NHS Doncaster CCG Quality Toolkit for Care Homes Best Practice Principles Part 1: Self-care treatment for a specific person guidance Date of Review Amendment Details Amended By Autumn 2020 In association with East Sussex Better Together Team http://www.doncasterccg.nhs.uk/your-care/quality/quality-toolkit-for- care-homes/ Printed copies of this document are not controlled. Document users are responsible for ensuring printed copies are valid prior to use. Please refer to the online copy for the latest version Quality Toolit for Care Homes Page 1 of 37 v7 Created 12/19
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NHS Doncaster CCG
Quality Toolkit for Care Homes
Best Practice PrinciplesPart 1: Self-care treatment for a specific person guidance
Date of Review Amendment Details Amended ByAutumn 2020
In association with East Sussex Better Together Team
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Part 1: Self-care treatment for a specific person guidanceSelf-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 GP or HCP advice
Nursing Home service users or relatives may buy and use their own “self-care products” under the guidance of the responsible nurse in the nursing home.
GP or other HCP request to purchase a self-care treatment
A GP or other healthcare professional(HCP) may instruct Nursing or Residential home staff to purchase a specific product to treat a minor ailment such as olive oil for ear wax, vitamins for maintenance.
The GP or other HCP should indicate how long the treatment is to continue and state if the dosing differs from the advice labels on the product package. This may be longer term e.g. hay-fever tablets for the duration of the summer season or short term e.g. mild cystitis.
OTC community pharmacist consultation
When consulting a community pharmacist they will need to know the current medication prescribed and may recommend an appropriate OTC treatment for a service user 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 a GP or other HCP and consultation is encouraged.
Appendix 1 contains a suggested Care home self-care medicine pad which supplies the care home with the information needed above.
Key points for self-care treatments for a specific person
The medicines are not for general use in the home and must remain specific to that service user. 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 appropriate dosing and stock control. The instructions for the treatments should be communicated (email / verbal) by the surgery or
pharmacy and written into the individual care plan; they only apply to the individual named. If symptoms worsen, the GP, other HCP or community pharmacist should be informed earlier than the
initial recommended duration.
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NHS England guidance (March 2018)1 has provided a list of common minor ailments that may be treated as self-care at the recommendation of a GP or health care professional
Medical condition Self-care GP/ Pharmacist advice
specified
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%
Coughs and colds and nasal congestion Non-drowsy cough mixture e.g. glycerol, 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
1 NHS England guidance (March 2018)1 https://www.england.nhs.uk/wp-content/uploads/2018/03/otc-guidance-for-ccgs.pdf
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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 Verruca 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 C tablets, Vitamin D tablets 400- 1000 units
Insect Bites and stings Antihistamine cream or tablets
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Appendix 1 Care Home Self- Care Medicine Pad
Name __________ DOB _______
NHS Number __________
Care Home __________
Surgery/pharmacy __________
HCP Name __________ HCP signature __________
Condition TreatmentSuggested
Directions – either:Tick “ as a packet” or if other specify
Duration of treatment: e.g. 7 days, hayfever season
Infrequent cold sores of the lip
__________ As a packet☐
Other: __________
__________
Conjunctivitis__________ As a packet
☐Other: __________
__________
Haemorrhoids (piles)__________ As a packet
☐Other: __________
__________
Mild Cystitis__________ As a packet
☐Other: __________
__________
Dry eyes/sore tired eyes
__________ As a packet☐
Other: __________
__________
Ear wax__________ As a packet
☐Other: __________
__________
Mild Acne (under 65 years)
__________ As a packet☐
Other: __________
__________
Mild to moderate hay fever/allergic rhinitis
__________ As a packet☐
Other: __________
__________
Oral Thrush__________ As a packet
☐Other: __________
__________
Ring worm /atheletes foot
__________ As a packet☐
Other: __________
__________
Thread worm__________ As a packet
☐Other: __________
__________
Travel sickness__________ As a packet
☐Other: __________
__________
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Name __________ DOB _______
NHS Number __________
Care Home __________
Surgery/pharmacy __________
HCP Name __________ HCP signature __________Condition Treatment
SuggestedDirections – either:Tick “ as a packet” or if other specify
Duration of treatment: e.g. 7 days, hayfever season
Acute sore throat__________ As a packet
☐Other: __________
__________
Coughs and colds and nasal congestion
__________ As a packet☐
Other: __________
__________
Dandruff __________ As a packet☐
Other: __________
__________
Head lice __________ As a packet☐
Other: __________
__________
Mild Acne
(under 65 years)
__________ As a packet☐
Other: __________
__________
Mild Dry Skin __________ As a packet☐
Other: __________
__________
Sunburn __________ As a packet☐
Other: __________
__________
Sun protection __________ As a packet☐
Other: __________
__________
Mouth ulcers __________ As a packet☐
Other: __________
__________
Probiotics __________ As a packet☐
Other: __________
__________
Prevention of dental caries
__________ As a packet☐
Other: __________
__________
Warts and Verruca __________ As a packet☐
Other: __________
__________
Vitamins and Minerals
__________ As a packet☐
Other: __________
__________
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Part Two: Homely Remedy GuidanceA 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 for example headache, occasional pain or indigestion.
The administration of a homely remedy can be either in response to a request from the service user or from a member of care home staff.
In a Nursing Home it is the responsibility of the 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 GP or other health care professional e.g. pharmacist, ANP should be consulted and the discussion documented.
Residential homes are not suitable to operate a homely remedies policy unless they have commissioned a health care professional to review the suitability of their residents.
Homely remedies should be given for a limited period, usually 48 hours or the period stated in the medicines policy
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
Key points for homely remedies
This toolkit serves as a template (Appendix 2) for Care Homes who agree to stock the approved list of products to treat minor ailments.
Homely remedies must be purchased by the care home and should not be labelled for individual service users.
Homely remedies should usually only be given for up to 48 hours, before referring to the GP if symptoms persist. If required for longer than 48 hours, the GP will need to review and advise.
Homely remedies should not be requested on prescription from GPs or non-medical prescribers. Dressings and items for first-aid are not homely remedies.
The conditions and products agreed by the CCG for homely remedies are tabled below.
Chart Condition Homely remedies OTC product
1 Pain (mild to moderate), discomfort and/fever.(e.g. aches and sprains, headache, period pain, back pain, tooth ache)
ParacetamolNB: Other medicines containing paracetamol may have been prescribed for some service users and this must be carefully checked
2 Constipation Macrogol powder Senna tablets or syrup
3 Indigestion and heartburn Sodium alginate liquids
4 Diarrhoea Oral rehydration therapy
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Appendix 2 – Homely remedy template for Care Homes to adapt
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.2
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.3
_______________________________ has adopted the self-care toolkit which is supported by our local GP practices and the MOCH team. The agreed list of medicines for homely remedies is:
Chart Condition Homely remedies 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 service users and this must be carefully checked
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Known patient of planned DN team or __________________
ANP or Proactive Care Coordinator
Telephone Known contact or GP Practice
Known to ANP/Proactive care coordinator and on their proactive care register
ECP Telephone 0300 123 1221 Referral criteria
8-8pm 7 days per week
Rapid Response
Telephone 01302 566999
Frailty Service Telephone 01302 566999Palliative Care Telephone 01302 566999
Out of Hours
ECP Telephone 0300 123 1221OOH GP Service
Telephone 0300 123 9990 Registered with a Doncaster GP Practice
Unplanned Nursing Service
Telephone 01302 566999
Non Acute How to make a referral
Contact Details
8-6pm GP Telephone Registered GP Practice
Registered patient
8-6pm Known or new District Nurse support
Telephone Known contact or01302 566999
Known patient of planned DN team or ___________
8-5pm CHC Case Manager
Telephone Case Manager contact
Known resident of CHC case manager
Who to contact for advise and support
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Obtaining supplies of homely remediesHomely remedies can be purchased from the regular pharmacy supplier
___________________________ [insert name of usual pharmacy].
[Local agreements on payment vary – insert the local agreement here]
N.B. The quantity of paracetamol tablets and capsules that can be purchase 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.
The Homely Remedies Stock Control Record Sheet (Appendix 4) should be used to record any purchases of homely remedies.
Medicines not suitable as homely remedies 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 Dressings and items for first aid 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. 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 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.
The administration of homely remedies
The administration of homely remedies must be recorded on each service user’s MAR chart. The entry should be annotated ‘homely remedy’.Appendix 3 contains an example self-care MAR chart.
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 5
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The document used to record the purchase of the medicinal product should be updated to indicate that it has been administered to a service user, each time any medication is administered.Appendix 4 contains a stock control form.
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.
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 6 is a staff list template.
Disposal of Homely Remedies
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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Medicines Information Forms
Pain
Paracetamol
Indication for use Relief of mild pain
Strength 500mg tablets/capsules/caplets/ tablets
Dose TWO tablets up to FOUR times a day
Maximum dose in 24 hours
8 tablets (4g) in divided doses
(Maximum of 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 informationMany medicines also contain paracetamol. Check current medication records and if in doubt check with Pharmacist.
Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
Paracetamol Liquid
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 of GP
Cautions Do not administer with other paracetamol containing
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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 informationMany medicines also contain paracetamol. Check current medication records and if in doubt check with Pharmacist.
Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
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Constipation
Macrogol 3350
Indication for use For relief of constipation
StrengthMacrogol 3350, with potassium chloride, sodium chloride and sodium bicarbonate.
Dose One to three sachets daily
Maximum dose in 24 hours
3 sachets
Maximum duration of treatment as homely remedy
Up to 48 hours then seek advice from GP
CautionsTo be made up in 125mL of water (half a glass). Can be mixed with any juices of preference. Reconstituted sachets must be discarded after 6 hours if not taken.
Additional information Can be chilled in fridge before giving.
Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
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
CautionsThis product should not be used when abdominal pain, intestinal obstruction, nausea or vomiting is present.
Additional information May colour urine
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For use when Macrogols are not tolerated
Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
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ECP
Indigestion/Heartburn
Sodium Alginate
Indication for use Gastric reflux and heartburn
Strength500mg sodium alginate, 100mg potassium bicarbonate per 5 ml
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
CautionsContains 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 East Sussex Formulary; it is included here as it is readily available OTC.
Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
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Diarrhoea
Oral hydration sachets
Indication for use For fluid and electrolyte replacement
Strength N/A
Dose One or two sachets after each loose stool
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
Additional information
Contents of each sachet should be dissolved in 200ml of drinking water. 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 resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF
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Appendix 3 – MAR chart for Self Care
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A separate sheet is required for each medicine, form and strength. Also record medication administered on the resident’s MAR chart and care plan
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Appendix 5 - Identified Residential Care Home Residient
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Appendix 6 – Staff list
Example Homely Remedies Staff Signature Sheet
All members of care home staff that are responsible for administering homely remedies should read the Homely Remedy guidance inline with their medicines management policy.
Care home staff should complete the details below to confirm that: they have understood the homely remedies guidance; 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
authorisationDate
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
__________ __________ _______
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