Care Homes - Homely Remedies Protocol

Transcription

1 Care Homes - Homely Remedies Protocol A homely remedy is a medicine for the short-term treatment of a minor ailment, such as indigestion, a cough, mild to moderate pain or constipation, and can be obtained without a prescription. 1 It is important that staff are able to respond in a timely way to residents when they feel unwell. Many people living in their own home purchase remedies from the pharmacy or the local shop and generally do this without involving the GP. Pharmacists will also provide advice on the best treatment and give advice on its use. For people living in a care setting, which is their own home, this is achieved by using homely remedies; by having these medicines available, an immediate need can be met and the GP is only called if the symptoms persist. The NICE Guideline Development Group (GDG) for the Managing of Medicines in Care Homes 2 guidance states that where a care home provider offers residents treatment for minor ailments with homely remedies a process for use should be in place, i.e. a Homely Remedy Protocol. This will ensure that advice from a healthcare professional, such as a GP or pharmacist, on the use of the medicine is in place for each resident in advance. This must be reviewed annually but checked regularly, especially if there is a change to the prescribed medication. The GDG also recommends that the homely remedy protocol should name all staff trained to follow the process. These members of staff should sign to confirm they are confident and competent to administer the homely remedy and to acknowledge that they are accountable for their actions. Homely Remedies Protocol Care home providers offering homely remedies should have a clearly documented protocol which includes the following: the name of the medicine and what it is for which residents should not be given certain medicines (for example, paracetamol should not be given as a homely remedy if a resident is already receiving prescribed paracetamol) the dose and frequency the maximum daily dose where any administration should be recorded, such as on the medicines administration record (MAR) chart how long the medicine should be used before referring the resident to a GP Obtaining Supplies Medications labelled for an individual resident, i.e. for whom a prescription has been issued, cannot be given to another resident as a homely remedy. Additionally, if a resident or their relative has purchased a homely remedy, it must be agreed with the GP before being given and can only be given to that individual resident. Bulk prescribing is also not a suitable way of obtaining supplies for homely remedies Only stock purchased by the care home for administration under the homely remedies protocol may be used and only medicines listed in the protocol may be administered. Homely remedies can be bought from a community pharmacy, supermarket or other store A record of all purchases should be kept so that there is a clear audit trail

2 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 an individual to avoid cross contamination Dressings and items for first aid Vitamin, herbal or homeopathic supplements Storage These medicines must be clearly identifiable as a homely remedy. They should be stored separately from other prescribed medication in a locked cupboard or trolley Medicines to be given as a homely remedy must be stored in their original package with a patient information leaflet wherever possible Excessive quantities of homely remedies should not be kept As with all medications, homely remedies should be stored below 25 C (unless stated otherwise on the medicine information), and away from damp and strong light Access to homely remedies should be restricted to trained staff Administration 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. If there is any uncertainty the GP or pharmacist should be consulted and the discussion documented If the resident self administers the homely remedy a risk assessment should be completed and kept with their care plans The administration of homely remedies must be recorded according to the care home policy and procedures. The ideal place would be the residents MAR chart. The entry should: o be annotated homely remedy o clearly state what was given, when it was given, who administered and why it was given o the effect of the medication should also be documented. 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 Homely Remedies Audit sheet should record the purchase of the medicinal product and should be updated to indicate that a dose has been administered to a resident and the running balance revised Homely remedies should be only given for a limited period, usually 48 hours Once opened, all liquids should have the date opened recorded on the container; (some products may have a shorter shelf life once opened, check the manufacturer s literature) Review The resident should be reviewed if the homely remedy is required beyond the agreed period, usually 48 hours (or 24 hours if diarrhoea is present and fluid intake is poor) If the homely remedy is required for longer than 48 hours or it is required regularly then a prescription should be provided

3 Audit The balance and expiry dates of the homely remedies must be checked regularly, ideally monthly. Some products may have a shorter shelf-life once opened and this should be highlighted. Disposal Expired stock should be disposed of in line with the home s policy on the disposal of medicines. References 1. PrescQIPP NHS Programme; 2. Managing Medicines in Care Homes;

4 Homely Remedies Agreement Name of Home:... The Homely Remedies Protocol details medication that can be administered to individual resident s that have not been prescribed this medication by the doctor Administration of these remedies should be limited to 48 hours and should be given in accordance with the directions listed. Any further doses will require discussion with the GP to re-assess the resident s condition and medication. If the GP agrees that the medication is required after this time then it should be prescribed by the GP. It cannot continue to be given under the Homely Remedies Protocol The decision to administer the remedies should be made by the registered manager or senior carer on duty. They must ensure that there are no contra-indications and the resident meets all the requirements of the protocol before giving the medicine Under no circumstances should another resident s medication be used Resident s should not purchase their own homely remedies but should be encouraged to tell staff what they require Where prescribed medication is also being taken, it will be necessary for the home to check with the pharmacist for possible drug interactions. This includes herbal and homeopathic remedies as they have the same potential for drug interactions and side effects as any other medication Where residents are administering their own homely remedies, a full risk assessment must be made and recorded in the care plan and the remedies must be kept in the resident s room in a locked cupboard or drawer Homely remedies must be stored in a separate, labelled cupboard away from prescribed medication. Expiry dates and storage details must be checked regularly and unused and expired items returned to the Pharmacy in the specified way Homely remedies must only be administered at the request of the resident or by a member of the care home staff for the condition specified on the Homely Remedy Protocol Before administering a homely remedy, the resident s care plan must be checked to make sure that the GP has not excluded it from the Homely Remedies Protocol Any medication administered must be clearly recorded on the MAR sheet and the Audit Sheet. This must state the date, time, quantity of the medication given and the fact that it was a homely remedy When a homely remedy is administered this should be brought to the attention of the senior staff on the next shift to allow them to assess the resident If a medication which is included on the Homely Remedy Protocol is prescribed by a doctor for a resident, it cannot be used as a homely remedy for that person but must be given according to the instructions on the prescription Agreed by: Registered Manager:... General Practitioner:... Date:... Review Date:...

5 Homely Remedies Protocol I agree that a suitably trained member of staff on duty at [name of care home] may administer the medications listed below for the indications stated to [insert name of resident] This agreement requires that staff involved in the administration of homely remedies ensure that the medicine is suitable for the resident's needs at that particular time and that the administration is recorded on both the MAR chart and the Audit Sheet Symptom Medicine Dose Frequency Indigestion or Heartburn Mild to Moderate Pain or Raised Temperature Mild to Moderate Pain or Raised Temperature Gaviscon Advance Oral Suspension 5-10ml After meals and at bed-time Maximum in 24 hours 40ml in divided doses Paracetamol Tablets 2 Tablets Every 4-6 hours 8 Tablets Paracetamol 250mg/5ml Suspension Constipation Senna Tablets 1-2 Tablets Constipation Dry Irritating Cough For fluid and electrolyte loss associated with Diarrhoea Senna Syrup Simple Linctus (sugar free) Oral Rehydration Sachets 10-20ml Every 4-6 hours 80ml Two to four 5ml spoonfuls Half an hour before bedtime Half an hour before bedtime 5-10ml Every 4-6 hours One or two reconstituted sachets After each loose motion 2 Tablets 20ml 40ml in divided doses 20-40ml / kg Additional Information Shake bottle well before use. Consider Sodium and potassium content Do not give with other paracetamol containing products Do not give with other paracetamol containing products May colour urine. Encourage fluids May colour urine. Encourage fluids Not suitable for productive coughs Keep the solution in the fridge for up to 24 hours Sore Throat Strepsils 1 Lozenge 4 Hourly Encourage oral fluids Contact GP if symptoms persist after 48 hours Indicate which products have been authorised GP signature Please print name Date Home Manager Please print name Date Review date

6 Record of Homely Remedies and Audit Sheet Name and strength of Homely Remedy (please use one sheet per product) Date Obtained Quantity Obtained Date Administered to Resident Name of Resident Dose Administered to Resident Name of Staff Administered By Balance Quantity and Expiry Date Checked Some products may have a shorter shelf-life once opened; check the patient information leaflet and packaging