5 14) The total number of patients in each of the last five calendar years are as follows: 2012 e. Category 1 pressure ulcers = 19 f. Category 2 pressure ulcers = 156 g. Category 3 pressure ulcers = 4 h. Category 4 pressure ulcers = e. Category 1 pressure ulcers = 78 f. Category 2 pressure ulcers = 372 g. Category 3 pressure ulcers = 3 h. Category 4 pressure ulcers = e. Category 1 pressure ulcers = 41 f. Category 2 pressure ulcers = 306 g. Category 3 pressure ulcers = 5 h. Category 4 pressure ulcers = e. Category 1 pressure ulcers = 67 f. Category 2 pressure ulcers = 356 g. Category 3 pressure ulcers = 9 h. Category 4 pressure ulcers = to date e. Category 1 pressure ulcers = 67 f. Category 2 pressure ulcers = 235 g. Category 3 pressure ulcers = 1 h. Category 4 pressure ulcers = 2 Attachment(s) Appendix 1 Cornwall and Isles of Scilly Joint Formulary Date Response Sent: 14 October 2016 ¹The appropriate limit is specified in regulations and for RCHT this is set at 450. This represents the estimated cost of 1 person spending 2½ working days in determining whether RCHT hold the information, locating, retrieving and extracting the information. Consequently RCHT is not obliged under Section 12 of the Freedom of Information Act 2000 to respond to this part of your request. Page 5 of 5

6 NECROTIC ODOUR INFECTED / COLONISED Cornwall & Isles of Scilly Joint Dressings Formulary 2015/16 - To be used in conjunction with the order form Hydrocolloid PRODUCT DRESSING GUIDANCE FOR USE AND COMMENTS ActivHeal Hydrocolloid ActivHeal Foam Hydrocolloid Comfeel Plus Transparent Comfeel Plus Any level of exudate, wear time 3-7 days. Hydrogel ActivHeal Hydrogel Use to hydrate dry wounds Hydrogel dressing Hydrogel sheet Charcoal Dressing (Non-absorbant) Antimicrobial Primary Silver Dressing Intrasite Conformable ActiFormCool CliniSorb Anabact Urgotul SSD Alginate/Manuka honey Algivon Plus RCHT use only Honey dresssing Antibacterial Cadaxomer Iodine Activon Tulle Activon Tube Flamazine (Silver Sulfadiazine 1% cream) 50g Iodoflex As above with the addition of a foam backing to increase absorption and increase comfort Comfeel is for low to medium exudate wounds. Can be left in place for a week. Warm before application. Do not use on infected wounds Not RCHT. FOR WOUND DEBRIDEMENT ONLY Single Use Application Daily. 10 x 10cm (equiv to 8g) 10 x 20cm (equiv to 15g) (RCHT 1st line)to remain in place for 2-3 days. Use for rehydration and debridement. Cut to size, can be used layered. Carbon dressing for malodorous wound. (Primary care only) Metronidazole gel for malodorous wounds. (RCHT use Metronidazole gel - obtain from pharmacy) Effective against MRSA and Pseudomonas spp. Urgotul SSD can be left in place for upto a week, select size of dressing to fit size of wound. Should be used for 2-3 weeks only then reviewed. Discuss with Tissue Viability for further advice and most appropriate product. Primarily used in the initial treatment of burns, if infected. Water based so can increase levels of exudate. Only use on dry wounds and apply daily. Max 7 day open storage time. Primarily used for sloughy wounds as an antibacterial. Change every 3 days or when white. 3 months on, 1 week off. Thyroid Function Test monthly. GRANULATIN G EPITHELIALIS ING MISCELLANEOUS Non Adherent Silicone PRODUCT DRESSING GUIDANCE FOR USE AND COMMENTS Adhesive Island Atrauman Telfa Adaptic Touch Hydrofilm Plus (water & bacteriaproof) Use where contact layer requires changing 3-4 times weekly (Podiatry) Absorbant, perforated plastic film faced dressing Use where Atrauman is inappropriate. CHANGE WEEKLY. Use on trauma and post-operative wounds when a WATERPROOF/BACTERIA PROOF is required. Semi-permeable Adhesive Hydrofilm Use as secondary dressing to aid debridement or to protect newly epithelising wounds. Absorbent Cellulose Dressing Barrier Negative Pressure Therapy Atraumatic skin closure Wound Irrigation Surgical Tape Zetuvit E Sterile Zetuvit Plus Cavilon film Cavilon Barrier cream 28g Vacuum Assisted Closure PICO Leukostrip on FP10. Steri-strips via EROS Clinipod Irripod Scanpor Finepore Additions/changes marked in yellow Items in blue - 2nd line formulary choice - not RCHT Items in red - Specialist initiated RCHT - shown for information, products interchangable x Absorbent cellulose dressing with fluid repellent backing, use for low level exudate Absorbent cellulose dressing with fluid repellent backing, use for heavy exudate Prevents maceration and for general skin protection. Ensure correct application. One application stick lasts 72 hours. DO NOT OVER APPLY. 28g tube should be sufficient for 1 months supply. Pea-sized amount applied daily or every 3rd to 4th episode of incontinence. Tissue Viability initiation only. Dressings available on FP10. For use on chronic wounds ( i.e. > 6 weeks) only. Wound reviewed by TV to assess response to treatment. Discontinue if wound becomes static. Used for skin flaps, trauma injuries etc. (RCHT use Steripods) Irrigate only if loose debris present. Dressing & bandage retention. Finepore - EROS order only (RCHT) Bleeding Wounds Kaltostat To aid the cessation of bleeding in wounds Keloid Scarring Cica-Care Tissue Viability Team advice only SLOUGHY Iodine Tulle Alginate flat sheet Alginate Pad Protease Modulating Matrix Rapid Capillary Dressing Povitulle Sorbsan Flat Sorbsan Plus Aquacel Extra (lasts 3-7 days depending on exudate) Urgoclean Vacutex Arterial, diabetic and trauma wounds. Change when white or wet. Short term single use only. (RCHT use Urgoclean flat 1st line) Use where daily applications are required due to wound site requiring daily bathing. (RCHT use Urgoclean 1st line) As above. Alginate with absorbent pad. Not RCHT. Management heavy exudate levels. Fibrous hydrocolloid. MUST OVERLAP WOUND EDGE. DO NOT USE RIBBON. For low to moderate wounds when Aquacel Extra not clinically appropriate Minimal exudate - secure with film dressing. Cut to size of wound. Single use only. High exudate - USE FOAM. Dressing pack Nurse it (Alvita) Dressit Glove size - suggest order M/L Gauze Swabs Type 1 retention bandage Sterile (7.5cm) Non-sterile K-Band Pack of 5 gauze swabs Pack of 100 gauze swabs Type 2 Light Support Profore #2 (RCHT use Hospicrepe) Class 3A light comp K-Plus Class 3B mod comp Profore #4 (RCHT use Coban) Cavity Biotherapy Sorbsan Ribbon Larvae - Maggots ActivHeal Foam Adhesive (RCHT use Urgoclean rope) Single use only. (RCHT available from pharmacy) Wound Debridement available on FP10. Consult Tissue Viability prior to ordering. Order direct from BioMonde (Tel: ) (Primary care only) Light to moderate exudate. Remove with wet gauze. BANDAGES Cohesive Short Stretch Stockinette Elasticated tubular bandage Actico Acti-Fast blue - 7.5cm Actifast yellow 10.75cm easigrip (RCHT Comfifast range) GRANULATING Foam (Adhesive) Foam (Non-Adhesive) Advazorb Border Advazorb Border Lite Biatain Adhesive PolyMem Biatain Non-Adhesive Advazorb USE ONLY FOR SENSITIVE OR FRIABLE SKIN. Use for light to moderate exudate. (formerly Advazorb silfo) (RCHT Biatain adhesive/gentle 1st line) Low to moderate exudate. Changed at least weekly depending on indicator for change. Shower and bath proof and bacteria proof. Used in radiotherapy and rheumatology. For light to moderate exudate, contains a nonionic surfactant Light to moderate exudate. USE ONLY FOR SENSITIVE OR FRIABLE SKIN. For moderately to heavily exudating wounds Paste bandage Padding Elastic Hosiery Viscopaste K-Soft Profore #1 Activa brand For use only when allergic to K-Soft PolyMem (RCHT specialist use - obtain from Equipment Library) Used in radiotherapy and rheumatology. For light to moderate exudate, contains a non-ionic surfactant Final Version May 2015 To be reviewed May 2016 Joanne Richards `