Dressings Formulary. Issue 5 Published January NHS Great Yarmouth & Waveney CCG in conjunction with East Coast Community Healthcare

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1 Great Yarmouth and Waveney Clinical Commissioning Group HealthEast Dressings Formulary 2017 Issue 5 Published January 2017 NHS Great Yarmouth & Waveney CCG in conjunction with East Coast Community Healthcare Revision date: April 2018

2 Updates: New to the formulary issue 5 or replacing a product from issue 4 Biatain TM Non-adhesive (new) Comfeel TM Plus (replacing Granuflex TM and Granuflex Bordered) Purilon TM gel (replacing Nu-Gel TM ) KerraLite TM Cool Non-adhesive (replacing Aciform TM Cool) KerraLite Cool Border (New) UrgoClean TM with probe (replacing Sorbsan TM Rope) Chemipore TM (replacing Scanpore TM ) PRIMAFIX Tape (replacing Mefix TM tape) Nurse It sterile dressing pack (replacing Polyfield TM Nursing homes only) Debrisoft TM Lolly (new) SECURA No-Sting Barrier Film (new) No longer in formulay Granuflex TM Actiform TM Cool Gauze and cotton tissue (Gamgee TM ) Algivon TM Plus Activon TM Tulle Tegaderm TM Film (only IV size available) Sorbsan TM Ribbon PROFORE Multi-layer Kit Stericlens Aquacel TM lubricating jelly Bowel products Emollient formulary 2 Dressing Formulary 2017

3 Contents Introduction Pathway TIME * to prepare for optimal healing Foams Hydrocolloid Hydrogel Film Dressing Primary Dressings Alginate Dressings Gelling Fibre Odour Control Dressings Absorbent Dressings Super Absorbent Dressings Medicated Bandages (Antimicrobial) Medicated Dressings (Antimicrobial) Short Stretch Compression Bandages Multi-Layer Bandaging Systems Retention Bandages Lightweight Elasticated Viscose Tubular Bandage Elasticated Tubular Bandages / Stockinette Tapes Sterile Dressing Pack Swabs Wound Cleanser Wound Debridement Barrier products Dressings listed alphabetically *International Advisory Board on Wound Bed Preparation Schultz GS, Sibbald RG, Falanga V et al., Wound Rep Reg (2003);11:1-28. Wound Bed Preparation and TIME are clinical concepts supported by Smith & Nephew Dressing Formulary

4 Introduction to Issue 5 of the Dressing Formulary Welcome to the fifth edition of the dressing formulary. We have redeveloped the formulary and pathway alongside our colleagues within ECCH and our Practice nurses, to help support the choice of the most appropriate dressing from the formulary. This Formulary is intended to be used within NHS Great Yarmouth and Waveney Clinical Commissioning Group, for locally contracted Community Services, GP practices and Nursing Homes. NHS supply chain deliver dressings directly to District Nurse bases and GP practices. This is intended to Speed up the process of obtaining dressings for patient care Reduce waste from the previous system of destruction of used patients dressings Reduce waste from stockpiling in patients home Increase adherence to formulary products Allow closer monitoring and control of non-formulary items Lead to reduced costs Reduce the amount of dressings supplied on prescription Nursing homes have to request prescriptions from the GP for NURSING RESIDENTS ONLY. They are supplied with an order form which is designed to be used with the formulary. We recommend that prescriptions for dressings are for a two week supply as there should be a clinical assessment and review every two weeks following the TIME pathway. We hope all parties will help us to achieve the above aims. 4 Dressing Formulary 2017

5 We will try and support the use of alternative dressings that are not in the formulary. These dressings may be requested from the acute sector or specialist nursing. Dressings should be supplied for a maximum of 14 days and then go through a review process every two weeks to ensure the clinical need for that the dressing is still appropriate. ECCH may also be able to advise if the dressing can switched to an appropriate dressing within our locally agreed formulary. Michael Dennis, Prescribing Advisor for NHSGYWCCG Formulary produced by Roisin Hawkes Pharmacy Technician Medicine Optimisation Team NHSGYWCCG with advice from the Clinical Service Leads from East Coast Community Healthcare s (ECCH) District Nursing Team, Tissue Viability Nurse and Practice Nurses from NHSGYWCCG. For clinical advice please contact ECCH on Formulary issues: please contact GYWCCG.medsqueries@nhs.net Dressing Formulary

6 Pathway STEP 1 STEP 2 STEP 3 STEP 4 Holistic Assessment Complete a Holistic Assessment including the following: Presenting complaint and comprehensive clinical history Social Factors and Chronic Disease Clinical Observations i.e. TPR/BP/BM/Blood Tests. Waterlow and Nutritional assessment Pain assessment Wound Aetiology Type of wound and mechanism of injury Wound Measurements location, size, base and depth Photograph Complete Wound Assessment Template (Evaluate findings) Time Assessment T Tissue Non-Viable/Deficient or Viable I Infection or Inflammation M Moisture Balance E Edge Treatment Options Identify Patient goal Promote Self-care advise on nutrition, hydration and exercise. Identify stage of wound. Dressing selection refer to formulary. Care plan and frequency of visits. Documentation provide rational for treatment. 6 Dressing Formulary 2017

7 STEP 5 Wound Evaluation Review wound every TWO weeks or sooner if it deteriorates. Repeat steps 1-4 in your review. Healed: Provide appropriate after care advice and discharge Non-Healing: please follow below Community/Hospital Teams Request Senior review after SIX weeks or if you are concerned before the six week review. If wound remains non-healing, refer to Tissue Viability Nurse. Practice/Nursing Home Team Request Tissue Viability Nurse advice/support after SIX weeks if wound non-healing or earlier if you are concerned. Dressing Formulary

8 TIME ** to prepare for optimal healing TIME Tissue Inflammation and/or Infection Wound Bed Appearance Viable Granulation Epithelisation Non Viable Slough Necrotic Superficial Tissue Infection Non-Healing Increased Exudate Friable Granulation Tissue Bright Red Granulation New areas of Necrosis Deep tissue infection Pain Increased size Warmth Erythema >1-2cm Odour Exposed Bone Clinical Action Promote Wound Healing Protect Fragile Skin Remove Defective Tissue Debride Do not rehydrate dry Eschar wounds To Manage Bacterial Burden Topical Antimicrobials. Debridement of devitalised tissue. If clinical signs of infection are indicated: Swab wound and liaise with GP. Low exudate Primary dressing High exudate CUTIPLAST OPSITE Atrauman TM * NA Ultra* Urgotul TM * Duoderm TM Thin Foam (see formulary) Comfeel TM Plus ALLEVYN LIFE Purilon TM Gel Duoderm Thin Comfeel Plus ALGISITE M Urgo TM Clean Rope DURAFIBER Kerralite TM Cool Kerralite Cool BDR Flaminal TM Hydro (Hydrates)* Activon TM Actilite TM Inadine IODOFLEX ALGISITE M Flaminal Forte (Absorbs)* Application of above to be restricted to TWO WEEKS, followed by a wound review Secondary dressing (if required) Gauze PRIMAFIX Retention Bandage Gauze NA-Ultra Zetuvit TM E Kerramax TM PRIMAFIX Retention Bandage Gauze CUTIPLAST N-A Ultra Zetuvit E PRIMAFIX Retention Bandage Outcome Viable Wound Bed Reduced Inflammation Comment Refer ALL Diabetic patients with Foot Ulcers to Podiatry. Monitor wound daily if applying a Hydrocolloid dressing to a diabetic wound. INADINE/IODOFLEX refer to manufactures guidance. Actilite/Activon consider monitoring capillary blood glucose in patients with DIABETES. *Gauze can be used as a secondary dressing with these products **The above is adapted from table 6, International Advisory Board on Wound Bed Preparation Schultz GS, Sibbald RG, Falanga V et al., Wound Rep Reg (2003);11:1-28. Wound Bed Preparation and TIME are clinical concepts supported by Smith & Nephew 8 Dressing Formulary 2017

9 Moisture Balance Edge of Wound Non-Advancing Heavy exudate (Can increase the risk of maceration). Dry wound bed E.g. Chronic Wound with prolonged inflammation. To restore moisture balance To avoid maceration and absorb exudate or to increase hydration of the wound bed. Do not rehydrate dry eschar wounds Seek advice Donates Moisture Manages Moisture Duoderm TM Thin Comfeel TM Plus Purilon TM Gel Kerralite TM Cool Foam (see formulary) ALGISITE M DURAFIBER Urgo TM Clean Rope Kerramax TM If evidence of maceration, apply either: Secura No Sting Film spray or Secura Applicator swab. Re-assess cause Review T, I and M Consider referral if non-advancing after 4 weeks Use appropriate dressing from the T. I. M. recommendation If evidence of maceration, apply either: SECURA No-Sting Film spray or SECURA No-Sting Barrier Film swab. Zetuvit TM E KerramaxTM PRIMAFIX Retention Bandage Use appropriate dressing from the T. I. M. recommendation Optimal moisture balance Seek advice before rehydrating dry eschar wounds for patients with DIABETIC or ARTERIAL wounds. Advancing wound bed *The above is adapted from table 6, International Advisory Board on Wound Bed Preparation Schultz GS, Sibbald RG, Falanga V et al., Wound Rep Reg (2003);11:1-28. Wound Bed Preparation and TIME are clinical concepts supported by Smith & Nephew Dressing Formulary

10 Pressure ulcer grading chart Adapted from EPUAP/NPUAP 2009 Superficial EPUAP - Category/Grade I Non-blanchable erythema of intact skin: persistent redness in light pigmented skin. Discolouration of the skin: observe for a change of colour as compared to surrounding skin In darker skin, the ulcer may be blue or purple. Warmth, oedema, induration or hardness as compared to adjacent tissue may also be used as indicators, particularly on individuals with darker skin. May include sensation (pain, itching). EPUAP System - Category/Grade 2 Partial thickness skin loss involving epidermis, dermis or both. Presents clinically as an abrasion or clear blister. Ulcer is superficial without bruising* Check for moisture lesion. *Bruising appearance and blood filled blister would indicate deep tissue injury. Deep EPUAP - Category/Grade 3 Full thickness skin loss. Subcutaneous fat may be visible but bone, tendon and muscle are not exposed. May include undermining and tunneling. The depth varies by anatomical location (bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and grade 3 ulcers can be shallow. In contrast area of significant adiposity can develop extremely deep grade 3 pressure ulcers. Bone/tendon is not visible or directly palpable. Dressing Formulary 2017

11 Deep Plus: Unclassified PU - now Grade 3 Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, grey, green brown, black, eschar) in the wound bed. Until enough slough is removed to expose the base of the wound, the true depth cannot be determined, but it will be either grade 3 or 4. Stable eschar (dry, adherent, intact without erythema or fluctuance) on the heels serves as the body natural (biological) cover and should not be removed. Should be documented as grade 3 until proven otherwise. EPUAP - Category/Grade 4 Full thickness tissue loss with exposed bone (or directly palpable), tendon. Often include undermining and tunneling. The depth varies by anatomical location (bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and grade 4 ulcers can be shallow. Grade 4 ulcers can extend into the muscle and/or supporting structures (eg fascia tendon or joint capsule). Moisture Lesions Redness or partial thickness skin loss involving the epidermis, dermis or both caused by excessive moisture to the skin from urine, farces or sweat. These lesions are not usually associated with a bony prominence. They can however be seen alongside a pressure ulcer of any grade. Dressing Formulary

12 Foams Foam bordered Sizes available Pad size Pack Comments ALLEVYN LIFE.3cm x.3cm 12.9cm x 12.9cm 15.4cm x 15.4cm 21cm x 21cm 5.1cm x 5.1cm 7.6cm x 7.6cm.2cm x.2cm 15.4cm x 15.4cm ALLEVYN LIFE Sacrum 17.2cm x 17.5cm (2.4cm x 8.5cm) ALLEVYN Gentle 7.5cm x 7.5cm cm x cm 15cm x 15cm cm x 20cm 5cm x 5cm 7.5cm x 7.5cm 12.5cm x 12.5cm 7.5cm x 17.5cm Foam non-bordered Sizes available Pack Comments Biatain TM Non-Adhesive Hydrocolloid 5cm x 7 cm cm x cm 15cm x 15cm cm x 20 cm 5 5 Hydrocolloid Dressing Standard Sizes available Pack Comments Comfeel TM Plus ulcer Non adhesive (Bevelled edge) cm x cm 15cm x 15cm Hydrocolloid Dressing Thin Sizes available Pack Comments DuoDERM TM extra thin (without adhesive border) 7.5cm x 7.5cm cm x cm 5 12 Dressing Formulary 2017

13 Hydrogel Hydrogel Preparation Sizes available Pack Comments Purilon TM Gel 8g 15g Hydrogel Dressing Non-Adhesive Sizes available Pack Comments KerraLite TM Cool 6cm x 6cm 12cm x 8.5cm 18cm x 12.5cm Hydrogel Dressing with adhesive border Sizes available Pack Comments KerraLite Cool Border Film Dressing 8cm x 8cm 11cm x 11cm 15cm x 15cm Dressing Sizes available Pack Comments OPSITE Plus (waterproof) 6.5cm x 5cm 25 Nursing homes only OPSITE Post-Op Dressing (Waterproof Dressing) 6.5cmx 5cm 0 Exact same product as Opsite Plus. Formeo only cm x 12cm cm x 20cm cm x 30cm IV Dressing film Sizes available Pack Comments Tegaderm TM IV dressing 7cm x 8.5cm 0 For use with cannulas only Dressing Formulary

14 Primary Dressings Knitted polyester primary impregnated with neutral triglyceride Sizes available Pack Comments Atrauman TM 5cm x 5cm 7.5cm x cm cm x 20cm 20cm x 30cm Must be stored flat Knitted viscose primary dressing BP type 1 Sizes available Pack Comments NA-Ultra TM 9.5cm x 9.5cm 19cm x 19cm Absorbent Perforated dressing with adhesive border Sizes available Pad size Pack Comments CUTIPLAST Steril 5 x 7.2 cm 8 x cm 8 x 15 cm x 20 cm 4cm x 2.7cm 3.8cm x 6.5cm 3.8cm x 11cm 5.5cm x 16cm Soft Polymer dressing Sizes available Pack Comments Urgotul TM 5cm x 5cm cm x cm To be used 2nd line, expensive dressing 14 Dressing Formulary 2017

15 Alginate Dressings Dressing Sizes available Pack Comments ALGISITE M 5cm x 5cm cm x cm 15cm x 20cm Rope Sizes available Pack Comments UrgoClean TM Rope with probe 2.5cm x 40cm 5 Desloughing and haemostatic properties Gelling Fibre Dressing Sizes available Pack Comments DURAFIBER Dressing 5cm x 5cm cm x cm 15cm x 15cm 5 No border Odour Control Dressings 2cm x 45cm 5 Ribbon Dressings Sizes available Pack Comments CliniSorb TM Dressing Absorbent Dressings cm x cm cm x 20cm Dressings Sizes available Pack Comments Zetuvit TM E Sterile cm x cm cm x 20cm 20cm x 20cm 20cm x 40cm Dressing Formulary

16 Super Absorbent Dressings Dressings Sizes available Pack Comments KerraMax TM Care cm x cm cm x 22cm 20cm x 22cm 20cm x 30cm 50 () 50 () 30 () 30 (5) Larger pack sizes on Formeo. Nursing homes continue to order in smaller pack sizes which appear in the brackets Medicated Bandages (antimicrobial) Bandages Sizes available Pack Comments VISCOPASTE PB7 7.5cm x 6m 1 ZIPZOC Stocking* One size 4 Medicated Dressings (antimicrobial) Dressing Sizes available Pack Comments Inadine 5cm x 5cm 9.5cm x 9.5cm 25 IODOFLEX 5g 5 Activon TM Medic Grade Honey in a tube manuka honey Actilite TM (impregnated tulle with honey and manuka oil) 25g cm x cm cm x 20cm single Flaminal TM Hydro gel 15g Tube 5 x 15g Flaminal Forte gel 15g Tube 5 x 15g *20% w/w Zinc oxide impregnated medicated stocking For prescribing information see back of booklet. Legal category P 16 Dressing Formulary 2017

17 Short Stretch Compression Bandages Bandages Sizes available Pack Comments Actico TM cm x 6m 1 Actico does contain latex although in a very low volume Multi-Layer Bandaging Systems Two layer bandages kits Sizes available Pack Comments UrgoKTwo TM Latex Free Kit 18cm 25cm Original pack UrgoKTwo Latex Free Kit Reduced 18cm 25cm Original pack UrgoKTwo Latex Free Kit 25cm 32cm Original pack UrgoKTwo Latex Free Kit Reduced 25cm 32cm Original pack Four layer bandages ( individual) Sizes available Pack Comments PROFORE # 1 latex free formulation cm x 3.5m 12 PROFORE # 2 latex free formulation cm x 4.5m 12 PROFORE # 3 latex free formulation cm x 8.7m 12 PROFORE + latex free formulation cm x 3m 12 Profore + for ankles greater than 25cm PROFORE # 4 latex free formulation cm x 2.5m 12 Retention Bandages Bandages Sizes available Pack Comments K-Band TM 7cm x 4m cm x 4m 15cm x 4m Replacing Knit Band for DN s and Practice Nurses only Nursing home to still use Knit-Band Dressing Formulary

18 Lightweight Elasticated Viscose Tubular Bandage Viscose Tubular Bandage Sizes available Pack Comments Clinifast TM Blue Line 3m or 5m single Clinifast Yellow Line 3m or 5m single Clinifast Beige Line 1m only single Orders placed via Formeo will come in metre lengths Nursing homes are to state either 3 or 5m lengths when ordering Elasticated Tubular Bandages / Stockinette Tubular bandages /stockinette Sizes available Pack Comments Cotton Stockinette Bleached BP 1988 cm x 6m 1 Comfigauz TM 78 20m roll 1 Comfigauz 01 finger 1 District Nurse and Practice nurse only. Formeo Practice nurse only. Formeo Tapes Apertured Permeable Non-Woven Synthetic Adhesive Tape BP 1988 Sizes available Pack Comments Chemipore TM Tape 2.5cm x m 1 If ordering on a prescription please note brand and length Permeable Non-Woven Synthetic Adhesive Tape BP 1988 Sizes available Pack Comments PRIMAFIX 5cm x m cm x m 1 1 If ordering on a prescription please note brand and length 18 Dressing Formulary 2017

19 Sterile Dressing Pack Sterile dressing pack Sizes available Pack Comments Nurse It Sterile Dressing pack small/medium, medium/large (based on glove size) 20 If ordered on prescription please prescribe as Nurse It sterile dressing pack. NHS supply chain may supply a different brand on direct supply Practice Nurse Dressing Pack Without gloves & aprons Swabs One size only 1 Only available for practice nurses. Practice nurses have the choice as to which dressing pack they prefer. These without gloves and aprons are cheaper Swabs Sizes available Pack Comments Non-woven fabric swabs NON-STERILE spec 28, 4ply cm x cm 0 Wound Cleanser Wound Cleanser (sodium chloride) Pod size Pack Comments Irripod TM (sodium chloride 0.9%) 20ml 25 Rigid container Wound Debridement Debridement Pad Size Pack Comments Debrisoft TM Pad cm x cm 5 Please seek training before using this product Debrisoft Lolly (New August 2016) (Pad with handle) 2cm x 5cm 5 Please seek training before using this product Dressing Formulary

20 Barrier products Barrier Preparations Size Pack Comments SECURA No-Sting Barrier Film Spray 28ml 1 May be used on damaged/broken skin SECURA No-Sting Barrier Film Swabs (sterile) 5 Use: to apply to the edges of a wound if protection needed. (On Formeo comes in pack of 50) 3ml When requesting a prescription for a barrier product please request ConotraneTM cream in tubes of 0g. This is the CCGs barrier of choice on unbroken skin, if skin is broken then please use SECURA No-Sting Barrier Film spray/swabs until skin has healed and then advise patient to return to using Conotrane cream. GPs please note District Nurses and Nursing homes do not have direct supply to barrier products other than SECURA. 20 Dressing Formulary 2017

21 Dressings listed alphabetically Product Section Page Actico TM Bandage Short stretch compress 17 Actilite TM Honey Dressing Medicated & Honey 16 Activon TM Honey Tube ALGISITE Medicated & Honey 16 M Dressing Alginate 15 ALLEVYN LIFE Bordered Foam 12 ALLEVYN LIFE Sacrum Bordered Foam 12 ALLEVYN Gentle Bordered Foam 12 Atrauman TM Primary 14 Biatain TM Foam Non-Bordered Foam 12 Chemipore TM Tape Tapes 18 Clinifast TM Elasticated stockinette 18 Clinisorb TM Odour control 15 Comfeel TM Plus Hydrocolloid 12 CUTIPLAST Steril Low adherence 14 Conotrane TM Cream Barrier 20 Debrisoft TM Pad Debridement 19 Debrisoft Lolly Debridement 19 DuoDERM TM Extra Thin Hydrocolloid 12 DURAFIBER Hydrocolloid Fibrous 12 DURAFIBER Ribbon Hydrocolloid Fibrous 12 Flaminal TM Hydro gel Medicated 16 Flaminal Forte gel Medicated 16 Inadine Medicated dressing 16 IODOFLEX Medicated dressing 16 Irripod TM Wound cleanser 19 KerraLite TM Cool Non-adhesive Hydrogel dressing 13 KerraLite Cool Hydrogel dressing 13 KerraMax TM Care Super absorbent 16 Knit Band Retention bandage 17 N-A Ultra TM Non-Sterile Fabric Swabs Primary dressing Swabs Dressing Formulary

22 Product Section Page OPSITE Plus Film dressing 13 OPSITE Post-Op Film dressing 13 PRIMAFIX Tape Tapes 18 PROFORE Four layer bandages 17 Purilon TM Gel Hydrogel 13 SECURA No-Sting Barrier Film spray Barrier 20 SECURA No-Sting Barrier Film Swabs Barrier 20 Sterile Dressing packs Sterile dressing packs 19 Stockinette Bleached Stockinette 18 Tegaderm TM IV dressing Film 13 UrgoClean TM Rope with Probe Alginate 15 UrgoKTwo TM 2 layer kit Two layer compression 17 UrgoKTwo 2 layer reduced kit Two layer compression 17 Urgotul TM Dressing Non-adherent lipido-colloid 14 VISCOPASTE Medicated bandage 16 Zetuvit TM E Sterile Absorbent dressings 15 ZIPZOC Stocking Medicated bandages Dressing Formulary 2017

23 Prescribing information ZIPZOC Medicated Stocking (Zinc Oxide impregnated medicated stocking) Abbreviated Prescribing Information Please refer to Summary of Product Characteristics (SmPC) before prescribing Presentation: Sterile rayon stocking (80cm x 7cm) impregnated with 41.5g of ointment containing Zinc Oxide Ph Eur 20% w/w. Indications: To be used as an aid in the treatment of chronic leg ulcers. Where chronic venous insufficiency exists the stocking can be used as a primary contact layer under compression bandaging or hosiery. Dosage and Administration: For Cutaneous use. ZIPZOC should be applied to cover the lower leg from the base of the toes to below the knee. All folds should be smoothed out. To protect clothes from ZIPZOC a suitable outer bandage should be worn. If chronic venous insufficiency exists, ZIPZOC can be used as a primary contact layer under suitable compression bandaging. The duration and frequency of application will depend on the clinical circumstances, but ZIPZOC must be changed no less frequently than weekly. Contraindications Arterial leg ulcers. Known hypersensitivity to zinc oxide or excipients in the ointment. Precautions and Warnings: If the outer bandage is inappropriate or the stocking is not changed with sufficient frequency it can cause the stocking to dry out. Undesirable Effects: Application site pain; Oedema; Application site folliculitis; Erythema. Consult SmPC for further information about adverse events. Legal Category: P Product Authorisation No: PL 14038/00 Cost: Each stocking 4.40 Marketing Authorisation Holder: Smith & Nephew Healthcare Ltd., Healthcare House, 1 Hessle Road, Hull HU3 2BN Further information is available on request from the Marketing Authorisation Holder Date of Preparation: April 2015 Asset Number: Adverse events should be reported. Reporting forms and information can be found at HYPERLINK " yellowcard" \o "External link to yellow card website, opens in a new window" \t "_blank" Adverse events should also be reported to: Smith & Nephew Healthcare Ltd., 1 Hessle Road, Hull HU3 2BN, UK Tel: advice@smith-nephew.com

24 The information and recommendations in this Dressing Formulary booklet are provided by Great Yarmouth and Waveney Clinical Commissioning Group and its physicians and have not been verified by Smith & Nephew. Smith & Nephew accepts no responsibility for the content of this Dressing Formulary booklet and shall not be responsible for any reliance placed on the content. It may harm a patient s health or cause injury to use the products listed in this Dressing Formulary booklet otherwise than in accordance with the uses for which they are licensed. Smith & Nephew does not recommend or promote unlicensed use of any of its products. Professional medical advice should be sought for the use of any product named in this Dressing Formulary booklet. Trademark of Smith & Nephew All Trademarks acknowledged January