Homely Remedies Guidelines for Community Hospital Wards
Version: V6
Ratified By: Medicines Governance & Safety Group
Date Ratified: 14/10/2021
Job Title of Author: Head of Medicines Management
Reviewed by Sub Group or Expert Group: Medicines Governance & Safety Group
Related Procedural Documents: MMPOL30 Medicines Policy
Review Date: 14/10/24
It is the responsibility of users to ensure that you are using the most up to date document template – ie obtained via the intranet.
In developing/reviewing these guidelines Provide Community has had regard to the principles of the NHS Constitution.
Version Control Sheet
Version Date
Author Status Comment
V1 Aug ‘10 Nisha Desai Approved PCT MMC Dec ‘10 New
V2 June 2012 Nisha Desai Approved Review
V3 May 2014 Jayne Lucas Review
V3.1 November 2014 Jayne Lucas MMC November 2014 Ratified
V4 June 2016 Jayne Lucas Review
V5 June2018 Head of Medicines Management
V6 July2021 Senior Medicines Management Technician/Community Health Specialist Pharmacist Ratified on 14/10/21 at MGSG Review
Micolette Micro enemas (sodium citrate)
1. Introduction
These are Pharmacy Medicines, which can be administered to patients by Healthcare Professionals. Healthcare Professionals are advised that only medicines indicated in these guidelines can be used as Homely Remedies.
The following guidelines have been produced to aid the administration of Homely Remedies for the treatment of minor ailments for PROVIDE, as an aid to symptom relief.
No Homely Remedy must be administered for more than 48 hours before consulting a doctor, to ensure that symptoms are adequately controlled.
The allergy status of all patients MUST be checked prior to any medication being administered. Known allergies must be clearly recorded in the patient’s notes.
The doctor responsible for the patient/client must then ensure that there are no contraindications to any Homely Remedy. The doctor must sign the relevant sections of the prescription chart to allow for administration by any nursing staff, recording any exclusion if appropriate.
Each dose administered must be recorded by a registered nurse on the patient/client prescription chart in the relevant section.
The Ward Manager is responsible for assessing the ability of individual Healthcare Professionals to administer Homely Remedies, and for monitoring any errors that may occur relating to these guidelines.
TheWard Manager is responsible for ensuring that all nursing staff are aware of the correct procedure for administration of Homely Remedies.
Pharmacy staff should be contacted for advice when needed.
Patient consent must be obtained before administering a Homely Remedy and the reason for treatment should be explained to the patient.
2. Medicines for Minor Ailments
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication Cautions
1.Compound Alginate
Suspension (Peptac) heartburn associated with gastro-intestinal reflux
• Patients with renal failure
• Patients awaiting a swallow reflux test, who cannot swallow, are NBM, are tube fed or have difficulty swallowing
Dose/Route/Frequency Comments
10-20ml orally after meals and at bedtime but not at the same time as any other drugs
• Shake well before use
• Caution: may impair absorption of some drugs
• Not to be used without prescription in patients with renal failure or with sodium restriction
• Should not be used in patients who are severely debilitated or suffering from kidney failure
• Antacids inhibit absorption of tetracyclines and vitamins and should not be taken at the same time. Leave at least 1-2 hours between doses
• Patients on medicines which may cause dyspepsia or with ALARM signals – refer to Doctor (See NICE Clinical Guideline CG184)
• Refer to Doctor if pain continues
2.Loperamide 2mg capsules
Acute/chronic diarrhoea as shown by more than 2 unformed stools in 24 hours
• Foul smelling stools
• Suspected infection
• Condition where inhibition of peristalsis should be avoided
• Active ulcerative colitis
• Antibiotic associated colitis
• IBS
• Bacterial enterocolitis
• Hepatic dysfunction
First dose 2 x 2mg capsules orally, then 2mg after each loose stool
Maximum 16mg in 24 hours
Side effects may include:
• Dizziness
• Flatulence
• Nausea
• Headache
• Abdominal cramps
• Urticaria
• Abdominal bloating
• Exclude possibility of Clostridia before commencing treatment
• Inform Doctor within 24 hours of onset of diarrhoea
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication Cautions
3.Macrogol 3350 sachets (Laxido)
Senna Tablets/Syrup
Tablet: total
Sennosides 7.5mg
Syrup: total
Sennosides
7.5mg/5ml
Altered normal bowel habit indicating constipation
• Intestinal obstruction
• Intestinal perforation
• Inflammatory bowel disorders
• Cardiovascular impairment
Altered normal bowel habit indicating constipation
Glycerol Suppositories BP (adult)
Micolette Micro enemas (sodium citrate)
Altered normal bowel habit indicating constipation
Altered normal bowel habit indicating constipation
Dose/Route/Frequency Comments
1-2 sachets
Mix each sachet in 125mls of water as directed by manufacture
Maximum 3 sachets in 24 hours
• Intestinal obstruction 1-2 tablets or 5-10ml orally
Maximum 2 tablets or 10ml in 24 hours
Usually taken at bedtime
• Avoid if rectal bleeding
• Rectal Fissure, Inflammatory or ulcerative bowel disease
• Patients with poor fluid intake
• Blood or mucus in their stools
• Elderly and debilitated
1 or 2 suppositories inserted rectally daily as required
Insert 1 enema rectally as required
• Nausea
• Vomiting
• Electrolyte imbalance
• Stop if gastrointestinal discomfort
• Reconstituted sachets must be discarded after 6 hours if not taken
• Avoid if significant abdominal cramps
• Initial dose should be low and gradually increase
• May colour urine
• Exclude use if: recent bowel surgery and history of intestinal obstruction
• Action may take 8 to 12 hours
• Ensure adequate fluid intake
• May occasionally cause local irritation
• Moisten with water before use
• Ensure patient has adequate fluid intake
• Ensure patients have sufficient fluid intake
• Dietary advice may be necessary if patient is prone to constipation
• Action may take 5 to 15 minutes to work
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication Cautions
Phosphate Enemas Altered normal bowel habit indicating constipation
4.Chlorphenamine
Maleate 4mg tablets Symptomatic relief of allergy, such as:
• Seasonal allergic rhinitis (Hay fever)
• Allergic reaction resulting in rash, inflammation or itchiness Insect bite or sting
5.Simple Linctus (Sugar Free) Dry, irritating cough
• Patients with congestive heart failure
• May cause faecal impaction
• Patients with electrolyte imbalance
• Use with caution in renal impairment
• Prostatic hypertrophy
• Urinary retention
• Renal impairment
• Known severe liver disease
• Epilepsy
• On tricyclic antidepressants (e.g., Amitriptyline, Lofepramine)
• On MAOI’s or treated with MAOI in the last 14 days
• Glaucoma
• Previous anaphylaxis due to Chlorphenamine – do not give
• Productive cough with purulent sputum
• Patient who appear unwell, with shortness of breath or wheeze, have liver disease/epilepsy/alcoholism
Dose/Route/Frequency Comments
1 enema rectally as required
• Local irritation may occur
• Ensure patients have an adequate fluid intake
One 4mg tablet orally
Take every 4-6 hours
Maximum 24mg daily
Side effects may include:
• Drowsiness, blurred vision, dry mouth, headache, inability to concentrate
• Gastro-intestinal disturbances
• Confusion may occur with oral use
• Avoid alcohol
• Do not use with other antihistamines
• Elderly more susceptible to side effects (consider a maximum dose of 12mg in 24 hours)
5ml orally, 3-4 times daily if needed
• Product contains 4g sucrose per dose – take into consideration in diabetic patients
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name
6.Cyclizine 50mg tablets
Metoclopramide 10mg tablets
• Anti–emetic Nausea and vomiting
• Antiemetic Nausea and vomiting
• Epilepsy
• Gastrointestinal obstruction,
• Heart failure
• Glaucoma
• Urinary retention
• Hepatic impairment
• Pheochromocytoma
• Prostatic hypertrophy
• Gastrointestinal obstruction, perforation or haemorrhage
• First four days following gastric surgery
• Pheochromocytoma
Epileptic patients and patients being treated with other centrally acting drugs
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
7.Co-codamol 8/500 (soluble) tablets
(Codeine 8mg and Paracetamol 500mg tablets) Analgesia for pain not responding to paracetamol
• Acute respiratory depression
• Severe constipation
• Faecal impaction
• Taking other opiates (including Tramadol)
• Taking MAOI or has taken within previous 2 weeks
• Known liver disease
50mg up to three times a day.
Max dose 150mg in 24nours
• Can cause agitation
• Drowsiness can affect ability to carry out tasks
• Avoid alcohol
• Hypersensitivity to the active substance or excipients
• Can cause antimuscarinic effects when given with other medications
• Can cause decreased level of consciousness
1 x 10mg tablet 3 times a day
Avoid in patients with:
• Severe renal impairment
• Severe liver disease
• Age under 20 years old
• Patient body weight under 61kg
• Parkinson’s Disease
• Following pyloroplasty or gut anastomosis
1 or 2 tablets dissolved in water before administration
Take orally
Repeat every 4-6 hours
Maximum of 4 doses a day
Side effects may include:
• Constipation
• Drowsiness
• Rash (rarely)
• Contains paracetamol – do not give with other paracetamol containing preparations
• Maximum 8 tablets in 24 hours
• May be given in conjunction with non-steroidal anti-inflammatories (NSAIDs)
• Not to be taken for more than 2 days without medical review
Paracetamol 500mg tablets
Paracetamol 500mg soluble tablets
Paracetamol 500mg suppositories
• Remember effervescent tablets contain sodium – avoid in patients with restricted sodium diets
• Avoid alcohol
• Patient with weight less than 50kg consider 1 tablet every 4-6 hours. Maximum of 4 tablets in 24hours
Mild to moderate pain associated with headache, muscle or joints Pyrexia
• Hepatic impairment
• Renal impairment
• Alcohol dependence
500mg-1g (1 or 2 tablets) orally or 1-2 suppositories rectally
May be administered every 4 to 6 hours
Not more than a total of 4g paracetamol in any 24-hour period by any route
• Do not give if patient is prescribed any medication containing paracetamol, remember that paracetamol is an ingredient of medicines such as co-codamol (Solpadol, Zapain) and codydramol
• Not to be used without prescription in patients with liver failure, severe liver disease or alcohol abuse
• Remember effervescent tablets contain sodium
• Avoid soluble tablets in patients with restricted sodium diet and hypertension Based on weight
• Under 40kg - 500mg every 4-6 hours. Maximum four times a day and no more than 2g (2000mg) in 24 hours.
• 41-49kg -1000mg every 4-6 hours. Maximum three times a day and no more than 3g (3000mg) in 24 hours.
• 50kg+ -1000mg every 4-6 hours. Maximum four times a day and no more than 4g (4000mg) in 24 hours.
If eGFR less than 30ml/min/1.73m2, the dosing interval must be a minimum of 6 hours.
• Avoid alcohol
Avoid the use of soluble tablets due to sodium contents
8.Clotrimazole 1% cream Fungal infection of the skin
• Apply 2-3 times daily
9.Octenisan wash Topical MRSA medication
• Patients with eczema and psoriasis
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
10.Glucagon 1% 1mg/ml (GlucaGen)
Emergency treatment of hypoglycaemic attack
• Patients known to Phaeochromocytoma
• Unable to take oral glucose
• Hypersensitive to glucagon or excipients
• Patient taking warfarin
Use for body and hair wash
Always observe contact time of 3 minutes
Use body was for 5 days
Wash hair on days 1 and 4
1mg by subcutaneous / intramuscular injection
Administer immediately after reconstitution
• Occasional skin irritation and may sting in acute fungal infection
• Continue to apply for 14 days after lesions have healed
• Patient sensitivity
• Avoid contact with eyes
• Recommended contact time is 3 minutes
Dextrose Liquid form (Dextrogel) 25g tube
Emergency treatment of hypoglycaemic attack
15-20g given by mouth
Side effects may include:
• Nausea
• Vomiting
• Abdominal pain
• Hypotension, hypertension
• Tachycardia
• Rarely hypersensitivity reactions
• Patient should respond within 10 minutes of glucagon injection – if not contact GP
• Top cap of syringe contains natural rubber latex
• DO NOT FREEZE
• Repeat after 10-15 minutes if necessary for a MAXIMUM of 2 doses
• Ensure patient has plenty of fluids and carbohydrates following recovery
• Seek medical advice where necessary
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
11.Uriflex G/
Suby G Urotrainer
12.Resource
Thicken UpClear
Maintenance of urinary catheter
Debris in urine
Blocked catheter
unresponsive to Sodium Chloride 0.9%
•
13.Hypromellos
e 0.3% Eye Drops
14.Sodium Bicarbonate 5% ear drops
Difficulty in swallowing normal fluid
Thickening agent
Lubricant for relief of dry eyes
Wax visible in ear canal
Difficulty in hearing
15.Oral Balance Gel Dry mouth (Xerostomia)
• No swallowing reflux present
One unit via urinary catheter
As required to maintain the catheter
• Regular use not advised unless there is regular blockage
• Leave in situ for a minimum of 20 minutes
• Eye infection
• Patients allergic to eye drop preservatives
• Pain and high temperature
• Discharge from ear
To be given orally in all food and drink taken by patient
As directed on the container
Use 1-2 drops up to 4 times daily
3-4 drops twice daily for 5 days
Half an inch as often as necessary, especially at night
• New guidelines for thickening of fluids for patients with swallowing difficulties: International Dysphagia Diet Standardisation Initiative (IDDSI)
• Occasional sensitivity and temporary blurred vision
• Do not apply when wearing soft contact lenses
• Occasional irritation and sensitivity
• Apply after brushing or rinsing mouth
• Lasts for up to 5 hours
• Sugar free
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
16.Choline
Salicylate
Dental Gel BP (Bonjela Sugar Free)
Painful mouth due to mild oral and perioral lesions (mouth ulcers)
• Suspected Candida infection
17.E45 Cream Emollient cream to sooth, smooth and hydrate skin in dry scaling disorders
18.Benzalkoniu
m Chloride 0.1% and Dimethicone
22.0% cream (Conotrane)
Barrier cream to protect skin
• Suspected infection
Half an inch of gel to be applied to the sore area of the mouth and massaged gently.
Do not use more often than once every 3 hours. Maximum of 6 applications daily
• Not to be applied to dentures
• Leave for at least 30 minutes before re-insertion of dentures
• Keep a separate tube per patient
• Not to be used in children under the age of 16 years
• Bronchospasm/asthma in susceptible patients
• Broken areas of skin
• Known hypersensitivity to Benzalkonium chloride
Apply a sufficient quantity to the skin 3 or 4 times a day, as necessary.
Apply in direction of hair growth to reduce the risk of folliculitis
A sufficient quantity to the sore area of skin several times a day as necessary
• Occasional sensitivity
• May be continued for duration of patient stay
• Keep separate tube per patient
• WARNING: Paraffin based emollient – Fire Hazard
•
• May cause local skin reactions (e.g., contact dermatitis)
3. References
• BNF online
• Summary of Product Characteristics
• Electronic Medicines Compendium