Job Title of author: Assistant Clinical Director – Pharmacy & Medicines
Reviewed by Committee or Expert Group Medicines Governance and Safety Group
Related procedural documents
MMPOL36 Managing Medicines in Provide Group Care Home Services and Domiciliary Care
MMSOP61 Standard Operating Procedure for Allergies and Sensitivities to Medicines
MMSOP28 Standard Operating Procedure for Patient Self-Administration of Medicines
Review date: 13 April 2024
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
V1 21 January 2021 Assistant Clinical Director – Pharmacy & Medicines
Community Health Specialist Pharmacist
Status
New
Comment
1. Introduction
This toolkit has been developed by Mid Essex Clinical Commissioning Group (CCG) in conjunction with Essex County Council (ECC) and has been adopted by Provide to support Provide Group Care Services such as Care Homes, Supported Living and Domiciliary Care.
CQC national guidance ‘Treating Minor Ailments and Promoting Self-Care in Adult Social Care’ and the RMOC position statement on homely remedies published in November 2018 have been taken into consideration in the adoption of this toolkit.
Pharmacists and pharmacy technicians working with Care Services will provide advice and support in implementing this toolkit. Community pharmacy services supporting care services with regular supplies of prescribed medicines are also aware of this toolkit and their role in supporting OTC advice and sales.
It is not appropriate to ask a prescriber to write prescriptions for a ‘just in case’ situation for minor ailments. Prescriptions are written to treat acute need, anticipatory drugs in terminal care or evidence-based preventative medicine.
It is important to recognise that common conditions will get better in time and antibiotics are not always appropriate. The average time span of some common conditions are:
• Part 1 – Self-care treatment for specific person guidance
• Part 2 – Homely Remedy guidance
• Part 3 – Personal care guidance
Definitions
Within this toolkit the term ‘HCP’ refers to a Registered Healthcare Professional, which includes:
• Doctor registered with the General Medical Council
• Pharmacist registered with the General Pharmaceutical Council
• Pharmacy Technician registered with the General Pharmaceutical Council
• Nurse registered with the Nursing and Midwifery Council
• Paramedic registered with the Health and Care Professions Council
• Physiotherapist registered with the Health and Care Professions Council
HCPs must work within their professional competencies when recommending medication.
2. Self-Care Principles, including Homely Remedies
These toolkits incorporate the transition from the prescribing of ‘a pill for every ill’; it is a guide for Provide Group Care Services with service users over 18 years of age, including people with learning difficulties, to support service users in self-caring for selected
conditions by buying over-the-counter treatments, as well as the use of a traditional Homely Remedy scheme.
Additionally, some items that historically may have been prescribed can be considered as personal care items and purchased by the service user/care service, rather than being prescribed.
NHS England guidance (March 2018) focuses on conditions that are:
1. Self-limiting and do not require medical advice or treatment as the condition will clear up on its own, and/or
2. A condition that is a minor illness and is suitable for self-care and treatment with items that can be purchased over the counter from a pharmacy, and
3. Vitamins, minerals and probiotics where there is a lack of robust evidence for clinical effectiveness
There are general exceptions to point 2 (above) and these are listed below.
NB – exemption from prescription charges does not warrant an exception to this guidance.
1. Service users that are prescribed and ‘over the counter’ (OTC) treatment for a longterm condition (e.g. regular pain relief for chronic arthritis, or treatments for inflammatory bowel disease)
2. For the treatment of more complex forms of a minor illness (e.g. severe migraine that is unresponsive to OTC medicines)
3. For those service users that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms such as indigestion with very bad pain)
4. Treatment of complex service users (e.g. immunocompromised)
5. Service users prescribed and OTC product to treat an adverse effect or symptom to a complex illness or a prescription-only medicine
6. Circumstances where the product licence does not allow an OTC sale
7. A service user that has not responded to treatment with the self-care OTC product
8. Service users where the clinician considers the presenting symptom is due to a condition that would not be considered a minor condition
9. Individual service users where the clinician considers that their ability to selfmanage is compromised, because of medical, mental health or significant social vulnerability, to the extent that their health and/or wellbeing could be adversely affected if reliant on self-care
10. Consideration of safeguarding issues
Medicines that can be purchased fall into two legal categories; General Sales List (GSL) which are available widely, or Pharmacy Only Medicines (P) which are available only from a pharmacy. Together they are commonly known as Over the Counter (OTC) products.
3. Part One – Self-care Treatment for Specific Person Guidance
Self-care products are medicinal preparations used to treat minor ailments, which can be bought OTC and do not require a prescription. In this situation they are specific to the patient and may be used for a short-term condition e.g. ear wax, or longer-term condition e.g. Hayfever.
Purchased by or on behalf of service user without HCP advice
Service users or relatives may purchase or bring in their own ‘self-care treatment products’. Medicines not listed on the home’s list of homely remedies need to be discussed with an HCP as to the suitability of the service user continuing to take/use.
HCP request to purchase a self-care treatment on behalf of the service user
An HCP may advise the home staff to recommend the service user or relative (on behalf of the service user) to purchase a specific product to treat a minor ailment, such as olive oil for ear was or vitamins for maintenance. The HCP should indicate how long the treatment is to continue and provide any necessary supplementary advice to support its use. This may be longer term, e.g. Hayfever tablets for the duration of the summer season, or short term e.g. mild cystitis. (See Appendix 1 – ‘no prescription required’ form).
OTC community pharmacist consultation
The community pharmacist may recommend an appropriate OTC treatment for a service user and will need to advise the care service about duration of treatment. A community pharmacist can also advise on the appropriate use of an OTC self-care product that has been recommended by an HCP, and consultation is encouraged.
Key Points for Self-care Treatments for a Specific Person
1. The medicines are not for general use in the home and must remain specific to that service user
2. The medicines should be counted into the home and recorded as for any other medication, by adding to the Medicines Administration Record (MAR) chart, to ensure regular dosing and stock control
3. The instructions for the treatment(s) should be communicated to the service user/relative/care service by the HCP and written into that individual’s care plan by Provide Group care staff; they only apply to the individual named
4. If symptoms worsen, Provide Group care staff should seek advice from an HCP earlier that the recommended duration
Examples of common minor ailments/conditions which are suitable for self-care:
Athlete’s foot cream, antifungal creams and sprays
Mebendazole (chewable) tablets/suspension
Travel sickness tablets
Multivitamin and minerals, vitamin B12 (cyanocobalamin), vitamin C tablets, vitamin D tablets 400-1000 units
4. Part Two – Homely Remedy Guidance
A homely or household remedy is another name for a non-prescription medicine which is kept in stock and used in Provide Group Care Services for the short-term management of minor, self-limiting conditions. Minor conditions will include cold symptoms, headache, occasional pain or indigestion. This guidance aims to ensure that access to treatment for minor ailments is the same as it would be for a service user living in their own home.
Key Points for Homely Remedies
• This toolkit includes a Homely Remedy Policy for Provide Group Care Services (Appendix 2) with or without nursing who agree to stock the approved list of products to treat minor ailments
• Homely remedies must be purchased by the Provide Group Care Service and should not be labelled for individual service users
• Homely remedies should usually only be given for up to 48 hours before referring to an HCP if symptoms persist. If required for longer than 48 hours, the HCP will need to assess and advise
• Homely remedies should not be requested on prescription from GPs or NonMedical Prescribers (NMP)
• This policy replaces the need to sign individual agreements for each patient for the medicines included in this toolkit
The conditions and products included for homely remedies are tabled below:
1 Pain (mild to moderate), discomfort and fever. (e.g. aches and sprains, headache, period pain, back pain, toothache)
• Paracetamol
NB: Other medicines containing paracetamol may have been prescribed for some service user and this must be carefully checked 2 Constipation
• Macrogol (Laxido®/ Movicol®)
• Senna tablets for syrup
• Gaviscon Advance®
• Mucogel® liquid
• Oral rehydration therapy e.g. Dioralyte®
• Loperamide 5 Insect bites and stings
• Hydrocortisone cream 1% NB: do not share tube between service user. 15g GSL pack to be used for one patient only and any remaining at the end of the treatment returned to the pharmacy for disposal
• Wasp-eze®
• Simple Linctus
• Pholcodine Pavacol D®
5. Part Three – Personal Care Guidance
Conditions and remedies listed as personal care are deemed to be outside the scope of medical care. They include remedies that are easily available ‘off the shelf’ from supermarkets in the health aisle, or community pharmacy, and do not necessarily require pharmacist advice to support the sale, although consultation with a pharmacist is recommended if available. Many of the conditions and items listed have been historically and safely used in care services in this manner.
If symptoms worsen, the GP or pharmacist should be contacted for advice.
Personal Care items do not need to be added to the MARs chart, however, where these items are taken regularly i.e. multivitamins and/or minerals, it is recommended that they are added to the MARs chart to ensure regular dosing and enable stock management. Personal Care items will also need to be added to the individuals care plan and daily personal care log. (See Appendix 6 for the list of personal care items)
6. Prompting/Administration
Care staff who have been appropriately trained and signed off as competent can prompt/administer homely remedies to service users. Care staff who are able to give homely remedies must sign the Staff Signature Sheet’ (Appendix 2) and sign to confirm they understand the Homely Remedies Policy and are competent to administer homely remedies
Authorised care staff can administer a homely remedy once they have established the following:
• The service user has no potentially serious symptoms
• There have been no changes to medication or the service user’s health since the homely remedies authorisation sheet was last reviewed
• Allergy/Sensitivity status
• What the service user has used in the past for these symptoms
• Whether the service user has any difficulties swallowing
• The service user is aware the medicine is not prescribed and has given their consent, or a Best Interests Decision’ is in place
If there are any additional concerns about potential interactions or contra-indications, or if there is any other uncertainty, additional medical advice should be sought before administration
7. Disposal of Homely Remedies
Homely remedies must be disposed of when they are no longer suitable for use or required by the service user and/or are out of date, returned to the community pharmacy for the safe disposal/destructions (See MMPOL XXX Managing Medicines in Provide Groups Care Homes and Domiciliary Care). The disposal of homely remedies should be recorded on the Stock Control Sheet – Homely Remedies Record Sheet (Appendix 4) for that particular medicine.
8. Summary of Documentation Advised
• As a prescription is not required a HCP will need to complete ‘No Prescription Required Form’ (Appendix 1)
• Provide Group Care Services Policy for Homely Remedies (Appendix 2)
• Medicines information about the homely remedy (Appendix 2) so that this can be accessed easily and quickly
• Self-administration policy to include the provision and administration of homely remedies
• Homely Remedies Staff Signature Sheet (Appendix 3) detailing who can administer homely remedies
• Homely Remedy Record Sheet (Appendix 4) to be completed each time a homely remedy is received, administered, or disposed of
• Disposal of Medicines Procedure MMPOL XXX Managing Medicines in Provide Groups Care Homes and Domiciliary Care
• Flow charts for each minor condition (refer to the National Care Forum ‘Safety of Medicines in Provide Group Care Services: Homely Remedies Guide 2019)
• Self-care Medication for Disposal Record Sheet (Appendix 5)
Appendix 1 – No Prescription Required Form
You have been diagnosed with a common condition that can be treated with medication available to buy over the counter from your local pharmacy.
You do not need to make an appointment to speak to the pharmacist, just pop in any time and they will be happy to help you.
Ask the pharmacist for help and advice on the most appropriate medication to relieve your symptoms for:
Coughs and colds
Sore throat
Allergies
Skin rash
Heartburn and indigestion
Upset stomach
Diarrhoea
Constipation
Colic
Piles (haemorrhoids)
Headache and migraine
Toothache
Eczema
Aches and pains
Teething
Sleep problems
Travel sickness
Threadworm
Head lice
Scabies
Athlete’s foot
Cold sores
Fungal skin infections – ringworm
Fungal nail infections
Conjunctivitis
Other – please indicate below
If at any time you are concerned about your condition or if your symptoms are not improving after 48 hours of treatmentwith over the counter medications, you should contact the local pharmacist or the surgery for more advice.
Appendix 2 – Homely Remedy Policy for Provide Group Care Services
This policy will allow Provide Group Care Services to stock certain Homely Remedies for use by service users for the treatment of minor ailments for a short duration, usually 48 hours. Any symptoms that persist beyond this time should be referred to a Medical practitioner or Non-Medical Prescriber (NMP) for advice and medical intervention where this is necessary.
A homely remedy is a medicinal preparation used to treat common minor ailments; they are purchased over the counter and do not require a prescription. They are kept as stock in care services to allow access to products that would commonly be available in any household.
The following table lists the Homely Remedies that can be stocked by Provide Group Care Services.
Condition
1 Pain (mild to moderate), discomfort and fever. (e.g. aches and sprains, headache, period pain, back pain, toothache)
2 Constipation
3 Indigestion and heartburn
• Paracetamol
NB: Other medicines containing paracetamol may have been prescribed for some service user and this must be carefully checked
• Macrogol (Laxido®/ Movicol®)
• Senna tablets for syrup
• Gaviscon Advance®
• Mucogel® liquid 4 Diarrhoea
• Oral rehydration therapy e.g. Dioralyte®
• Loperamide
5 Insect bites and stings
6 Cough
• Hydrocortisone cream 1%
NB: do not share tube between service user. 15g GSL pack to be used for one patient only and any remaining at the end of the treatment returned to the pharmacy for disposal
• Wasp-eze®
• Simple Linctus
• Pholcodine Pavacol D®
Obtaining supplies of Homely Remedies
Homely remedies can be purchased from the regular pharmacy supplier:
[Insert name of usual pharmacy]
Homely remedies can ONLY be purchased by the service user or on behalf of the service user, from the service users’ regular pharmacy. This will ensure the medication can be checked with the pharmacist to ensure suitability and appropriateness for the service user.
[Payment will be agreed and paid for by the individual service user requiring homely remedy]
The Homely Remedies Stock Control Record Sheet (Appendix 4) should be used to record any purchases of homely remedies.
NB: The quantity of paracetamol tablets and capsules that can be purchased is restricted by law. Packets of 32 are available OTC from pharmacy counter; packets of 16 can be purchased off the shelf in a pharmacy or other outlet. It is recommended that only packs of 16 are used for homely remedies.
Medicines not suitable as Homely Remedies
• Products requiring invasive administration e.g. suppositories
• Medicines that take up to 48 hours to work e.g. lactulose
• External preparations as these should only be used for individuals to avoid cross contamination – except hydrocortisone cream (individual pack)
• Vitamins, herbal or homeopathic supplements
• Medicines being obtained via bulk prescription
Storage
• All homely remedies should be clearly identifiable as a ‘homely remedy’ e.g. with a sticker or marker pen
• Homely remedies should be stored in a lockable cupboard or trolley and kept separate to service users’ prescribed medication
• Access should be restricted to staff with medicines management responsibilities
• Homely remedies should be stored in accordancewith the instructions in the patient information leaflet
• Stocks and expiry dates should be checked monthly
➢ Liquids and eye drops have a reduced shelf-life once opened, therefore the date opened should be recorded on the bottle/label. For liquids, expiry should be noted as 6 months after first opening the bottle and for eye drops the expiry will be one month from opening the bottle
Administration of Homely Remedies
Homely remedies would be administered/prompted at the request of the service user to aid symptom control or based on a clinical decision by a suitably trained care staff or care manager It is the responsibility of the trained senior carer or duty nurse to check that the administration of a homely remedy is appropriate (e.g. not prescribed a similar or the same treatment). If there is any uncertainty, the HCP should be consulted and the discussion documented.
When using the flow charts below the carer/nurse must ascertain:
• that the service user has no potentially serious symptoms
• past medical and drug history
• any known allergies/sensitivities
• what the service user has used in the past for these particular symptoms
• the service user is made aware that the medicine is not prescribed and has given their consent, or a ‘best interests decision’ is in place
• that the service user consents and is aware that the medicine is not prescribed
• that the homely remedy medicine will be used for up to 48 hours only
The carer/nurse will regularly review and reassess the service user's response to the medication. Homely remedies should be given for a limited period, usually 48 hours If a homely remedy is given for 48 hours with no symptom relief the service user must be referred to the GP
The administration/prompt of homely remedies must be recorded on each service user’s MAR chart. The entry should be annotated ‘homely remedy ’ It should be clear what was given, when it was given (date and time), what dose, who administered and why it was given, as well as the effect of the medication. This is particularly important so other members of care staff are aware of when the last dose was given to monitor effectiveness and avoid overdosing
The stock control form, Appendix 4, must be completed to record the purchase of the medicinal product, and should be updated to indicate that it has been administered to a service user each time any medication is administered. This will ensure there is an audit trail and stock management of the medicine
All care staff using this homely remedy policy should sign to confirm they have the skills to administer the homely remedy and acknowledge they will be accountable for their actions (Appendix 3). The care manager must ensure that Appendix 3 is accurate and updated and is the current list of staff who are able to administer homely remedies.
Homely remedies are solely for service user use and must not be used for staff or family members.
Disposal
• Expired stock should be returned to the community pharmacy for the safe disposal/destructions (See MMPOL XXX Managing Medicines in Provide Groups Care Homes and Domiciliary Care)
• Disposal of homely remedies should be recorded in the medication for disposal record sheet (Appendix 5)
Adverse reaction
In the rare event of any adverse reactions, the GP must be informed immediately. The yellow card adverse drug reaction reporting scheme is a voluntary scheme through which doctors notify suspected adverse reactions to medicines. It is for the GP to decide, following discussions with the senior staff/nurse, whether to submit a yellow card to the Medicines Control Agency/Committee on Safety of Medicines.
In the event of a serious life-threatening adverse reaction the nurse/carer will carry out emergency treatment and refer the service user direct to the accident and emergency department.
A incident report will need to be completed through Provide Datix system.
Chart 1 – Pain
MILD PAIN only; all cases of sudden onset severe pain MUST be referred YES
Communication of pain is not just verbal. Look for facial signs, sighing, groaning, and calling out, aggression and withdrawal which is out of character.
Use Abbey Pain Score or PAINAD tool
Has service user been given any medicines containing paracetamol during the last 24 hours?
REMEMBER that paracetamol is an ingredient of medicines such as co-codamol (includes Solpadol, Zapain and others), co-dydramol, as well as many products purchased over the counter such as cough and cold remedies.
CHECK LABELS CAREFULLY DON’T FORGET TO CHECK LIQUID MEDICINES
Paracetamol may only be given provided the maximum dose in 24 hours is not exceeded and that it is at least FOUR hours since the last dose.
Can patient swallow solid dose medicines?
• Give paracetamol 500mg tablets/caplets
• For adults give TWO tablets per dose and repeat if necessary every FOUR to EIGHT hours
• NO MORE THAN EIGHT TABLETS TO BE TAKEN IN 24 HOURS
• Give paracetamol suspension 250mg/5ml
• For adults give 20ml per dose and repeat if necessary every FOUR to SIX hours
Maximum dose in 24 hours 8 tablets (4g) in divided doses (maximum 2 tablets (1g) in any 4 hours)
Maximum duration of treatment as homely remedy
Cautions
Up to 48 hours then seek advice from GP
Do not administer with other paracetamol containing products (check all current medication taken). Not suitable if history of severe liver disease or alcohol abuse. If body weight is <39 kgs consider give 1 tablet up to four times a day
Additional Information
Additional Resources
Many medicines also contain paracetamol. Check current medication records and if in doubt check with pharmacist.
Patient Information leaflet (check the label/leaflet for the product purchased), BNF
Drug
Indication for Use
Strength
Relief of mild pain
Paracetamol Suspension
250mg/5ml suspension (Calpol six plus)
Dose FOUR 5ml spoonful’s (20ml) up to FOUR times a day
Maximum dose in 24 hours 80ml (4g) in divided doses (maximum 20ml (1g) in any 4 hours)
Maximum duration of treatment as homely remedy
Cautions
Additional Information
Additional Resources
Up to 48 hours then seek advice from GP
Do not administer with other paracetamol containing products (check all current medication taken). Not suitable if history of severe liver disease or alcohol abuse. If body weight is <50 kgs give 10ml up to four times a day
Many medicines also contain paracetamol. Check current medication records and if in doubt check with pharmacist.
Patient Information leaflet (check the label/leaflet for the product purchased), BNF
Chart 2 – Constipation
Initial changes in bowel habits should be reported to GP. Bowel charts should be kept in care plans for monitoring purposes. Constipation in the elderly is often due to insufficient fluid intake. Avoid large glasses of fluid – little and often is more effective.
Does the service user show any of the following alarm signs?
• Blood in stools
• Severe abdominal pain
• Unintentional weight loss
• Associated diarrhoea
• Painful and ineffectual straining
Is the service user taking any medication which could cause constipation? See Information Table and patient information leaflets
Increase dietary fibre, try prune juice, and increase mobility if possible. If not possible, give one macrogol sachet as instructed in medicines information for constipation.
In addition to above give senna tablets TWO at night (or if unable to swallow tablets, give 10ml senna liquid)
Contact GP or NHS 111
Contact GP or NHS 111
Information Table
Some common drugs which can cause constipation:
• Indigestion remedies containing aluminium
• anti-diarrhoeals e.g. Loperamide (Immodium®)
Check with pharmacist or GP and follow advice given. If medication is stopped, make note in care plan
Continue lifestyle advice to help prevent re-occurrence
• antihistamines e.g. chlorpheniramine (Piriton®) promethazine (Phenergan®)
• pain killers containing opioids e.g. codeine, Dihydrocodeine, morphine, tramadol
• some antidepressants e.g. amitriptyline, imipramine;
If constipation frequently reoccurs, ask GP to review
• some Parkinson’s drugs e.g. levodopa;
• some drugs to treat high blood pressure e.g. amlodipine;
• anticholinergic for urinary frequency e.g. oxybutinin
Medicines Information – Constipation
Drug Macrogol ‘3350’ powder sachet (Laxido/Movicol)
Indication for Use
Strength
Dose
Maximum dose in 24 hours
Maximum duration of treatment as homely remedy
Cautions
For relief of constipation
Macrogol 3350 with potassium chloride, sodium chloride and sodium bicarbonate
One to three sachets daily
To be made up in 125mo of water (half a glass). Can be mixed with any juices of preference.
3 sachets
Up to 48 hours then seek advice from GP
Reconstituted sachets must be discarded after 6 hours if not taken.
Additional Information Can be chilled in fridge before giving.
Additional Resources
Patient Information leaflet (check the label/leaflet for the product purchased), BNF
Drug Senna
Indication for Use
Strength
Dose
Maximum dose in 24 hours
Maximum duration of treatment as homely remedy
Cautions
For relief of constipation
7.5mg tablet; 7.5ml/5ml syrup
ONE to TWO tablets at night; 5 to 10ml at night
TWO tablets/10ml syrup
Up to 48 hours then seek advice from GP
This product should not be used when abdominal pain, intestinal obstruction, nausea or vomiting is present
Additional Information May colour urine
Can cause abdominal cramps For use when macrogols are not tolerated
Additional Resources
Patient Information leaflet (check the label/leaflet for the product purchased), BNF
Indigestion/Heartburn
Indigestion is experienced as discomfort, or a burning pain in the central chest region. When this burning rises towards the throat it is referred to as heartburn. Flowchart for use when service user has MILD pain only – all cases of acute or severe pain MUST be referred immediately.
Is there any doubt that the symptoms are caused by indigestion or is the service user generally unwell?
Is the service user taking any medicines which could cause indigestion? Check patient information leaflets and see Box 1
Is the service user taking any medicine which carries a warning to avoid antacids or indigestion remedies? Check the medicines label
Give Gaviscon Advance® or Mucogel® after meals and at bedtime. Give lifestyle advice – see Box 2
Contact GP or NHS 111
Box 1
Some medicines that commonly cause indigestion:
• Anti-inflammatory medicines e.g. aspirin, ibuprofen, naproxen
Contact pharmacist or GP and follow advice. Record actions
Contact pharmacist for advice or avoid giving indigestion medicine within 2 hours either side of affected medicine.
Contact GP or NHS 111 if symptoms are not relieved by treatment
• Oral corticosteroids e.g. prednisolone
Box 2
• Eat small regular meals. Chew food well
• Avoid bending or stooping during and after meals
• Cut down or stop smoking, alcohol, caffeine (contained in coffee, carbonated drinks, tea and some pain killers) if possible
• Avoid spicy foods e.g curries
• Avoid fatty foods e.g. pastry
• Avoid clothing which is tight around the waist
Medicines Information – Indigestion/Heartburn
Drug Gaviscon Advance® liquid (peppermint or aniseed flavour)
Indication for Use
Strength
Gastric reflux and heartburn
500mg sodium alginate, 100mg potassium bicarbonate per 5ml
Dose 5-10ml after meals and at bedtime
Maximum dose in 24 hours 40ml in divided doses
Maximum duration of treatment as homely remedy
Cautions
Additional Information
Additional Resources
Up to 48 hours then seek advice of GP
Contains sodium (2.3mmol in 5ml) and potassium (1mmol in 5ml). Avoid where sodium restriction is indicated
Shake well before use. Sugar free, so suitable for diabetics. Gaviscon Advance® is not listed on the Mid-Essex Formulary; it is included here as it is readily available OTC
Patient Information Leaflet (check the label/leaflet for product purchased), BNF
Drug Mucogel® liquid (Co-Magaldrox)
Indication for Use
Strength
Heartburn and gastric hyperacidity
Each 5ml dose contains: Aluminium Hydroxide Gel BP 220mg Magnesium Hydroxide BP 195mg
Dose
10-20ml three times a day 20 minutes to one hour after meals, and at bedtime
Maximum dose in 24 hours 100ml daily
Maximum duration of treatment as homely remedy
Cautions
Additional Information
Additional Resources
Up to 48 hours then seek advice of GP
Should not be used in service user who are severely debilitated or suffering from kidney failure. Antacids inhibit the absorption of tetracyclines and vitamins and should not be taken at the same time. Leave at least two hours between doses.
Shake well before use. Sugar free so suitable for diabetics. Must be discarded 28 days after opening
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Diarrhoea in the frail elderly can quickly lead to dehydration and deterioration in health
Are any of the following present?
• Blood or mucus in stools
• Recent history of constipation
• Diarrhoea accompanied by vomiting lasting more than 24 hours
• Stools are black and tarry or profuse and foul smelling
• Severe abdominal pain
• Drowsiness
• Confusion
Is the service user taking any medicines which could cause diarrhoea? E.g. antibiotics (current or very recent) or laxatives
Is the service user experiencing uncomplicated sudden, short term diarrhoea?
Contact GP or NHS 111
Infection Control
Staff and service users must exercise rigorous hand hygiene as diarrhoea can spread through hand surface contact to other service users. Seek medical advice if more than one case occurs, as this could indicate a serious cause e.g. C.difficile
Contact Pharmacist or NHS111 AND encourage service user to drink plenty of clear fluids such as water or diluted squash. If diarrhoea is severe it may be useful to offer rehydration solutions(e.g. Dioralyte®). Such solutions should be prepared following leaflet instructions and drunk within 1 hour (stored in a refrigerator may be kept for up to 24 hours)
Continue fluids and if diarrhoea is severe it may be useful to offer rehydration solutions (e.g. Dioralyte®) to drink. Such solutions should be prepared following leaflet instructions and drunk within 1 hour (stored in a refrigerator may be kept for up to 24 hours)
Give loperamide* for 24 hours only as instructed in patient leaflet and continue to encourage to drink clear, non-milky fluids such as water or diluted squash little and often. Avoid dairy products such as milk or cheese. Foods suitable to eat include bananas, plain boiled rice, stewed apples and toast.
REFUSAL FOR MORE THAN 24 HOURS
Contact GP or NHS111
Prolonged diarrhoea can reduce the effectiveness of medication and de-stabilise patients, such as those with diabetes and epilepsy. Monitor more closely
Medicines Information: Diarrhoea
Drug Dioralyte® sachets
Indication for Use
For fluid and electrolyte replacement
Strength N/A
Dose
One or two sachets after each loose stool. Contents of each sachet should be dissolved in 200ml of drinking water
Maximum dose in 24 hours N/A
Maximum duration of treatment as homely remedy
Cautions
Additional Information
Additional Resources
Up to 24 hours if refusing to drink. Up to 48 hours; if diarrhoea is persistent then seek advice from GP
None
The solution may be stored for up to 24 hours in a fridge, otherwise any solution remaining an hour after reconstitution should be discarded
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Drug Loperamide Capsules
Indication for Use
For fluid and electrolyte replacement
Strength 2mg
Dose
Two capsules immediately then one after each loose stool
Maximum dose in 24 hours 8 capsules
Maximum duration of treatment as homely remedy
Cautions
Up to 24 hours then seek advice of GP (see place in flow chart)
Dehydration risk must be addressed first
Additional Information GP may suggest continued treatment but should be prescribed
Additional Resources
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Chart 5 – Minor Skin Problems
Emollients – can be used to soothe the skin, reduce irritation, prevent skin from drying and may be directly applied to skin or added to bathwater. E45 cream and Doublebase are the named emollients but there are many others and service user preference and tolerance is important. As a homely remedy the emollient should be used as a trial to address an immediate need but continued use should be prescribed. For homely remedy use, purchase small tubes and when opened only use for the individual service user. Olive oil and Vaseline (white soft paraffin) are readily available OTC products.
Incontinence rash - Cavilon cream. No creams orpowders should be usedon service users who may at times be incontinent as this affects the absorbency of the incontinence pads. Service users with red excoriated skin should have their urine tested to exclude urinary tract infection. Service users should be washed with non-perfumed soap, dried and pad applied. Small amounts of barrier cream can be used if excoriation continues but should be reviewed. Barrier creams do not prevent pressure sores, if redness is due to pressure, pressure assessment needs to be completed. Cavilon cream® is recommended for those service users who are faecally incontinent, as it can be applied every 12 hours and skin washed in between.
Insect bites and stings - a homely remedy treatment is used to soothe the associated irritation and itching. Complications of bites are allergic reactions, infection and cellulitis. These would need immediate referral. Look for excessive swelling and widespread hotness and redness. Calamine lotion and aqueous cream are unbranded OTC products which soothe by cooling.
Severe swelling and redness must be referred to GP or NHS 111
Service users known to be allergic to wasp or bee stings must always keep their emergency treatment with them
Drug Hydrocortisone 1% Cream
Indication for Use
For symptomatic treatment of all insect bites and stings
Strength 1% w/w, 15g
Dose Apply sparingly to a small area, once or twice a day
Maximum dose in 24 hours One finger-tip unit twice in 24 hours
Maximum duration of treatment as homely remedy 48 hours, then seek advice of GP
Cautions
The product should not be used on the eyes or face, the ano-genital area or broken or infected skin – including impetigo, cold sores, acne, athlete’s foot, scabies or infected bites or stings
Additional Information
Additional Resources
Drug
Indication for Use
GP may suggest continued treatment but should be self-care from an individual (form available at Appendix 1). N.B, do not share tube between service user. 15g GSL pack to be used for one patient only, any remaining at the end of the treatment returned to the pharmacy for disposal.
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Wasp-eze® bite and sting spray
For symptomatic treatment of all insect bites and stings
Strength Contains benzocaine 1% and mepyramine 0.5%
Dose Spay locally onto skin
Maximum dose in 24 hours Can be repeated once after 15 minutes
Maximum duration of treatment as homely remedy 48 hours, then seek advice of GP
Cautions
Additional Information
Do not use if you are sensitive to any of the ingredients.
Do not apply to large areas of skin, eczematous, sunburnt or broken skin. Do not use the spray on the face.
Hold nozzle approximately five inches from the skin and spray once for 2-3 seconds. Stop spraying immediately if a white deposit or 'frost' appears. Flammable. Do not use near fire or flame. Pressurised container. Protect from sunlight and do not expose to temperatures exceeding 50oC. Do not pierce or burn, even after use. Do not spray on a naked flame or any
Additional Resources
incandescent material. Do not use near or place container on polished or painted surfaces.
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Chart 5 – Cough
Flow chart for onset of cough. Antibiotic treatment is not indicated for the majority of otherwise well service user with coughs.
Is the service user over 65 with two or more of the following?
• Type 1 or 2 diabetic
• History of heart failure
• Currently taking prednisolone
• Has been in hospital for chest problems in last 12 months
Does the service user have any other symptoms such as shortness of breath, chest pain, wheeziness or seem generally unwell?
Does the service user have asthma or chronic obstructive pulmonary disease?
Is cough dry and irritating?
Is phlegm clear white or pale yellow?
Is phlegm copious, dark coloured, bloodstained and unpleasant?
Check medication with pharmacist to eliminate possible side effects. Give simple linctus or Pavacol D / sugar free simple linctus for diabetics*.
Give plenty of fluids. Watch and wait. Monitor daily for signs of deteriorationin which case follow arrow.
Drug Simple Linctus
Indication for Use For relief of occasional non-persistent cough
Strength N/A
Dose 5-10ml up to four times a day
Maximum dose in 24 hours 40ml
Maximum duration of treatment as homely remedy
Cautions
Additional Information
Additional Resources
Indication for Use
48 hours, then seek advice of GP
High sugar content, do not use for diabetics
More soothing if taken with warm water
Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
For relief of occasional non-persistent cough
Strength 5mg/5ml
Dose 5-10ml three to four times a day
Maximum dose in 24 hours 40ml
Maximum duration of treatment as homely remedy
Cautions
Additional Information
48 hours, then seek advice of GP
Not suitable for productive coughs Not suitable for severe liver or kidney failure
More soothing if taken with warm water sugar free suitable for diabetes
Additional Resources Patient Information Leaflet (check the label/leaflet for the product purchased; BNF
Drug
Pholcodine Linctus Pavacol D®
REFERENCES
British Pain Society and British Geriatrics Society, Guidance on the assessment of pain in older people, 2007,http://www.bgs.org.uk/Publications/Publication%20Downloads/Sep2007PainAssess ment.pdf
Care Quality Commission, http://www.cqc.org.uk/standards
Care Quality Commission, 'What providers should do to comply with the Section 2.0 regulations of the Health and Social Care Act 2008' in Essential Standards of Quality and Safety, March 2010
Royal Pharmaceutical Society of Great Britain, The handling of medicines in social care, http://www.rpharms.com/support-pdfs/handlingmedsocialcare.pdf
Blenkinsopp A, Paxton P, Blenkinson, J. Symptoms in the pharmacy: A Guide to the Management of Common Illness, 2009, 6th ed. London: Wiley-Blackwell
Homely remedies guide: For local adaptation to fit within individual care home medication policies (2019) https://www.nationalcareforum.org.uk/wpcontent/uploads/2019/11/Homely-Remedies-guide.pdf
Appendix 3 – Provide Group Care Services Homely Remedies Staff Signature Sheet
STAFF SIGNATURE SHEET
All members of care staff that are responsible for prompting/administering homely remedies should read the Homely Remedy Policy in full.
Provide Group Care Service staff should complete the details below to confirm that:
• They have understood the Homely Remedies Policy
• They are competent to administer/prompt to service users
• They acknowledge accountability for their actions
Only staff members who have signed below are authorised to administer homely remedies.
Appendix 4 – Stock Control Sheet
Homely Remedies Record Sheet
Medicine Name: e.g. Paracetamol
Strength: e.g 500mg
Date Quantity Obtained Quantity Administered Details For example:
• Purchased
• Patient’s name
• Stock check
Quantity Disposed of
Formulation: e.g. tablets
Running balance Staff signature
Balance transferred to new sheet
• A separate sheet is required for each medicines, form and strength
• Also record medication administered on the service user’s MAR chart and care plan. The entry should be annotated ‘homely remedy’. It should be clear what was given, when it was given, what time, what dose, who administered it and why it was given, as well as the effect of the medication. This is particularly important so other members of care staff are aware of when the last dose was given to monitor effectiveness and avoid overdosing.
Appendix 5 – SELF-CARE Medication for Disposal Record Sheet
Service user Name:
Date Identified for disposal:
Name of Care staff identified:
Signature of Care staff identified:
Appendix 6 – Provide Group Care Services Self-Care and Personal-Care Medication
Conjunctivitis
Chloramphenicol eye drops
Haemorrhoids
• For the treatment of acute bacterial conjunctivitis
Seek medical advice if experience:
• Blurred vision
• Pain in eye
One drop every 2 hours for the first 48 hours and four hourly thereafter. The course of treatment is 5 days
• Store in fridge
• Do NOT wear contact lenses for duration of treatment
• Use during waking hours only
• Discard after 5 days
• For external use only
Zinc Oxide
Bismuth Oxide
Balsam Peru
Anusol Cream
• Symptomatic relief of uncomplicated internal and external haemorrhoids
• Do NOT use if rectal bleeding or blood in stools- seek medical advice Apply to affected area night and morning and after each evacuation as necessary.
• Cleanse and dry affected area before use
• For internal conditions use rectal nozzle provided
• Clean nozzle after each use
• NOT to be taken orally
Dry Eyes
Name Indication Cautions
Hypromellose eye drops
Ear Wax
• Artificial tears
• Immediate relief of dry eye conditions
• If there is irritation, mild stinging or blurred vision see medical advice
Name Indication Cautions
Olive Oil Ear Drops
• Removal of ear wax
Mild to Moderate Hay Fever/ Allergic Rhinitis
Name Indication Cautions
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
• Prostatic hypertrophy
• Urinary retention
• Renal impairment
• Known severe liver disease
• Epilepsy
• On tricyclic antidepressants (e.g. Amitriptyline, Lofepramine)
Dose/Route/Frequency Comments
ONE to TWO drops into the eye THREE times daily as needed
• For ocular use only
• The dropper should NOT touch any part of the eye or any surface.
• DO NOT use if wear contact lenses
• Shelf life once opened: discard after FOUR weeks
Dose/Route/Frequency Comments
Place 2-3 drops in the ear and gently massage around the outside of the ear. Use twice a day for up to 7 days.
• Allow ear drops to warm to room temperature before use
• The person should lie with the affected ear uppermost for 5 to 10 minutes after a generous amount of the softening remedy has been introduced into the ear
Dose/Route/Frequency Comments
ONE 4mg tablet orally
Take every 4-6 hours
Maximum SIX tablets (24mg) daily
Side effects may include:
• Drowsiness, blurred vision, dry mouth, inability to concentrate
• Gastro-intestinal disturbances
• Confusional psychosis may occur rarely in the elderly
• Avoid alcohol
• Do not use with other antihistamines
• Under the advisement of a pharmacist.
• On MAOI’s or treated with MAOI in the last 14 days
• Glaucoma
• Previous anaphylaxis due to Chlorphenamine –do not give Loratadine 10mg tablets
• Symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria.
• Under the advisement of a pharmacist.
• Liver impairment
ONE tablet daily
• Avoid alcohol
• Avoid if Body weight <30kg
Cetirizine 10mg tablets
• For the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis
• Under the advisement of a pharmacist.
• Seasonal Allergic Rhinitis
• Hypersensitivity to the active substance, to hydroxyzine or to any piperazine derivatives.
• Service user with severe renal impairment
ONE tablet daily
• Caution is recommended in epileptic service user and service user at risk of convulsions. SEEK medical advice
• In sensitive service user, the concurrent use of alcohol or other CNS depressants may cause additional reductions in alertness and impairment of performance
• TWO sprays into each nostril morning and
• If symptoms do NOT improve in 7 days seek medical advice
Beclometasone
Beconase
Hayfever Relief for Adults 0.05% Nasal Spray
Sodium Cromoglicate 2% eye drops
(hayfever). Provides relief from nasal congestion, runny nose, sneezing, itchy nose
evening. MAXIMUM 8 sprays in 24 hours.
• Shelf life once opened: discard after 3 months
• Relief of acute allergic conjunctivitis
Athletes Foot/ Ringworm
Name
Clotrimazole 1%
Canesten Dual Action 1% Cream
Clotrimazole 1%
• Treatment for athletes foot
• ONE or TWO drops into each eye FOUR times daily
• Discard any remaining after four weeks of opening
• Treatment for Ringwormfungal infection
• Cream contains cetostearyl alcohol, which may cause local skin reactions
APPLY thinly two or three times daily rubbing in gently
• DO NOT use for nail or scalp infections
• Seek medical advice if symptoms persist more than 7 days
• Feet should be thoroughly washed and dried, especially between toes, before applying the cream
• Store in cool dry place
• Cream contains cetostearyl alcohol, APPLY thinly two or three times daily rubbing in gently
• Treatment should be continued for at least 2 weeks
• Store in cool dry place
Threadworm
which may cause local skin reactions
Name Indication Cautions
Mebendazole
100mg
Ovex
Acute Sore Throat
• Treatment for Enterobius Vermicularis (threadworm)
• Oral suspension should be considered if unable to swallow tablets
• Do NOT use if patient is taking: Metronidazole Cimetidine
Name Indication Cautions
Strepsils Honey and Lemon Lozenges
Coughs and Colds
• Symptomatic relief of cough and sore throat
Dose/Route/Frequency Comments
One tablet chewed, crushed or swallowed whole. A second tablet can be taken after 2 weeks if reinfection is suspected
Liquid: ONE 5ml as soon as possible. A second 5ml dose should be taken after 2 weeks if reinfection is suspected
•
Name Indication Cautions
Dose/Route/Frequency Comments
Dissolve 1 lozenge slowly in mouth every 2-3 hours. Maximum 12 lozenges in 2 hours
• None know
Dose/Route/Frequency Comments
Simple Linctus (Sugar Free)
Glycerol 100%
Glycerin
Nasal Congestion
Name
Camphor / eucalyptus / menthol (Vicks VapoRub)
• Dry, irritating cough
• Productive cough with purulent sputum
• Relief of cough and sore throat
• DO NOT give if diabetic
• Use in caution with renal disease, cardiac failure or dehydration
5ml orally, 3-4 times daily if needed
• None know
ONE or TWO 5ml spoonful. Repeat after four hours if needed •
Nasal congestion and cough with cold symptoms
Apply to the chest or nasal area up to three time a day OR
Rub liberally on chest, throat and back, leave night clothes loose to allow easy inhalation
OR
Melt 2 teaspoonfuls in a bowl of hot but not boiling water and inhale vapours for 10-15 minutes
• Each person MUST have their tub of
VapoRub
Dandruff
Name Indication Cautions
Neutrogena T/Gel
Therapeutic
• Treatment of dandruff
• Do NOT use on acutely inflamed or broken skin, erythrodermic and generalised pustular psoriasis
• If irritation develops seek medical advice.
• Avoid contact with eyes
Mild Dry Skin
Benzalkonium
Chloride 0.1% and Dimethicone 22.0% cream (Conotrane)
• Protection of the skin from moisture, irritants, chafing
• It may be used in situations such as in the prevention of pressure sores and in the management of incontinence
• Emollient cream to sooth, smooth and hydrate skin in dry scaling disorders
• Broken areas of skin
• Known hypersensitivity to Benzalkonium chloride
Apply liberal amounts, massage into wet scalp and leave for several minutes. The scalp should be rinsed, the application repeated and then the scalp rinsed thoroughly. Use 2-3 times WEEKLY
• If no improvement after 6 weeks seek medical advice
• Store away from direct sunlight
A sufficient quantity to the sore area of skin several times a day as necessary
• May cause local skin reactions (e.g. contact dermatitis)
• For External Use Only
• Suspected infection Apply a sufficient quantity to the skin 3 or 4 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
• For External Use Only
E45 Cream
Cetraben Cream
• Moisturising and protective cream for the relief of symptoms such as red, inflamed, damaged, dry, or chapped skin, especially when associated with eczema
Mild Skin Conditions
Calamine 15%w/w
Zinc Oxide 5%w/w
(Calamine Lotion)
Cetrimide 0.5% w/w
Chlorhexidine
• Symptomatic relief of mild sunburn and minor skin conditions
• Mild skin reactions, such as redness and rash, have been seen very rarely. Should this occur, use of the product should be stopped. SEEK medical Advice
Apply in direction of hair growth to reduce the risk of folliculitis
Apply to dry skin areas as often as required and rub in.
• Apply with a pad of cotton wool to the affected skin as required.
• For External Use Only
• WARNING: Paraffin based emollient – Fire Hazard
Digluconate 0.1% w/w Skin conditions such as cuts and grazes
• For external use only
• Avoid contact with the eyes, middle ear, meninges and
Apply to the affected area as directed in patient information leaflet after cleansing.
• Shake the bottle
• For external use only
• Each person MUST have their tube of cream
EXPIRY DATES - Shelf life after opening is 12 months
(Savlon Antiseptic cream)
other nervous tissue
• If accidentally splashed into the eye, the open eye should be irrigated for at least 10 minutes
Lidocaine Hydrochloride
2.0% w/w / Zinc Sulphate
1.0% w/w / Cetrimide
0.5% w/w
(Savlon bites & stings cream)
For the symptomatic relief of pain, itching, irritation, and for antiseptic protection. For use in insect bites and stings, and skin reactions such as nettle rash, caused by contact with
• Contact with the eyes should be avoided
• For external use only
• Not suitable for animal bites Apply a small amount to the affected area with a fingertip. Repeat if required up to 3-4 times daily.
• Each person MUST have their tube of cream
• EXPIRY DATES - Shelf life after opening of the tube: 3 months
Choline Salicylate
Dental Gel BP (Bonjela Sugar Free)
• Painful mouth due to mild oral and perioral lesions (mouth ulcers)
• Suspected Candida 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 person
• Not to be used in children under the age of 16 years
• Bronchospasm/asthma in susceptible service user
• If unresolved in 7 seven seek medical advice
Hypoglycaemia
Name Indication Cautions
Dextrose Liquid form (Dextrogel) 25g tube
• Emergency treatment of hypoglycaemic attack
Dose/Route/Frequency Comments
10-20g given by mouth
• Repeat after 10-15 minutes if necessary for a MAXIMUM of 2 doses
• Ensure patient has plenty of fluids and carbohydrates following recovery
