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Dressings on the Drug Tariff

Andrew Heenan RMN RGN BA(Hons)
Editor,
World Wide Wounds
a.heenan@smtl.co.uk
Introduction References
Submitted: 18 November 1998
Published: 13 December 1998
Edition 4.0

Bandages on the Drug Tariff
Previous Drug Tariff articles



Introduction

In the UK, the availability of dressings for use in patients' homes is dictated by the Drug Tariff[1]. This monthly publication defines what may be prescribed in the community (and paid for by the National Health Service).

The Drug Tariff is not an arbitrary list; it contains only those products that are tried and tested; so it tends to exclude the latest products. The exact criteria for selection are not published, but it may not be a coincidence that products with a lower unit cost have, in the past, had a greater chance of quick inclusion than more expensive products. This, it might be suggested, shows a lack of understanding of the principles of wound management: a higher unit cost might apply to a product which needs applying less frequently and/or requires less time and skill to apply. Such a product might be more cost effective over a period of time.

The Drug Tariff has also shown obscure prejudice against certain areas; cavity wound dressings, and dressings for malodorous wounds have fared badly.

Recently, however, the Drug Tariff seems to have become more closely related to the market place and to patients' needs. New products, particularly those with a CE mark, and new sizes/formulations of existing products, appear to reach the Tariff more easily.

The Drug Tariff matters, because products that are not included cannot be obtained on an FP10 prescription (England and Wales; GP10 in Scotland) (Hospitals are not bound by the Drug Tariff; they are free to draw up their own lists of acceptable purchases - but that is another story!). In practice, non-Tariff dressings are obtained by the time honoured techniques of begging, stealing and borrowing. Hospital staff need to be aware of the Drug Tariff and its limitations, in order to plan for continuity of wound management as patients go home.

This article (and its companion, Bandages on the Drug Tariff reflect on information already available in the Drug Tariff [1], arranged in tables for convenience. These articles intentionally exclude obsolete dressings and gauze swabs which are used for cleansing purposes as well as items like paraffin gauze which are still available on community prescription, but are rarely the dressing of choice[2], particularly those impregnated with antibiotics which are an anachronism to be avoided. Colonization and contamination are not an indication for topical antibiotics, rather an imperative to effect wound healing as quickly as possible, and any sign of significant wound infection is an indication for appropriate systemic antibiotics.

This edition updates May's edition; the article now excludes all bandages, which are discussed in Bandages on the Drug Tariff. All details and links have been checked, and price changes are included from the latest (October) edition of the Drug Tariff. There is one new sections:
Activated Charcoal Cloth with Silver; this is a major step forward for the Drug Tariff, which hitherto has denied the existence of malodorous wounds.


Absorbent, perforated plastic film faced dressings

These dressing were probably the first serious attempt to improve on the cotton gauze 'dry dressing', and combine absorbency with reduced risk of adherence. They were also the first to be described as 'non-stick' or non adherent, a claim that brings them close to falling foul of the Trades Descriptions Act (1963). Compared with the fabric dressings used before, however, they were certainly low adherent.
Perforated film absorbent dressings
Melolin (Smith & Nephew) 5cm x 5cm 13p
10cm x 10cm
21p
20cm x 10cm
41p
Release (Johnson & Johnson) 5cm x 5cm
12p
10cm x 10cm
20p
20cm x 10cm
37p
Skintact (Robinson) 5cm x 5cm
10p
10cm x 10cm
17p
20cm x 10cm
33p



Absorbent, perforated film dressing with adhesive border

Absorbent, perforated film with adhesive border Pad Border
Mepore
(Mölnlycke)
6cm x 7cm 8p 3cm x 4cm 1.5cm
9cm x 10cm
17p
5cm x 6cm 2cm
9cm x 15cm
29p
5cm x 10cm 2.0 - 2.5cm
9cm x 20cm 35p 5cm x 15cm 2.0 - 2.5cm
9cm x 25cm 48p 5cm x 20cm 2.0 - 2.5cm
9cm x 30cm 55p 5cm x 25cm 2.0 - 2.5cm
9cm x 35cm 60p 5cm x 30cm 2.0 - 2.5cm
Primapore
(Smith & Nephew)
6cm x 8.3cm 14p 3.4cm x 5.7cm 1.3cm
8.25 x 12cm 22p 4.5cm x 7.3cm 1.875-2.35cm
8.25cm x 18cm 32p 4.5cm x 12cm 1.875-3.0cm
8.25 x 25 37p 4.5cm x 19cm 1.875-3.0cm
12cm x 35cm 80p 6.6cm x 29cm 2.7-2.95cm



Knitted viscose primary dressing BP

These dressings are designed to be used with a secondary dressing, depending on the level of absorbency required; they rely on the low adherent property of knitted viscose.
Knitted viscose primary dressings
N-A Dressing (Johnson & Johnson) 9.5cm x 9.5cm
30p
N-A Ultra (1) (Johnson & Johnson) 9.5cm x 9.5cm
28p
Tricotex (Smith & Nephew) 9.5cm x 9.5cm
26p

Povidone iodine fabric dressing

A knitted viscose primary dressing impregnated with povidone iodine
Povidone iodine fabric dressing
Inadine
(Johnson & Johnson)
5cm x 5cm
27p
9.5cm x 9.5cm
40p



Vapour permeable adhesive film dressing BP

Though they have found a variety of uses in securing primary dressings intravenous cannulae and other medical devices, their main indication is lightly exuding, clean, superficial wounds.
Vapour permeable adhesive film dressings
Bioclusive
(Johnson & Johnson)
10.2cm x 12.7cm
£1.29
Cutifilm
(Beiersdorf)
7.5cm x 10cm
£0.65
10cm x 14cm
£1.11
EpiView
(Convatec)
6cm x 7cm
£0.40
10cm x 12cm
£1.05
Mefilm
(Mölnlycke)
6cm x 7cm
£0.37
10cm x 12.7cm
£0.99
10cm x 25cm
£1.93
15cm x 21.5cm
£2.45
Opsite Flexigrid
(Smith & Nephew)
6cm x 7cm
£0.43
10cm x 12cm
£1.22
15cm x 20cm
£2.90
Tegaderm
(3M Health Care)
12cm x 12cm
£1.21
15cm x 20cm
£2.30



Activated charcoal cloth with silver

Activated charcoal cloth with silver
Actisorb Plus
(Johnson & Johnson)
10.5cm x 10.5cm £2.20
10.5cm x 19cm £4.00



Alginate dressings

Possibly one of the most underrated of primary dressings, alginates have the supreme advantage over their competitors that the dressing can simply be soaked off with saline or a low-force shower; even after several days. Useful for medium to heavily exuding wounds (or parts of wounds), alginates are not the dressing of choice for infected wounds; there is little point in using alginates for dry wounds.
Alginate dressings
Algisite
(Smith & Nephew)
5cm x 5cm
£0.72
10cm x 10cm
£1.49
15 x 20cm
£4.00
Algosteril
(Beiersdorf)
5cm x 5cm
£0.74
10cm x 10cm
£1.69
Comfeel SeaSorb
(Coloplast)
6cm x 4cm
£0.72
10cm x 10cm
£1.50
15cm x 15cm
£3.10
Kaltogel
(Convatec)
5cm x 5cm
£0.71
10cm x 10cm
£1.48
Kaltostat 
(Convatec)
5cm x 5cm
£0.73
7.5cm x 12cm
£1.59
Melgisorb
(Molnlycke)
5cm x 5cm
£0.71
10cm x 10cm
£1.48
10x 20cm
£2.78
Sorbsan
(Maersk)
5cm x 5cm
£0.91
10cm x 10cm
£1.60
Tegagel
(3M Health Care)
5cm x 5cm
£0.73
10cm x 10cm
£1.54
Alginate dressing with absorbent backing
Sorbsan Plus
(Maersk)
7.5cm x 10cm
£1.43
10cm x 15cm
£2.53
10cm x 20cm
£3.23



Hydrocolloid dressings

Probably the first dressings to fully exploit the concept of moist wound healing, there is still a major role for hydrocolloid dressings in light to medium exuding wounds. Hydrocolloids are not ideal for infected wounds. The dressing requires a margin of smooth skin around the wound to ensure adhesion. Dressings need frequent change with heavily exuding wounds.
Hydrocolloid dressings: 1. Semipermeable With Adhesive Border
Comfeel Plus Contour Dressing
(Coloplast)
6cm x 8cm (1)
£1.70
9cm x 11cm (1)
£2.95
Granuflex (Bordered)
(Convatec)
10cm x 10cm (2)
£2.55
10cm x 13cm (3)
£3.01
15cm x 18cm (3)
£4.69
Hydrocoll Border
(Hartmann)
5cm x 5cm (4)
£0.84
7.5cm x 7.5cm (4)
£1.38
6cm x 14cm (5)
£1.77
10cm x 10cm (4)
£2.01
15cm x 15cm (4)
£3.78
15cm x 18cm (5)
£3.01
Tegasorb Advanced Formulation
(3M Health Care)
10cm x 12cm (6)
£2.05
13cm x 15cm (6)
£3.83
Hydrocolloid dressings: 2. Semipermeable Without Adhesive Border
Comfeel (bevelled edge)
(Coloplast)
10cm x 10cm
£2.13
15cm x 15cm
£4.27
20cm x 20cm
£6.53
Comfeel Plus Ulcer Dressing
(Coloplast)
10cm x 10cm
£2.19
15cm x 15cm
£4.36
18cm x 20cm
£4.40
20cm x 20cm
£6.54
Cutinova Foam
(Beiersdorf)
5cm x 6cm
£0.99
10cm x 10cm
£2.13
15cm x 20cm
£3.88
Granuflex (Improved Formulation)
(Convatec)
10cm x 10cm
£2.14
15cm x 20cm
£4.40
15cm x 15cm
£4.06
20cm x 20cm
£6.11
Hydrocoll Basic
(Hartmann)
10cm x 10cm
£2.04
15cm x 20cm
£4.34
20cm x 20cm
£5.98
Tegasorb Advanced Formulation
(3M Health Care)
10cm x 10cm
£2.09
15cm x 15cm
£4.05
Hydrocolloid dressings: 3. Thin Semipermeable No Adhesive Border
DuoDerm Extra Thin (Convatec) 7.5cm x 7.5cm
£0.61
10cm x 10cm
£1.01
15cm x 15cm
£2.18
Hydrocoll Extra Thin
(Hartmann)
7.5cm x 7.5cm
£0.58
10cm x 10cm
£0.96
15cm x 15cm
£2.16
Hydrocolloid dressings: 4. Thin Semipermeable + Adhesive Border
Combiderm
(Convatec)
10cm x 10cm (1)
£1.27
14cm x 14cm (2)
£1.77
15cm x 18cm (3)
£3.06
20cm x 20cm (2)
£3.40
20cm x 23cm (4)
£4.10
Hydrocolloid dressings: 5. Fibrous, No Adhesive Border
Aquacel
(Convatec)
5cm x 5cm
£0.89
10cm x 10cm
£2.12
15cm x 15cm
£3.99

Hydrogel dressings

Particularly useful for dry, sloughy or necrotic wounds, hydrogels have a role in lightly exuding wounds and granulating wounds. Hydrogels are not suitable for infected or heavily exuding wounds; an appropriate secondary dressing is required.
Hydrogel dressings
AquaForm (Robert Bailey) 15g
£1.74
Granugel Hydrocolloid Gel (Convatec) 15g
£1.78
Intrasite Gel (Smith & Nephew) 8g
£1.38
15g
£1.85
Nu-Gel (Johnson and Johnson) 15g
£1.75
Purilon Gel (Coloplast) 15g
£1.78
Sterigel (Seton) 15g
£1.78



Polyurethane foam dressing BP

Indicated for light to medium exuding wounds; not recommended for dry superficial wounds.
Polyurethane foam dressing
Lyofoam
(Seton)
7.5cm x 7.5cm
£0.89
10cm x 10cm
£1.05
17.5cm x 10cm
£1.63
20cm x 15cm
£2.20

Polyurethane foam/film dressings

Indicated for light to medium exuding wounds; not recommended for dry superficial wounds.
Polyurethane foam/film dressing: 1. with adhesive border
Allevyn Adhesive
(Smith & Nephew)
7.5cm x 7.5cm (1)
£1.17
12.5cm x 12.5cm (1)
£2.10
17.5cm x 17.5cm (1)
£4.14
22.5cm x 22.5cm (1)
£6.03
Lyofoam Extra Adhesive
(Seton)
15cm x 15cm (2)
£2.10
22cm x 22cm (3)
£4.14
22cm x 26cm (3)
£3.26
30cm x 30cm (4)
£6.02
Tielle (Adhesive Margin)
(Johnson & Johnson)
7cm x 9cm (5)
£1.07
11cm x 11cm (5)
£1.99
15cm x 15cm (5)
£3.25
15cm x 20cm (5)
£4.07
18cm x 18cm (5)
£4.14
18cm x 18cm (6)
£3.01
Polyurethane foam/film dressing: 2. Without adhesive border
Allevyn (Non-adhesive)
(Smith & Nephew)
5cm x 5cm
£0.99
10cm x 10cm
£1.96
10cm x 20cm
£3.15
20cm x 20cm
£5.26
Flexipore
(Polymedica)
6cm x 7cm
£0.93
10cm x 10cm
£1.73
10cm x 30cm
£3.60
15cm x 20cm
£3.70
20cm x 20cm
£5.06
Lyofoam Extra (Non-adhesive)
(Seton)
10cm x 10cm
£1.75
10cm x 17.5cm
£2.96
10cm x 25cm
£3.59
15cm x 20cm
£3.84
Spyrosorb (Adhesive)
(Perstorp)
10cm x 10cm
£1.98
20cm x 20cm
£5.65


Final Note

This article is not intended to provide advice on the suitability of a particular dressing for a particular wound; it is intended simply to be a guide to dressings availability in Great Britain. The warnings and uses given are indicative only, and are largely taken from the Drug Tariff [1] and the British National Formulary [2], but any opinions expressed are those of the author. Readers are urged to refer to manufacturers' information and published research before using any dressing. The Drug Tariff is updated on a monthly basis and is available on subscription from HMSO.

Other Drug Tariff articles in World Wide Wounds

Bandages on the Drug Tariff Edition 1.0 (November 1998)

Dressings on the Drug Tariff: Previous Editions:
Edition 3.1 (07 May 1998)
Edition 3.0 (16 Feb 1998)
Edition 2.0 (19 Sept 1997)
Edition 1.1 (31 July 1997)
Edition 1.0 (14 July 1997)

References

1. Department of Health. Drug Tariff. London: HMSO, October 1998

2. British National Formulary. London BMA/RPSGB, September 1998


All materials copyright © 1992-Feb 2001 by SMTL, March 2001 et seq by SMTL unless otherwise stated.

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