Quality Toolkit for Care Homes - NHS Doncaster CCG
NHS Doncaster CCGQuality Toolkit for Care HomesBest Practice PrinciplesPart 1: Self-care treatment for a specific person guidanceDate of ReviewAmendment DetailsAmended ByAutumn 2020In association with East Sussex Better Together Team TOC \o "1-3" \h \z \u Part 1: Self-care treatment for a specific person guidance PAGEREF _Toc27391907 \h 3Appendix 1 Care Home Self- Care Medicine Pad PAGEREF _Toc27391908 \h 5Part Two: Homely Remedy Guidance PAGEREF _Toc27391909 \h 8Key points for homely remedies PAGEREF _Toc27391910 \h 8Appendix 2 – Homely remedy template for Care Homes to adapt PAGEREF _Toc27391911 \h 9Who to contact for advise and support PAGEREF _Toc27391912 \h 10Obtaining supplies of homely remedies PAGEREF _Toc27391913 \h 11Medicines not suitable as homely remedies PAGEREF _Toc27391914 \h 11Storage PAGEREF _Toc27391915 \h 11The administration of homely remedies PAGEREF _Toc27391916 \h 11Disposal of Homely Remedies PAGEREF _Toc27391917 \h 12Medicines Information Forms PAGEREF _Toc27391918 \h 13Pain PAGEREF _Toc27391919 \h 13Constipation PAGEREF _Toc27391920 \h 16Indigestion/Heartburn PAGEREF _Toc27391921 \h 19Diarrhoea PAGEREF _Toc27391922 \h 21Appendix 3 – MAR chart for Self Care PAGEREF _Toc27391923 \h 23Appendix 4 – Stock control sheet PAGEREF _Toc27391924 \h 27Appendix 5 - Identified Residential Care Home Residient PAGEREF _Toc27391925 \h 28Appendix 6 – Staff list PAGEREF _Toc27391926 \h 29Part 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 adviceNursing 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 treatmentA 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 personThe 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. NHS England guidance (March 2018) has provided a list of common minor ailments that may be treated as self-care at the recommendation of a GP or health care professionalMedical conditionSelf-care GP/ Pharmacist advice specified Example of OTC productInfrequent 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 oilMild to moderate hay fever/allergic rhinitis?Antihistamine tablets or liquids; steroid nasal sprays; sodium cromoglicate eye dropsOral thrush?Antifungal oral gelRingworm/athletes foot?Athletes foot cream, antifungal creams and sprays?Threadworm?Mebendazole (chewable) tablets/ suspension Travel sickness??Travel sickness tabletsAcute sore throat?Lozenges e.g. LocketsCoughs 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, PolytarHead lice?Creams and lotions for head lice e.g. HedrinMild Acne(under 65 years)?Multitude of skin care optionsMild Dry Skin?Emollient creams and lotions e.g. E45, Aveeno, QV cream, VaselineSunburn?Multitude of after sun creamsSun protection?Multitude of skin protection creamsMouth ulcers?Antiseptic mouthwashe.g. Corsodyl, Listerine, BonjelaRefer to GP if not resolved in 7 days or multiple/painful/redPrevention of dental caries?Normal fluoride toothpasteWarts and Verruca?Creams, gels, skin paints and medicated plasters containing salicylic acidRefer to GP or podiatrist if diabetic Probiotics?Probiotic sachets, yoghurtsVitamins and minerals*?Multivitamin and minerals, Vitamin C tablets, Vitamin D tablets 400- 1000 unitsInsect Bites and stings?Antihistamine cream or tabletsAppendix 1 Care Home Self- Care Medicine PadName__________DOB_______NHS Number__________Care Home__________Surgery/pharmacy__________HCP Name__________HCP signature__________ConditionTreatmentSuggestedDirections – either:Tick “ as a packet” or if other specifyDuration of treatment: e.g. 7 days, hayfever seasonInfrequent 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: ____________________Name__________DOB_______NHS Number__________Care Home__________Surgery/pharmacy__________HCP Name__________HCP signature__________ConditionTreatmentSuggestedDirections – either:Tick “ as a packet” or if other specifyDuration of treatment: e.g. 7 days, hayfever seasonAcute 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: ____________________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 policyThe service user is made aware that the medicine is not prescribed and has given their consent, or a ‘best interests decision’ is in placeKey points for homely remediesThis 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.ChartConditionHomely remedies OTC product1Pain (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 checked2ConstipationMacrogol powderSenna tablets or syrup3Indigestion and heartburnSodium alginate liquids4DiarrhoeaOral rehydration therapy 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. _______________________________ 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:ChartConditionHomely remedies OTC product1Pain (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 checked2ConstipationMacrogol Senna tablets or syrup3Indigestion and heartburnSodium Alginate4DiarrhoeaOral rehydration therapy Acute How to make a referralContact DetailsCriteria for Referral8-6pmGPTelephone Registered GP PracticeRegistered patientKnown or new District Nurse supportTelephone Known contact orSpa 01302 566999Known patient of planned DN team or __________________ANP or Proactive Care CoordinatorTelephone Known contact or GP PracticeKnown to ANP/Proactive care coordinator and on their proactive care registerECPTelephone 0300 123 1221Referral criteria\s 8-8pm 7 days per weekRapid Response Telephone01302 566999Frailty Service Telephone 01302 566999Palliative CareTelephone01302 566999Out of HoursECPTelephone 0300 123 1221OOH GP ServiceTelephone 0300 123 9990Registered with a Doncaster GP PracticeUnplanned Nursing Service Telephone 01302 566999Non AcuteHow to make a referralContact Details8-6pmGPTelephoneRegistered GP PracticeRegistered patient8-6pmKnown or new District Nurse supportTelephoneKnown contact or 01302 566999Known patient of planned DN team or ___________8-5pmCHC Case Manager TelephoneCase Manager contactKnown resident of CHC case managerWho to contact for advise and supportObtaining 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 StorageAll 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 remediesThe 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 5The 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 RemediesExpired 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).Medicines Information FormsPainParacetamol Indication for useRelief of mild painStrength500mg tablets/capsules/caplets/ tabletsDoseTWO tablets up to FOUR times a dayMaximum dose in 24 hours8 tablets (4g) in divided doses(Maximum of 2 tablets (1g) in any 4 hours)Maximum duration of treatment as homely remedyUp to 48 hours then seek advice from GPCautionsDo 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 LiquidIndication for useRelief of mild painStrength250mg/5ml suspension DoseFOUR 5ml spoonfuls (20ml) up to FOUR times a dayMaximum dose in 24 hours80ml (4g) in divided doses(Maximum of 20ml (1g) in any 4 hours)Maximum duration of treatment as homely remedyUp to 48 hours then seek advice of GPCautionsDo 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 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 ConstipationMacrogol 3350Indication for useFor relief of constipationStrengthMacrogol 3350, with potassium chloride, sodium chloride and sodium bicarbonate. DoseOne to three sachets dailyMaximum dose in 24 hours3 sachetsMaximum duration of treatment as homely remedyUp to 48 hours then seek advice from GPCautionsTo 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 informationCan be chilled in fridge before giving.Additional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF SennaIndication for useFor relief of constipationStrength7.5mg tablet; 7.5ml/5ml syrupDoseONE to TWO tablets at night; 5 to 10ml at nightMaximum dose in 24 hoursTWO tablets, 10ml syrupMaximum duration of treatment as homely remedyUp to 48 hours then seek advice from GPCautionsThis product should not be used when abdominal pain, intestinal obstruction, nausea or vomiting is present.Additional informationMay colour urineFor use when Macrogols are not toleratedAdditional resourcesPatient Information leaflet (check the label / leaflet for the product purchased), BNF 50342801275715ECP00ECPIndigestion/HeartburnSodium AlginateIndication for useGastric reflux and heartburn Strength500mg sodium alginate, 100mg potassium bicarbonate per 5 mlDose5-10ml after meals and at bedtimeMaximum dose in 24 hours40ml in divided dosesMaximum duration of treatment as homely remedyUp to 48 hours then seek advice of GPCautionsContains sodium (2.3mmol in 5mls) and 1mmol of potassium in 5mls. Avoid where sodium restriction is indicatedAdditional informationShake well before use. Sugar free, so suitable for diabeticsGaviscon 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 DiarrhoeaOral hydration sachetsIndication for useFor fluid and electrolyte replacementStrengthN/ADoseOne or two sachets after each loose stoolMaximum dose in 24 hoursN/AMaximum duration of treatment as homely remedyUp to 24 hours if refusing to drink.Up to 48 hours, if diarrhoea is persistent then seek advice of GP.CautionsAdditional informationContents 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 Appendix 3 – MAR chart for Self CareAppendix 4 – Stock control sheetExample Homely Remedies Record SheetMedicineNameStrengthFormulationDateQuantity ObtainedQuantity AdministeredQuantity DisposedDetailsFor example: purchasedname of resident administered tostock checkRunning BalanceStaff signature_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Balance transferred to new sheetA separate sheet is required for each medicine, form and strength. Also record medication administered on the resident’s MAR chart and care planAppendix 5 - Identified Residential Care Home ResidientNameNHS numberHomely RemedySignature of GP/HCPDate of ReviewPainConstipationIndigestion/heartburnDiarrhoeaAt least 6 monthly____________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????___________________________????_______Appendix 6 – Staff listExample Homely Remedies Staff Signature SheetAll 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.NameSignatureInitialsManager authorisationDate__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ................
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