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Self-Care Toolkit for use in

Care Homes

For local adaption to align with individual care home

medicine policies August 2019 Document produced by: Medicines Optimisation for Care Homes Service (MOCH) with Medicines Management Teams Approved for use in Mid Essex CCG Approved by Mid Essex Area Prescribing Committee August 2019 To be reviewed 2022 or sooner if required

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Contents

Self-care principles including homely remedies……………………………………...Page 3

Part One: Self‐care treatment for specific person guidance……………………….Page 5 Purchased by or on behalf of service user without Health Care Professional advice

Key points for self‐care treatments for a specific person GP or other Health Care Professional request to purchase a self‐care treatment Over The Counter community pharmacist consultation

Part Two: Homely remedy guidance……………………………………………………Page 6

Part Three: Personal care guidance……………………………………………………Page 7 Appendix 1: NO PRESCRIPTION REQUIRED………………………………………...Page 10 Appendix 2: Homely remedy template (for care homes to adapt)………………...Page 11

Treatment flow chart and Medicines Information for: Pain …………………………………………………………………………..Page 13 Constipation………………………………………………………………….Page 15 Indigestion/Heartburn………………………………………………………..Page 17 Diarrhoea……………………………………………………………………..Page 19 Insect bites……………………………………………………………………Page 21

Appendix 3: Example Homely Remedies Staff Signature Sheet…………………..Page 22 Appendix 4: Example Homely Remedies Record Sheet…………………………….Page 23 Appendix 5: Self-care Medication Administration Record (MAR) chart………….Page 24

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Self-care principles including homely remedies

This toolkit incorporates the transition from the prescribing of “a pill for every ill”; it is a guide for care homes with residents over 18 years of age, including people with learning difficulties, to support residents 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 resident/care home 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. N.B. exemption from prescription charges does not warrant an exception to the guidance.

1. Residents that are prescribed an ‘Over the Counter’ (OTC) treatment for a long term 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

unresponsive to OTC medicines).

3. For those residents that have symptoms that suggest the condition is not minor (i.e. those with

red flag symptoms e.g. indigestion with very bad pain).

4. Treatment of complex residents (e.g. immunocompromised).

5. Residents on prescription only treatments (i.e. POM medicines).

6. Residents prescribed an OTC product to treat an adverse effect or symptom to a complex

illness or a prescription only medicine.

7. Circumstances where the product licence does not allow an OTC sale.

8. A resident that has not responded to treatment with the self-care OTC product.

9. Residents where the clinician considers the presenting symptom is due to a condition that

would not be considered a minor condition.

10. Individual residents where the clinician considers that their ability to self-manage is

compromised as a consequence 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.

11. Consideration of safeguarding issues.

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Medicines that can be purchased fall into two legal categories, GSL (General Sales List), which are

available widely, or P (Pharmacy Only Medicines) which are available only from a pharmacy.

Together, they are commonly known as OTC (over the counter) products.

This toolkit has been approved by Mid Essex CCG working in conjunction with Essex County Council.

The intention is that this policy will be incorporated across all CCGs within Essex in conjunction with

the relevant District and County Councils.

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 production of this toolkit.

Pharmacists and pharmacy technicians working with care homes will provide advice and support in

implementing this toolkit. Community pharmacy services supporting care homes 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:

1. Acute otitis media – 4 days

2. Acute sore throat/pharyngitis/tonsillitis – 1 week

3. Common cold – 1½ weeks

4. Acute rhinosinusitis – 2½ weeks

5. Acute cough/bronchitis – 3 weeks

This toolkit is divided into three sections:

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 General Pharmaceutical Council

Pharmacy technician registered with General Pharmaceutical Council

Nurse registered with Nursing and Midwifery Council

Paramedic registered with Health and Care Professions Council

Physiotherapist registered with Health and Care Professions Council

HCPs must work within their professional competencies when recommending medication.

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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. earwax, or longer term e.g. hay-fever.

Purchased by or on behalf of service user without HCP advice

Residents or relatives may purchase or bring in their own “self-care treatment products”. Medicines not listed on the homes list of homely remedies need to be discussed with an HCP as to the suitability of the resident continuing to take/use.

HCP request to purchase a self‐care treatment on behalf of the resident

An HCP may advise the home staff to recommend the resident or relative (on behalf of the resident) to purchase a specific product to treat a minor ailment such as olive oil for ear wax 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. hay-fever tablets for the duration of the summer season or short term e.g. mild cystitis. Appendix 1 contains a ”No prescription required form”

OTC community pharmacist consultation

The community pharmacist may recommend an appropriate OTC treatment for a resident and will need to advise the care home around 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 resident. 2. The medicines should be counted into the home and recorded as for other medication, by

adding to the MAR (Medicines Administration Record) chart to ensure regular dosing and stock control.

3. The instructions for the treatment(s) should be communicated to the resident/relative/care home by the HCP and written into that individual’s care plan by care home staff; they only apply to the individual named.

4. If symptoms worsen, care home staff should seek advice from an HCP earlier than the initial recommended duration.

Examples of common minor ailments/conditions which are suitable for self-care. Common minor ailments Example of OTC product

Infrequent cold sores of the lip Antiviral cold sore cream

Conjunctivitis Antibacterial eye drops or ointment

Haemorrhoids (piles) Haemorrhoid cream or ointment

Mild cystitis Sodium bicarbonate or potassium citrate sachets

Dry eyes/sore tired eyes Eye lubricants e.g. hypromellose 0.3%

Earwax Drops containing sodium bicarbonate, hydrogen peroxide, olive oil, almond oil

Mild acne (under 65 years) Products containing benzoyl peroxide or salicylic acid

Mild to moderate hay fever/allergic rhinitis Antihistamine tablets or liquids; steroid nasal sprays; sodium cromoglicate eye drops

Oral thrush Antifungal oral gel

Ringworm/athletes foot Athletes foot cream, antifungal creams and sprays

Threadworm Mebendazole (chewable) tablets/suspension

Travel sickness Travel sickness tablets

Vitamins and minerals Multivitamin and minerals, vitamin B12 (cyanocobalamin), vitamin C tablets, vitamin D tablets 400-1000 units

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Part Two: Homely remedy guidance

A homely or household remedy is another name for a non-prescription medicine which is kept as stock and used in a care home 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 resident living in their own home.

Key points for homely remedies

1. This toolkit provides a template policy (Appendix 2) for Care Homes with or without nursing who agree to stock the approved list of products to treat minor ailments.

2. Homely remedies must be purchased by the care home and should not be labelled for individual residents.

3. 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.

4. Homely remedies should not be requested on prescription from GPs or non-medical prescribers.

5. This policy replaces the need to sign individual agreements for each patient for the medicines included in the toolkit

The conditions and products agreed by the CCG for homely remedies are tabled below.

Chart Condition

Homely remedy OTC product

1 Pain (mild to moderate), discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain, tooth ache)

Paracetamol NB: Other medicines containing paracetamol may have been prescribed for some patients and this must be carefully checked

2 Constipation Macrogol (Laxido®/ Movicol®)

Senna tablets or syrup

3 Indigestion and heartburn Gaviscon Advance®

Peptac® liquid

4 Diarrhoea Oral rehydration therapy e.g. Dioralyte®

5 Insect bites and stings Hydrocortisone cream 1% N.B. do not share tube between patients. 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.

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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 used in care homes in this manner. If symptoms worsen, the GP or pharmacist should be contacted for advice. NHS England has provided a list of common minor ailments that may be treated as self-care and the CCG has agreed that they do not necessarily have to be discussed with an HCP. Similarly, recording the product used does not always have to be added to the MAR chart, but does have to be recorded in the care plan and daily personal care log. However it is recommended that regular items e.g. vitamins and minerals, should be added to the individual patient MAR chart and indicate them as a self-care item or recorded on a separate self-care MAR chart (Appendix 5) to ensure regular dosing and stock management. This list is not exhaustive but reflects the current emphasis on moving from prescribed to self-care items.

Personal

Care Example OTC products

Acute sore throat Lozenges e.g. Lockets

Coughs and colds Simple linctus, glycerol, honey and lemon

Nasal congestion Saline nasal drops, menthol vapour rub

Dandruff Anti-dandruff shampoo e.g. Neutrogena®, Polytar®

Head lice Creams and lotions for head lice e.g. Hedrin®

Mild Acne (under 65 years) Multitude of skin care options

Mild Dry Skin Emollient creams and lotions e.g. E45®, Aveeno®, QV cream, Vaseline®

Sunburn Multitude of after sun creams

Sun protection Multitude of skin protection creams

Mouth ulcers

Antiseptic mouthwash e.g. Corsodyl®, Listerine®, Bonjela® Refer to GP if not resolved in 7 days or multiple/painful/red

Prevention of dental caries Normal fluoride toothpaste

Warts and Verrucas Creams, gels, skin paints and medicated plasters containing salicylic acid Refer to GP or podiatrist if diabetic

Probiotics Probiotic sachets, yoghurts

Vitamins and minerals* Multivitamin and minerals, vitamin B12 (cyanocobalamin), vitamin C tablets, vitamin D tablets 400-1000 units

* Record on MAR and indicate them as a self-care item or record on a separate self-care MAR chart.

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Administration All care home staff who are appropriately trained (refer to NICE Guidance SC1 Managing Medicines in care homes, March 2014) and can give homely remedies to residents should be named; see ‘Homely Remedies Staff Signature Sheet’ (Appendix 2). Care home staff should sign to confirm that they understand the Homely Remedies Policy, are competent to administer homely remedies, and to acknowledge that they will be accountable for their actions. The decision to administer a homely remedy can only be made by appropriately trained care home staff, who must establish the following:

the resident has no potentially serious symptoms

there have been no changes to the medication or the residents health since the homely remedies authorisation sheet was last reviewed.

allergy status

what the resident has used in the past for these symptoms

whether the resident has any difficulties swallowing

the resident is aware that 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.

Disposal of Homely Remedies Homely remedies must be disposed of when they are no longer fit for purpose and/or are out of date, in accordance with the care homes disposal of medicines procedure. The disposal of homely remedies should be recorded on the Stock control sheet - Homely Remedies Record Sheet (Appendix 4) for

that particular medicine.

Summary of documentation advised

No prescription required form for use by an HCP Appendix 1

Care Home Policy for Homely Remedies (template in 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, to include the disposal of homely remedies.

Flow charts for each minor condition (refer to the National Care Forum Safety of Medicines in Care Homes: Homely Remedies Guide, 2013)

Self-care Medication Administration Record (MAR) chart template (Appendix 5)

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Appendix 1 NO PRESCRIPTION REQUIRED 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 anytime 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 aches and pains

sore throat teething

allergies sleep problems

skin rash travel sickness

heartburn and indigestion threadworm

upset stomach head lice

diarrhoea scabies

constipation athlete’s foot

Colic cold sores

Piles (haemorrhoids) fungal skin infections - ringworm

headache and migraine fungal nail infections

toothache conjunctivitis

eczema Other - please indicate below

If at any time you are concerned about your condition or if your symptoms are not improving after a few days of treatment with the over the counter medications you should contact the local pharmacist or the surgery for more advice. For more information visit http://www.nhs.uk/Livewell/Pharmacy/Pages/Commonconditions.aspx

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Appendix 2 – Homely remedy template (for care homes to adapt) _______________________________Homely Remedies Policy [Insert care home name] A homely remedy is a medicinal preparation used to treat minor ailments; they are purchased over the counter and do not require a prescription. They are kept as stock in the care home to allow access to products that would commonly be available in any household. The NICE Social Care Guideline (SC1) Managing Medicines in care homes includes a recommendation that care home providers offering non-prescription medicines or other OTC products (homely remedies) for treating minor ailments should consider having a homely remedies process or policy. The Care Quality Commission agrees that a small range of products may be kept in stock in a care home for service users for the treatment of minor ailments for a short duration.5 ______________________________ has adopted the self-care toolkit which is supported by our local GP practices and the care home pharmacy team. The agreed list of medicines for homely remedies is:

Chart Condition Homely remedy OTC product

1 Pain (mild to moderate), discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain, tooth ache)

Paracetamol NB: Other medicines containing paracetamol may have been prescribed for some patients and this must be carefully checked

2 Constipation Macrogol (Laxido®/ Movicol®)

Senna tablets or syrup

3 Indigestion and heartburn Gaviscon Advance®

Peptac® Liquid

4 Diarrhoea Oral rehydration therapy e.g. Dioralyte®

5 Insect bites and stings Hydrocortisone cream 1% N.B. do not share tube between patients. 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.

Obtaining supplies of homely remedies Homely remedies can be purchased from the regular pharmacy supplier _________________________________________________ [insert name of usual pharmacy].

[Local agreements on payment vary – insert the local agreement here] The Homely Remedies Stock Control Record Sheet (Appendix 4) should be used to record any purchases of homely remedies. N.B. 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.

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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 residents’ prescribed medication.

Access should be restricted to staff with medicines management responsibilities.

All homely remedies MUST be stored in their original packaging together with any information supplied with the product about the medicine use.

They should be stored in accordance with the instructions in the patient information leaflet.

Stocks and expiry dates should be checked monthly.

Some liquids and eye drops have a reduced shelf-life once opened therefore the date opened should be recorded on the bottle/label. The manufacturer’s instructions should be checked for this information.

Administration of homely remedies The administration of a homely remedy can be either in response to a request from the resident or from a member of care home staff. It is the responsibility of the senior carer or duty nurse to check that the administration of the 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.

All care home staff using a homely remedies protocol should be named in it, and should sign to confirm they have the skills to administer the homely remedy and acknowledge that they will be accountable for their actions.

Appendix 3 is a staff list template.

Homely remedies should be given for a limited period, usually 48 hours or the period stated in the medicines policy

The resident is made aware that the medicine is not prescribed and has given their consent, or a ‘best interests decision’ is in place

The administration of homely remedies must be recorded on each resident’s MAR chart. The entry should be annotated ‘homely remedy’.

It should be clear what was given, when it was given, what 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.

Appendix 4 contains a stock control form. This document can be used to record the purchase of the medicinal product should be updated to indicate that it has been administered to a resident, each time any medication is administered.

If a homely remedy is given regularly, this must be reviewed with the GP.

Homely remedies are not for the use of anyone else e.g. family member or staff.

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Appendix 5 is a template SELF CARE Medication Administration Record (MAR) chart which can be used for self-care items e.g. vitamins and minerals to ensure regular dosing and stock management.

Disposal

Expired stock should be disposed of in line with the [insert care home’s name] policy on the

disposal of medication. Disposal of homely remedies should be recorded in the Homely

Remedies Stock Control Record sheet (Appendix 4).

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Has resident 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 that 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?

Communication of pain is not just verbal. Look for facial signs, sighing, groaning, calling out, aggression and withdrawal which is out of character. Use Abbey pain score or PAINAD tool.

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 repeat if necessary every FOUR to SIX hours. NO MORE THAN 80ml (4g) TO BE TAKEN IN 24 HOURS

YES NO

NO YES

Chart 1 – Pain MILD PAIN only; all cases of sudden onset severe pain MUST be referred

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Medicines Information: Pain

Drug Paracetamol

Indication for use Relief of mild pain

Strength 500mg tablets/ capsules/ caplets/ effervescent tablets

Dose TWO tablets up to FOUR times a day

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

Up to 48 hours then seek advice from GP

Cautions 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 < 50kgs give 1 tablet up

to four times a day.

Additional information Many medicines also contain paracetamol. Check current

medication records and if in doubt check with Pharmacist.

Additional resources Patient Information leaflet (check the label / leaflet for the

product purchased), BNF

Drug Paracetamol suspension

Indication for use Relief of mild pain

Strength 250mg/5ml suspension

Dose FOUR 5ml spoonfuls (20ml) up to FOUR times a day

Maximum dose in 24 hours 80ml (4g) in divided doses (Maximum of 20ml (1g) in any 4 hours)

Maximum duration of treatment as homely remedy

Up to 48 hours then seek advice from GP

Cautions 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 < 50kgs give 10ml up to

four times a day.

Additional information Many medicines also contain paracetamol. Check current

medication records and if in doubt check with Pharmacist.

Additional resources Patient Information leaflet (check the label / leaflet for the

product purchased), BNF

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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 resident show any of the following alarm signs? ●Blood in stools ●Severe abdominal pain ●Unintentional weight loss ●Associated diarrhoea ●Painful and ineffectual straining

Is the resident taking any medicines 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

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

If constipation frequently re-occurs, ask GP to review

Information table Some common drugs which can cause constipation: Indigestion remedies containing aluminium; antidiarrheals e.g loperamide (Imodium®); antihistamines e.g. chlorpheniramine (Piriton®) promethazine (Phenergan®); antipsychotics e.g. risperidone; diuretics e.g bendroflumethiazide, furosemide (if dehydration occurs); iron and calcium supplements; pain killers containing opioids e.g. codeine, dihydrocodeine, morphine, tramadol; some antidepressants e.g. amitriptyline, imipramine; some Parkinson’s drugs e.g. levodopa; some drugs to treat high blood pressure e.g. amlodipine; anticholinergic for urinary frequency e.g. oxybutinin

NO

NO

Not effective

YES

YES

Effective

YES

Not effective

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Medicines Information: Constipation

Drug Macrogol ‘3350’ powder sachet (Laxido/ Movicol)

Indication for use For relief of constipation

Strength Macrogol 3350, with potassium chloride, sodium chloride and sodium bicarbonate.

Dose One to three sachets daily To be made up in 125mL of water (half a glass). Can be mixed with any juices of preference.

Maximum dose in 24 hours 3 sachets

Maximum duration of treatment as homely remedy

Up to 48 hours then seek advice from GP

Cautions 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 For relief of constipation

Strength 7.5mg tablet; 7.5ml/5ml syrup

Dose ONE to TWO tablets at night; 5 to 10ml at night

Maximum dose in 24 hours TWO tablets, 10ml syrup

Maximum duration of treatment as homely remedy

Up to 48 hours then seek advice from GP

Cautions This product should not be used when abdominal pain, intestinal obstruction, nausea or vomiting is present.

Additional information May colour urine For use when macrogols are not tolerated

Additional resources Patient Information leaflet (check the label / leaflet for the product purchased), BNF

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Chart 3 – Indigestion/heartburn Indigestion is experienced as discomfort, or a burning pain in the central chest region. When this burning rises up towards the throat it is referred to as heartburn. Flowchart for use when resident 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 resident generally unwell?

Is the resident taking any medicines which could cause indigestion? Check patient information leaflets and see box 1

Is resident taking any medicine which carries a warning to avoid antacids or indigestion remedies? Check the medicines label

Give Gaviscon Advance® or Peptac® after meals and at bedtime. Give lifestyle advice – see box 2

Contact GP or NHS 111

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

Box 1 Some medicines that commonly cause indigestion:

Anti-inflammatory medicines e.g. aspirin, ibuprofen, naproxen

Oral corticosteroids e.g. prednisolone

NO

NO

NO

YES to either

YES

YES

YES

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

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Medicines Information: Indigestion/ Heartburn

Drug Gaviscon Advance® liquid (peppermint or aniseed flavour)

Indication for use Gastric reflux and heartburn

Strength 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

Up to 48 hours then seek advice of GP

Cautions Contains sodium (2.3mmol in 5mls) and 1mmol of potassium in 5mls. Avoid where sodium restriction is indicated

Additional information 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.

Additional resources Patient Information leaflet (check the label / leaflet for the product purchased), BNF

Drug Peptac® liquid aniseed/peppermint

Indication for use Heartburn and gastric hyperacidity

Strength 133.5mg sodium bicarbonate, 250mg sodium alginate and 80mg calcium carbonate in 5ml.

Dose 10-20ml after meals, and at bedtime.

Maximum dose in 24 hours 80ml daily

Maximum duration of treatment as homely remedy

Up to 48 hours then seek advice of GP

Cautions Should not be used in patients 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 1-2 hours between doses

Additional information Shake well before use Sugar free so suitable for diabetics

Additional resources Patient Information leaflet (check the label / leaflet for the product purchased), BNF

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Chart 4 – Diarrhoea

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 resident taking any medicines which could cause diarrhoea? E.g. antibiotics (current or very recent) or laxatives

Is the resident experiencing uncomplicated sudden, short term diarrhoea?

Contact GP or NHS 111

Contact GP or NHS 111

Contact pharmacist or NHS 11 AND encourage resident to drink plenty of clear fluids such as water or diluted squash. Avoid dairy products such as cheese or milk

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)

Prolonged diarrhoea can reduce the effectiveness of medication and de-stabilise patients such as those with diabetes and epilepsy. Monitor more closely

Infection control

Staff and residents 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

NO

NO

NO

YES

YES/unsure

YES

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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

Up to 24 hours if refusing to drink. Up to 48 hours, if diarrhoea is persistent then seek advice of GP.

Cautions None

Additional information The solution may be stored for up to 24 hours in a fridge, otherwise any solution remaining an hour after reconstitution should be discarded.

Additional resources Patient Information leaflet (check the label / leaflet for the product purchased), BNF

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Chart 5 – Insect bites and stings

Drug Hydrocortisone 1% cream

Indication for use For symptomatic treatment of all insect bites and stings

Strength 1% w/v, 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 days then seek advice of GP (see place in flow chart)

Cautions The product should not be used on the eyes or face, the ano-genital area or on broken or infected skin including impetigo, cold sores, acne, athlete's foot, scabies or infected bites or stings.

Additional information GP may suggest continued treatment but should be self-care for an individual (form available at appendix 1) N.B. do not share tube between patients. 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.

Additional resources Patient Information leaflet (check the label / leaflet for the product purchased), BNF

Bites and stings can be treated:

First line – with a cold compress

Second line – hydrocortisone 1% cream may be applied for localised redness and itching – only if skin is unbroken Severe swelling and redness must be referred to GP or NHS 111. Residents known to be allergic to wasp or bee stings must keep their emergency treatment with them at all times.

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Appendix 3

Example Homely Remedies Staff Signature Sheet

All members of care home staff that are responsible for administering homely remedies

should read the Homely Remedy Policy in full.

Care home staff should complete the details below to confirm that:

they have understood the homely remedies Policy

they are competent to administer to residents

they acknowledge accountability for their actions.

Only staff members who have signed below are authorised to administer homely

remedies.

Name Signature Initials Manager authorisation

Date

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Appendix 4 - Stock control sheet

Example Homely Remedies Record Sheet

Medicine

Name Paracetamol

Strength

500mg

Formulation Tablets

Date Quantity Obtained

Quantity Administered

Details For example:

purchased

patient’s name

stock check

Quantity Disposed (for example if wasted, expired)

Running Balance

Staff signature

Balance transferred to new sheet

A separate sheet is required for each medicine, form and strength.

Also record medication administered on the resident’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 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.

Based on a template provided by Yorkshire and Humber Commissioning Support Medicines Management Social Care Support Team

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Appendix 5 - SELF CARE Medication Administration Record (MAR) chart Patient name: D.O.B.

ALLERGIES:

GP name and address: Tel No.

Community pharmacy name and address: Tel. No

Date Time Initials Treatment Dose Reason Outcome Date Time Initials

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Document title

Self-Care Toolkit for use in Care Homes

Document reference

CarehomeselfcaretoolkitPOL201906V1.0FINAL

Author Medicines Optimisation Team, Mid Essex CCG

References NHS England guidance (March 2018) https://www.england.nhs.uk/wpcontent/ uploads/2018/03/otc-guidance-for-ccgs.pdf CQC national guidance “Treating minor ailments and promoting self-care in adult social care” https://www.cqc.org.uk/guidance-providers/adult-social-care/treating-minor-ailments-promotingself-care-adult-social-care https://www.nice.org.uk/guidance/sc1 Adapted kindly from East Sussex Self-Care Toolkit for Care homes, December 2018

Website https://midessexccg.nhs.uk/medicines-optimisation/prescribing-policy-statements

Document location

Medicines Guidance Current > Care Homes

Approved by Mid Essex Area Prescribing Committee

Date approved

August 2019

Review date August 2022