Homely Remedies Protocol Version 5.0 For Care Homes with and without nursing

Homely Remedies Protocol Version 5.0 For Care Homes with and without nursing Name of Care Home: Signature of Care Home Manager: Date implemented: Definition: A homely remedy is a product that can be purchased, without a prescription, for the immediate relief of a minor, self-limiting ailment. Ipswich and East Suffolk CCG expects that people living in their own homes would have access to these types of medicines, and residents of care and nursing homes should be no different. This is also the case where items are available to be purchased over the counter as recommended by GPs. Where this is expected of a resident in their own home, this should also be expected in a care home. There is no need for a GP to prescribe items available over the counter, and care home staff should not request this from surgeries for acute conditions. Records of over-the-counter medications brought into the care home by a service user should be made by care home staff and the medication(s) should be stored appropriately What a homely remedy is not: Medications prescribed for other residents are intended only for that named resident, and cannot be used as a homely remedy, even if the medication is listed within this protocol. Aim: The purpose of this protocol is to facilitate access to various over the counter medications and dressings without a prescription so that it is similar to a patient being in their own home. The medications listed below are for the treatment or symptom management of common minor ailments. The wound care products listed below should be used to safely cover the wound as a first aid measure. The dressing is for the temporary treatment of newly found minor wounds such as cuts or scratches that break the skin. Medications: It is recommended that the following items are purchased for appropriate use in response to symptoms of a minor nature and not routinely requested on prescription. Name of medicine Indication for its use as a homely remedy 1. Paracetamol 500mg tablets For relief of occasional mild to moderate pain or high temperature 2. Paracetamol 250mg/5ml suspension For relief of occasional mild to moderate pain or high temperature Page 1 of 27

3. Maalox suspension For relief of dyspepsia 4. Senna 7.5mg tablets For relief of constipation 5. Senna 7.5mg/5ml liquid For relief of constipation 6. Bisacodyl 5mg tablets For relief of constipation 7. Loperamide 2mg capsules For relief of acute onset diarrhoea 8. Oral rehydration sachets To replace fluids in diarrhoea/vomiting 9. Simple linctus For patients needing something to soothe a dry irritating cough 10. Cetirizine 10mg tablets For relief of allergy 11. Cetirizine 5mg/5ml liquid For relief of allergy Wound Care Products: It is recommended that the following items are purchased for newly found minor wounds such as cuts or scratches that break the skin and are not routinely requested on prescription. Wound care product 12. Irripod sterile pod Size 20ml Indication for its use as a homely remedy To clean a minor wound such as a cut or scratch that breaks the skin 13. Non woven sterile swab 7.5cm x 7.5cm 14. Cosmopor E 5 x 7.2cm 8xm x 10cm To clean and dry a minor wound such as a cut or scratch that breaks the skin Do not use as a dressing To cover minor wounds such as cuts or scratches that break the skin without the need for additional tape or bandages Only those ailments/wounds specified in the homely remedy protocol may be treated and the specified products and doses/sizes must be used. The maximum duration of treatment should not exceed that specified for each particular medication/dressing without obtaining medical advice. If the symptoms persist, or give cause for concern, medical advice should be obtained in case they are masking other more serious underlying conditions. Further information on homely remedy ailments included in this protocol is detailed below. Emollients: Emollients are not considered to be homely remedies as they should not be shared between residents. Those needing a moisturiser for simple dry skin without a diagnosed clinical need should purchase emollients and barrier creams themselves from supermarkets and pharmacies. This should be labelled with the residents name and opening date. Further advice on expiry dates on in use items can be found here. There is no requirement that a GP has to prescribe these items, especially if they feel there is no clinical need. Page 2 of 27

Administration Administration must only be undertaken by staff that have undertaken the appropriate medication training and signed the relevant form stating that they have read and understood each homely remedy protocol (Appendix 1). Remedies must not be labeled for individuals if they are to be administered to several service users. The patient s symptoms should be assessed regularly to determine whether the medicine is still required before giving further doses. Care must be taken to ensure that any homely remedies given are not contra-indicated and do not interact with the resident s prescribed medication. If there is any doubt about the suitability of the medication, then the care staff must contact the community pharmacist responsible for the home s medicine supply. Storage of Homely Remedies A locked medicine cupboard or trolley is required for the storage of all homely remedies. They should be separated from all prescribed medicines and clearly marked as homely remedies. Recording of Homely Remedies It is essential that all medicines and dressings used are recorded to maintain accurate records and avoid possible overdosing. Administration of such remedies must be recorded on the appropriate resident s Medication Administration Record (MAR) sheet. The reason for administration should also be recorded on the MAR chart. An appropriate record should also be made in the resident s care plan. Checking Stock When a dose of a homely remedy/dressing is given to a patient it must be logged out of the stock sheet (Appendix 2) and a running balance maintained so a clear audit trail of these items can be maintained. Stock should be counted every week to maintain an audit trail of usage and to check expiry dates. Expiry Dates The expiry dates of all homely remedies/dressings must be checked regularly (at least every 6 months). All liquids and suspensions for internal use should have the date of opening recorded on the bottle. They should be discarded no longer than 6 months after this date. Individual preparations may specify a shorter expiry. Approved Homely remedies This protocol has been reviewed and approved by Ipswich and East Suffolk prescribing leads; Dr Flather, Dr Solway and Dr Egan, for indications listed within this protocol. This approval does not remove the requirement that staff involved in the distribution and administration of homely remedies, must ensure that the medicine administered is suitable for resident s particular circumstances (including medicine interactions and co-existing disease states) at the time of administration. Name of home:.. Page 3 of 27

Signature of Care Home Manager: Signature of I&ESCCG GP prescribing leads: Page 4 of 27

1. Paracetamol 500mg tablets Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of occasional mild to moderate pain or fever PARACETAMOL tablets 500mg ONE or TWO tablets every four to six hours up to FOUR times a day EIGHT tablets/capsules/caplets (4g) in four divided doses (Maximum of two tablets (1g) in any four hours) Up to 72 hours then seek (and document) advice of GP Exclusions: Under 18yrs Resident is already taking a paracetamol containing product for example; co-codamol, co-dydramol and some cough and cold preparations History of liver disease or alcohol abuse Hypersensitivity to paracetamol or any of the ingredients Action if resident excluded: Cautions: Additional information: Refer to GP as appropriate If body weight is <39kgs consider reducing the dose to one tablet up to four times a day *Care of accidental overdose * Many medicines, both prescribed and bought also contain paracetamol. Always refer to the patient information leaflet Side effects are rare but may cause a rash Page 5 of 27

2. Paracetamol 250mg/5ml suspension Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of occasional mild to moderate pain/fever PARACETAMOL suspension 250mg/5ml TWO to FOUR 5ml spoonfuls every four to six hours up to FOUR times a day SIXTEEN 5ml spoonfuls (80mls) in four divided doses (Maximum of four 5ml spoonfuls (1g) in any 4 hours) Up to 72 hours then seek (and document) advice of GP Exclusions: Under 18yrs Resident is already taking a paracetamol containing product for example; co-codamol, co-dydramol and some cough and cold preparations History of liver disease or alcohol abuse Hypersensitivity to paracetamol or any of the ingredients Action if resident Refer to GP as appropriate excluded: Cautions: If body weight is <39kgs consider reducing the dose and giving two 5ml spoonfuls up to four times a day *Care of accidental overdose* Many medicines, both prescribed and bought, also contain paracetamol. Always refer to the patient information leaflet Additional information: Side effects are rare but may cause a rash Page 6 of 27

3. Maalox suspension Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of dyspepsia (heartburn) /indigestion Maalox (magnesium hydroxide/aluminium hydroxide)(low Na+) Magnesium hydroxide 195mg, dried aluminium hydroxide 220mg/5ml TWO to FOUR 5ml spoonfuls 20 minutes to an hour after meals and at bedtime or when required. Maalox may be taken with water or milk SIXTEEN 5ml spoonfuls (80mls) in 24hrs Up to 72 hours then seek (and document) advice of GP Exclusions: Under 14yrs Maalox should not be used in residents who o are severely debilitated o are suffering from renal insufficiency or o if there is severe abdominal pain and/or the possibility of bowel obstruction Patients with porphyria undergoing haemodialysis Hypersensitivity to any ingredient in Maalox Action if resident excluded: Refer to GP as appropriate Cautions: Always refer to the patient information leaflet Do not administer at the same time as other medicines as it may affect their absorption Additional information: Gastrointestinal side effects are uncommon. However, occasional diarrhoea or constipation may occur if use is excessive. Discard any medicine remaining 28 days after opening the bottle Page 7 of 27

4. Senna 7.5mg tablets Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of constipation Senna tablets 7.5mg TWO tablets at night TWO tablets in 24hrs Up to 72 hours then seek (and document) advice of GP Exclusions: Under 12yrs Action if resident excluded: Hypersensitivity to any of the ingredients. Abdominal pain, intestinal obstruction or if nausea or vomiting is present. Refer to GP as appropriate Cautions: Hypersensitivity to sennosides or any ingredient Always refer to the patient information leaflet Additional information: Laxatives should not be taken where there is severe abdominal pain or used regularly for prolonged periods except on medical advice. Senna tablets will work in 8-12hrs. Resident should keep drinking plenty of fluids and increase fibre in diet Temporary mild griping may occur Page 8 of 27

5. Senna 7.5mg/5ml syrup Indication for use: Drug: Strength: For relief of constipation Senna 7.5mg/5ml syrup 7.5mg/5ml TWO 5ml spoonfuls at night Maximum dose in 24 TWO 5ml spoonfuls in 24hrs hours: Maximum duration of Up to 72 hours then seek (and document) advice of GP Exclusions: Under 12yrs Hypersensitivity to any of the ingredients. Abdominal pain, intestinal obstruction or if nausea or vomiting is present. Action if resident Refer to GP as appropriate excluded: Cautions: Senna syrup should not be used for prolonged periods since it may decrease the sensitivity of the intestinal mucous membranes, so larger doses have to be taken and the bowel fails to respond to normal stimuli. Hypersensitivity to sennosides or any ingredient Always refer to the patient information leaflet Additional information: Laxatives should not be taken where there is severe abdominal pain or used regularly for prolonged periods except on medical advice. Senna syrup will take 8-12hrs for onset of action. Temporary mild griping may occur Keep drinking plenty of fluids and increase fibre in diet Page 9 of 27

6. Bisacodyl tablets Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of constipation Bisacodyl Tablets 5mg ONE or TWO tablets at night TWO tablets at night Up to 72 hours then seek (and document) advice of GP Exclusions: Under 10 years Residents with ileus, intestinal obstruction, acute abdominal conditions including appendicitis, acute inflammatory bowel diseases, severe abdominal pain associated with nausea and vomiting which may be indicative of the aforementioned severe conditions. severe dehydration and in patients with known hypersensitivity to bisacodyl or any other component of the product. Action if resident excluded: Refer to GP as appropriate Cautions: Bisacodyl will take 6-12 hours to work Always refer to the patient information leaflet Additional information: Most commonly reported side effects are abdominal pain and cramps and diarrhoea Keep drinking plenty of fluids and increase fibre in diet Page 10 of 27

7. Loperamide 2mg capsules Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of acute onset diarrhoea Loperamide capsules 2mg TWO capsules (4 mg) initially followed by ONE capsule (2 mg) after every loose stool. SIX capsules (12 mg) in any 24 hour period. Up to 24 hours then seek (and document) advice of GP Exclusions: Under 18yrs Residents with a known hypersensitivity to loperamide hydrochloride or to any of the ingredients Residents who are lactose intolerant Residents who have severe diarrhoea after taking antibiotics In patients with acute dysentery which is characterised by blood in stools and high fever. Residents with acute ulcerative colitis. Residents who are constipated or whose stomach appears swollen Action if resident Refer to GP as appropriate excluded: Cautions: Residents may experience abdominal cramps, nausea, vomiting, tiredness, drowsiness, dizziness, dry mouth and skin reactions Always refer to the patient information leaflet Additional information: Drink plenty of fluids to maintain hydration consider oral rehydration sachets Ensure appropriate infection control procedures are followed to minimise risk of an infection spreading Page 11 of 27

8. Oral rehydration sachets Indication for use: Drug: Maximum dose in 24 hours: Maximum duration of Diarrhoea/Vomiting Oral rehydration sachets ONE or TWO sachets after every loose motion (reconstituted according to manufacturer s instructions) Sixteen sachets in 24hrs Up to 24 hours then seek (and document) advice of GP Exclusions: Under 18yrs Diarrhoea has lasted for more than 24 hours Hypersensitivity to any of the ingredients Severe dehydration seek GP advice Intestinal obstruction Resident suffers from liver or kidney disease Resident suffers from inflammatory bowel disease Antibiotic-associated colitis Bloody diarrhoea Action if resident Refer to GP as appropriate excluded: Cautions: Oral rehydration sachets should only be reconstituted in water Always follow the manufacturer s guidance when preparing the sachets. Always refer to the patient information leaflet Additional information: The contents of each sachet should be dissolved in 200ml (approximately 7fl oz) of drinking water. Use fresh drinking water or where drinking water is unavailable, the water should be freshly boiled and cooled. The solution should be made up immediately before use and may be stored for up 24 hours in a refrigerator otherwise any solution remaining an hour after reconstitution should be thrown away. The solution itself must not be boiled. If vomiting is present then the solution should be given in small frequent sips. Ensure appropriate infection control procedures are followed to minimise risk of an infection spreading. Page 12 of 27

9. Simple linctus Indication for use: Drug: Maximum dose in 24 hours: Maximum duration of For patients needing something to soothe a dry irritating cough Simple linctus ONE 5ml spoonful THREE or FOUR times a day FOUR 5ml spoonfuls (20mls) Up to 72 hours then seek (and document) advice of GP Exclusions: Under 12yrs Cautions: N/A Additional information: Make sure the resident has access to plenty of fluids throughout the day Page 13 of 27

10. Cetirizine 10mg tablets Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of allergy Cetirizine tablets 10mg ONE tablet once a day ONE tablet Up to 72 hours then seek (and document) advice of GP Exclusions: Under 12yrs Hypersensitivity to cetirizine or any other ingredients Resident is allergic to other antihistamines Resident has kidney failure Resident has lactose intolerance Resident has taken any antihistamine within the last 24 hours Action if resident Refer to GP as appropriate excluded: Cautions: Although cetirizine is not a sedating antihistamine it can still cause some degree of sedation so be aware of this with regard to the risk of falling Resident has epilepsy or fits talk to pharmacist or doctor Always refer to the patient information leaflet Resident should not drink alcohol whilst taking this medicine Additional information: Cetirizine can occasionally cause drowsiness, headache, somnolence, dry mouth and throat, stomach upset, nausea, diarrhoea Stop taking the medicine immediately if the resident has difficulty breathing, swelling of the face, lips, tongue or throat (severe allergic reaction) Page 14 of 27

11. Cetirizine 5mg/5ml solution Indication for use: Drug: Strength: Maximum dose in 24 hours: Maximum duration of For relief of allergy Cetirizine solution 5mg/5ml TWO 5ml spoonfuls (10mg) once a day TWO 5ml spoonsuls (10mls) Up to 72 hours then seek (and document) advice of GP Exclusions: Under 12yrs Hypersensitivity to cetirizine or any other ingredients Resident is allergic to other antihistamines Resident has kidney failure Resident has lactose intolerance Resident has taken any antihistamine within the last 24 hours Action if resident Refer to GP as appropriate excluded: Cautions: Although cetirizine is not a sedating antihistamine it can still cause some degree of sedation so be aware of this with regard to the risk of falling Resident has epilepsy or fits talk to pharmacist or doctor Resident should not drink alcohol whilst taking this medicine Always refer to the patient information leaflet Additional information: Cetirizine can occasionally cause drowsiness, headache, somnolence, dry mouth and throat, stomach upset, nausea, diarrhoea Stop taking the medicine immediately if the resident has difficulty breathing, swelling of the face, lips, tongue or throat (severe allergic reaction) Page 15 of 27

Dressings and wound care products In nursing homes the products listed below can be used to clean and cover the wound until an appropriate dressing from the Suffolk Wound Care Formulary is obtained on FP10 prescription. In residential homes the products listed below can be used to clean and cover the wound until a district nurse can attend to assess the wound. The District Nurse must be informed immediately if a resident develops a wound and should be requested to visit within 48 hours. This request should be recorded in the person s daily notes. In residential homes dressings should only be applied at the discretion of the senior person on duty. In addition to this, homes are expected to keep a small supply of first aid items. These items should not be requested from a GP Application of dressings: Follow the manufacturer s instructions as provided with dressings in the box. o o o Check that the dressing to be used is still in date Wash and dry your hands and put on disposable gloves before attending to the wound. The dressing pad should overlap the wound edge by a minimum of 1-2 centimetres. If the wound is too big to be covered safely by a 8cm x 10cm dressing: Residential homes: contact district nurse immediately for advice Nursing homes: request prescription from GP practice using the CCG dressings pro forma for appropriate dressing from wound care formulary o Remove the dressing carefully from the packaging. Remove the protective handles and ensure that the dressing is applied to the wound without touching the surface of the dressing that will be next to the wound. In residential homes, nursing or medical advice should be sought immediately if the wound is deep, bleeding heavily or too big to be safely covered by a 8cm x 10cm dressing. Page 16 of 27

12. Irripod sterile pod Indication for use: To clean minor wounds such as cuts or scratches that break the skin Wound care product Irripod 20ml sterile pod (normal saline) Sufficient to clean the wound Maximum duration of Residential homes: Use once to clean the wound then contact district nurses. Nursing homes: Use as clinically appropriate. Exclusions: Large wound Multiple wounds Existing wounds already receiving treatment Deep wounds Heavily bleeding wounds Action if resident excluded: Cautions: Additional information: Residential homes: Contact district nurses or GP practice immediately for advice Nursing homes: Review patient and request appropriate dressing from the wound care formulary; if wound severe seek medical advice Take care to clean wound fully. If unable to clean the wound, or wound remains visibly contaminated, seek nursing or medical advice. Once clean, dry the wound using a dry sterile non-woven gauze swab Page 17 of 27

13. Non woven sterile swab 7.5x7.5cm Indication for use: Wound care product Maximum duration of To clean and dry minor wounds such as cuts and scratches that break the skin Non woven sterile swab 7.5 x 7.5cm Use sufficient swabs to clean the wound. Use once to clean the wound then contact district nurses. Exclusions: Large wound Multiple wounds Existing wounds already receiving treatment Deep wounds Heavily bleeding wounds Action if resident excluded: Cautions: Additional information: Residential homes: Contact district nurses or GP practice immediately for advice Nursing homes: Review patient and request appropriate dressing from the wound care formulary; if wound severe seek medical advice. Do not use as a dressing to cover a wound Dispose of any unused swabs from the pack of 5 after use do not store for future use as they will no longer be sterile. Page 18 of 27

14. Cosmopor E Indication for use: Wound care product To cover minor wounds such as cuts and scratches that break the skin Cosmopor E (adhesive dressing with absorbent pad) Sizes available: 5cm x 7.2cm 8cm x 10cm One dressing to be applied to the wound, then contact the district nurses. Ensure the pad overlaps the wound edge by a minimum of 1-2 centimetres. Maximum duration of Residential homes: change dressing as advised by district nurses until a district nurse can attend the patient. Maximum duration without district nurse review 48 hours. Nursing homes: Change as dictated by the amount of exudate avoid strikethrough. Use until suitable dressing from Suffolk wound care formulary can be obtained on prescription Exclusions: Large wound (cannot be covered by 8 x 10cm dressing) Multiple wounds Existing wounds already receiving treatment Deep wounds Heavily bleeding wounds Action if resident excluded: Cautions: Additional information: Residential homes: contact district nurses or GP practice immediately for advice Nursing homes: review patient and request appropriate dressing from the wound care formulary; if wound severe seek medical advice. To remove dressing peel carefully from one corner. Page 19 of 27

Nutritional Supplements Over The Counter (OTC) nutritional drinks In line with the Oral Nutritional Supplements (ONS) in Care Homes Policy 1,2 which applies across Ipswich and East Suffolk and West Suffolk, the prescribing of ONS for residents in care homes should not be commenced, unless exclusion criteria applies.* Instead, residents should be commenced on homemade nourishing drinks 3 and food first rather than be prescribed ONS. Where nutritional drinks are indicated, these should be purchased over the counter by the care home. * Exclusion criteria: - ONS is to be administered via an enteral tube - A specialist ONS is required, e.g. Elemental 028 Extra - Resident has been assessed as requiring ONS by a dietitian, after food fortification and homemade supplements have failed to result in weight gain or due to underlying clinical condition. All residents should have their risk of malnutrition screened for using the Malnutrition Universal Screening Tool (MUST). Care homes should follow the MUST Local Policy and Action Plan 4 Where a resident has a: MUST score of 1 (medium risk of malnutrition) they should be offered: - Encouragement with eating and drinking - In-between meal nourishing snacks 5 - One homemade nourishing drink per day 3 - If there is no improvement after two weeks, food fortification should also be commenced. MUST score of 2 or higher without high risk factors** they should be offered: Encouragement with eating and drinking In-between meal nourishing snacks 5 Food and drink fortification Two homemade nourishing drinks per day 3 Trial of an OTC nutritional drink up to twice per day Consider a daily OTC multivitamin and mineral supplement if dietician recommended. MUST score of 2 or higher with high risk factors** they should be offered: Encouragement with eating and drinking In-between meal nourishing snacks 5 Food and drink fortification Two homemade nourishing drinks per day 3 Page 20 of 27

Consider a daily OTC multivitamin and mineral supplement if dietician recommended. Where the MUST score is 1 or higher, the resident should also be commenced on a food record chart and re-screened weekly using the MUST. ** High risk factors: - Rapid weight loss (>10% in 3-6 months) - Therapeutic diet i.e. renal, diabetes - Breathing difficulties, i.e. COPD - Current increased nutritional requirements e.g. infection, pressure sores - Trialed two different types of OTC nutritional drinks and no improvement in nutritional status - Dysphagia / swallowing difficulties OTC nutritional drinks OTC nutritional drinks are available to purchase from most supermarkets and some pharmacies. There are two varieties: Ready to Drink from a bottle, can or carton, e.g. Complan Smoothie, Nurishment Original, Nurishment Extra. Powdered to mix with milk (full fat milk is preferable), e.g. Complan, Meritene Energis, AYMES retail range. Prices vary, dependent upon retailer. The prices below are correct as of 27/06/17. Use of OTC nutritional drinks One to two servings daily of the OTC nutritional drinks are recommended. The drink should only be used for the specific resident they are intended for, and administered and recorded in the same way as all other medications on a MAR sheet. OTC nutritional drinks products available Product Powdered products Complan (Nutricia) Complan Original (Nutricia) Presentation and flavours 55g sachet sold in boxes of 4 of one flavour. Vanilla, banana, chocolate, strawberry flavours 425g tub (approx. 8 servings per tub). Original flavour Nutritional content per serving 379kcal, 15g protein when mixed with 200ml full fat milk 379kcal, 15g protein when mixed with 200ml full fat milk Cost per serving Additional information 0.67-0.83 Contains milk. Gluten free. Suitable for vegetarians. Consult dietitian / GP if diabetic or pregnant 0.51-0.56 Contains milk. Gluten free. Suitable for vegetarians. Consult dietitian / Page 21 of 27

Meritene Energis (Nestle) AYMES Retail (AYMES) Soups / savoury drinks Complan soup (Nutricia) Meritene Energis (Nutricia) 30g sachet sold in boxes of 15 of one flavour or 270g tub of one flavour. Vanilla, chocolate, strawberry flavours 38g sachet sold in boxes of 4 of one flavour. Vanilla, banana, chocolate, strawberry flavours 55g sachet sold in boxes of 4 of one flavour. Chicken flavour 50g sachet sold in boxes of 4 of one flavour. Vegetable or chicken flavour 243kcal, 16g protein when mixed with 200ml full fat milk 265kcal, 15g protein when mixed with 200ml full fat milk 243kcal, 9g protein when mixed with water. 378kcal, 15g protein when mixed with full fat milk. 207kcal, 7g protein when mixed with 150ml hot water. 0.45 (sachet) 0.30 (tub) GP if diabetic or pregnant. Contains milk. Gluten free. Suitable for vegetarians. Consult dietitian / GP if diabetic. Contains milk. Gluten and soya free. Suitable for vegetarians. Halal. Not suitable for infants or young children. Use with caution in children <6 years of age. Consult dietitian / GP if diabetic. 0.67-0.83 Contains milk and soya. Gluten free. Suitable for vegetarians. Consult dietitian / GP if diabetic, pregnant or a child. 0.59 Contains milk. Gluten free. Suitable for vegetarians. Consult Page 22 of 27

Ready to drink Complan Smoothie (Nutricia) Nurishment Original (Dunn s River) Nurishment Extra (Dunn s River) 250ml carton sold individually in one flavour. Tropical or Juicy Berry flavours 400g can sold individually in one flavour. Vanilla, chocolate, strawberry, banana, peanut, mango, raspberry flavours. 310ml bottle sold individually in one flavour. Vanilla, banana, chocolate, strawberry flavours. pharmacist/gp if using supplemental Calcium and Vitamin D or using coumarinanticoagulants. 272kcal, 9g protein 1.31 Contains milk. Gluten free 380 424kcal depending on flavour, 20g protein 292 298kcal, depending on flavour, 13g protein 1.35 Contains milk. Gluten free. Strawberry and raspberry flavours are not suitable for vegetarians. Not suitable for children <3 years of age or pregnant / breastfeeding women. 1.10 Contains milk. Gluten free. Strawberry flavour is not suitable for vegetarians. Links: 1. Oral Nutritional Supplements in Care Homes: Information for Care Homes Staff. Download from: http://www.ipswichandeastsuffolkccg.nhs.uk/yourhealth/stayinghealthy/onsincarehomes.aspx 2. Oral Nutritional Supplements (ONS) in Care Homes Policy. Download from: http://www.ipswichandeastsuffolkccg.nhs.uk/yourhealth/stayinghealthy/onsincarehomes.aspx 3. Recipes for homemade nourishing drinks. Download from: http://www.ipswichhospital.nhs.uk/dietetics/documents/food%20first%20recipes.pdf Page 23 of 27

4. Care home MUST Local Policy and Action Plan see page 11 of the Ipswich and East Suffolk Adult sip feed prescribing guidelines 2017/18. Download from: http://www.ipswichandeastsuffolkccg.nhs.uk/portals/1/content/members%20area/clinical%20area/medicine%20 managment/ccg%20formularies/dietetics%20formulary/sip%20feed%20prescribing%20guidelines%20may%2017. pdf 5. Nourishing snacks, desserts and drinks list. Download from: http://www.ipswichhospital.nhs.uk/dietetics/documents/nourishing%20snacks%20and%20desserts.pdf Page 24 of 27

Appendix 1 Authorisation to administer a medication or apply a dressing under the homely remedies protocol Name of Home The named staff in this home who have the authority to decide whether a resident is able to have a dose of a homely medication or have a homely dressing applied are (print name, sign and date below): Part A Print name Signature Date Below are the staff members who have confirmed to say that they have read and understood the homely remedies protocol and are now able to administer a homely remedy in accordance with the protocol. Only the staff named in Part A, above, can decide if it is appropriate for patients to receive a homely remedy. Part B Print Name Signature Date Page 25 of 27

Appendix 2 Homely remedies stock audit sheet Name of Medication/Dressing:. Stock Audit Sheet Please note a weekly stock check must be performed for all medications Entry no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Date Time of administration Quantity supplied Resident s name Initials Balance Page 26 of 27

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