Standard Operating Procedure for Administering creams and ointments in care homes within NHS Sutton CCG Introduction All health and social care organisations are accountable for ensuring the safe management of external medicines. This procedure is intended to encourage good practice in the management of external medicines like creams and ointments, to ensure that service users always have these medicines used correctly, stored correctly, their application recorded and that the medicine is in date. Organisation within which the SOP applies: All care homes receiving medicines from community pharmacies and/or whose service users are registered with GP practices within NHS Sutton CCG Objectives / Purpose To ensure that the external medicine is stored correctly To ensure that there are records of where the preparation is stored and when it was opened To provide information about how much cream should be applied How this application should be recorded Suggested expiry dates for opened external medicines To ensure practice is in line with the regulatory frameworks Scope This Standard Operating Procedure applies to Managers, Nurses and care staff working within Care Homes in NHS Sutton CCG who are responsible for medicines Responsibilities Staff working in the areas who have a responsibility the safer management of medicines in care homes within NHS Sutton CCG Related Guidelines and Standing Operational Procedures Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities 2009) Regulation 2010 THE HANDLING OF MEDICINES IN SOCIAL CARE Royal Pharmaceutical Society November 2007 The Health and Social Care Act 2008 (regulated activities) Regulations 2014. Safe Care and treatment. Regulation 12 Emollients for Eczema (www.patient.co.uk) Review Period November 2018 (or earlier if indicated) Validation process: This guidance has been approved by Sutton and Merton MMC for use in care homes within NHS Sutton Clinical Commissioning Group Author and contributors: Hai To, Care Home Pharmacist, NHS Sutton CCG Acknowledgement: Tania Cook, Specialist Senior Medicines Management Technician Social Care Lead, NHS Nottingham City CCG Date Approved: November 2016 1
Process Actions Ensure staff wear disposable gloves when administering creams, ointments etc. This is important for corticosteroid creams so that the cream and its active ingredients are not absorbed through staff member s skin. Ensure good hand hygiene and wash hands before and after administering the cream / ointment. Check that the preparation is in date, creams or ointments in a tube or pump pack, shampoo, bath or shower preparation or lotion will usually last for 3 months after opening. Any tub in which gloved fingers have to be used to remove the cream has a 1 month expiry after opening and do not return any unused cream to the tub as this will contaminate it To check the external preparation is fit to be applied, the date of opening should be written on the label and also on the tube/bottle in case the outer box is thrown away Always apply creams or ointments to clean skin When using creams or ointments, apply by smoothing them gently into the skin along the line of hair growth and do not rub in. Any discontinued or out-of-date preparation should be disposed of as per disposal procedure, recording what has been sent for destruction. See SOP 18 for details. Medicated External Preparations e.g topical steroids, topical antiinflammatory All external preparations like creams, shampoos, bath preparations or ointments should be stored securely in a locked cupboard separated from all internal medicines Where external preparations e.g Daktacort, Timodine that need to be stored in the fridge, this should either be in a lockable drugs fridge or in the case of small homes, a lockable box like a cash tin which can be kept in the domestic fridge. See SOP 4 Refridgerated Items. The MAR chart should show when the preparation should be used and where (e.g. apply to sore skin under breasts) The date of opening should be written on the label and the MAR chart and transferred each month to check that it is fit to be applied When applying a medicated cream like a steroid cream or ointment (e.g. hydrocortisone or betametasone), it should be applied sparingly and only to the affected areas as this minimises the amount absorbed into the body through the skin. One fingertip unit from a tube (that s the length from the top joint of the index finger to its tip) will cover an area approximately the size of the palm of your hand. Refer to Appendix 1 for Fingertip Unit illustration. Responsible Person Designated Nurse or Home Manager/ Senior Carer Unmedicated External Preparations e.g emollients Some creams are prescribed to use a soap substitute. The care plan should list these products and what they are for. A record that 2
the cream had been used to wash the resident should be made. Unmedicated external preparations, i.e. emollients, can be kept in the service user s room with their permission within a locked cupboard. They should not be stored on window ledges or anywhere where the temperature exceeds 25 C. If an external preparation is to be stored in the service users room, then the date that the preparation was put into the room should be recorded on the MAR chart (i.e. the date that it was opened) and that date should be transferred onto each new month s MAR chart to show that it is available and in date Where external preparations e.g Daktacort, Timodine that need to be stored in the fridge, this should either be in a lockable drugs fridge or in the case of small homes, a lockable box like a cash tin which can be kept in the domestic fridge. See SOP 4 Refridgerated Items. The MAR chart should show when the preparation should be used and where (e.g. apply to sore skin under breasts) The date of opening should be written on the label and the MAR chart and transferred each month to check that it is fit to be applied Every time an external preparation is used, this must be recorded. This can either be done by signing the service users MAR chart or a topical MAR chart kept in the service users room. Write on the MAR chart See topical chart in room. At the end of the month attach the topical MAR chart with their main MAR chart for a complete record. Registered nurses can delegate the application of moisturising creams (emollients), barrier creams, shampoos or bath preparations to a suitably trained member of the care staff. The nurse is responsible for ensuring that these preparations are used correctly. However, the care staff must sign the topical MAR chart NOT the registered nurse. If applying a moisturising cream or ointment this can be applied liberally 3
Appendix 1: Fingertip unit: The length can be measured in terms of a fingertip unit (the distance from the tip of the adult index finger to the first crease). One fingertip unit, approximately 500mg from a tube with a standard 5mm diameter nozzle), is sufficient to cover an area that is twice that of the flat adult handprint (palm and fingers) [4]. Figure 1: Dermatological guidelines: Guidelines for the management of common dermatological disorders in primary care, Page 6, (3 rd edition 10 ). Table 1: Number of Finger-Tip-Units (FTUs) needed to apply on various areas of an adult. Body Area Number of Finger-Tip Units Scalp 3 Face and neck 2.5 One hand (front and back including fingers) 1 One arm (including entire hand) 4 Elbows (large plaque) 1 Both soles of feet 1.5 One foot (dorsum and sole) including toes 1.5 One leg (including entire foot) 8 Buttocks 4 Knees (large plaque) 1 Trunk (front) 8 Trunk (back) 8 Genitalia 0.5 4
I have read and understood this standard operating procedure and agree to work to it. Name Job Title Signature Date Home Manager 5