Care Homes: homely remedies

Care home staff have a recognised duty of care to be able to respond to minor symptoms experienced by residents. This guidance aims to ensure that access to treatment for minor ailments is as it would be for a patient living in their own home.

What is a homely remedy?

A homely remedy is a medicinal product for the short-term treatment of minor ailments such as indigestion, coughs, mild to moderate pain and constipation. They can be obtained without a prescription and are usually purchased by the care home..

The NICE Guideline SC1 managing of medicines in care homes1 guidance agreed that where a care home provider offers residents treatment for minor ailments with homely remedies, a process for use should be in place and this should be recorded in the care home medicines policy. Advice from a healthcare professional, such as a GP or pharmacist, on the use of homely remedies should be taken for each resident in advance, or at the time of need.

The NICE guideline SC1 recommended that all care home staff using a homely remedies protocol should be named in it and that they should sign to confirm they are competent to administer the medicinal product, acknowledging that they will be accountable for their actions.

The guidance recommends that homely remedies protocols should include:

Which medicinal product may be administered and for what indication it may be administered.
Which residents may be excluded from receiving specific homely remedies, g. paracetamol is not be given to a resident who is already prescribed paracetamol.
The dose and
Maximum daily
Recording administration of the homely remedy, such as on the medicines administration record (MAR)
Duration of use (maximum 48 hours use before referring the resident to the GP if symptoms persist).

Key points

If a homely remedy protocol is in use, it is good practice to make the GP aware of this and to agree the duration of time that the treatment with the homely remedy can continue (usually 48 hours) before the resident needs to be referred to the
The use of the homely remedy should be reviewed periodically and taken into consideration when there are changes to the medication
Only stock purchased by the care home for administration under the ‘Homely Remedies Policy’ may be used and only preparations listed in the homely remedies policy may be administered without a prescription.ey points continued
If the resident or their relative has purchased any remedies Over-The-Counter or from a community pharmacy it should be agreed with the GP and kept separate for the use of that resident only. It should not be used as stock or treated as a homely remedy.
Products labelled for an individual resident, e. for whom a prescription has been issued,

must not be given to another resident as a homely remedy. Nor should those purchased by a resident for their personal use be administered to other residents.

Bulk prescribing is not a suitable way of obtaining homely

References

NICE Guideline SC1Managing medicines in care homes, March 2014. https://www.nice.org.uk/guidance/SC1/

Information for care home staff

This information can be found in adaptable Word documents (attachments 1, 3 & 4) here: https://www.prescqipp.info/our-resources/bulletins/bulletin-72-care-homes-homely-remedies/

The NICE Guideline Managing medicines in care homes agreed that where a care home provider offers residents treatment for minor ailments with homely remedies, advice from a healthcare professional, such as a GP or pharmacist, on the use of homely remedies should be taken for each resident in advance, or at the time of need.

If the advice is taken in advance, it should be clearly documented and reviewed periodically (especially if there is a change to the prescribed medication). The record should identify which

homely remedies are appropriate for individual residents. See attachment 3 (see above link) for an example of an advance agreement which may be completed by the GP.

This can be done when the resident initially goes to reside at the care home. This should be kept either with their care plans or with their current medicine administration record (MAR) chart.
It is left to the healthcare professional’s discretion whether certain drugs are excluded from the

If the advice is sought at the time of need, this must be done in a timely manner and there must be a robust process for doing so, which not only includes from whom advice would be sought but how the advice is to be documented.

Obtaining supplies

Homely remedies can be purchased from a community pharmacy, supermarket or other store. A record should be kept of purchases made (see attachment 2 on above link).

Local agreements on payment vary, however it is usual practice for the pharmacy to invoice the home and to be paid from petty
Bulk prescribing is not a suitable way of obtaining homely
No products requiring invasive administration, g. suppositories should be included nor is it appropriate to include products that take up to 48 hours to work, e.g. lactulose.
External preparations are best excluded from the homely remedy policy as they should ideally be used by an individual to avoid cross

Dressings and items for first-aid are not homely remedies, neither are vitamin supplements, herbal or homeopathic preparations. (Note residents who wish to purchase vitamin supplements, herbal or homeopathic preparations for their own use long- term, should discuss these with the GP).

Storage

All homely remedies should be clearly identifiable as a ‘homely remedy’ (if purchased from a community pharmacy they may label the product to indicate that it is a homely remedy).
All homely remedies MUST be stored in their original packaging together with any information supplied with the product about the medicine use.
Excessive quantities of homely remedies should not be stored by care homes.
They should be stored securely in a lockable cupboard or trolley and kept separate to the resident’s prescribed medication.
Homely remedies should be stored:
- At temperatures below 25OC (unless stated otherwise on the medicine information).
- Away from damp and strong light.
- In accordance with the patient information leaflet or any instruction on the packaging.
If the homely remedy is kept in a resident’s room it should be stored in a lockable drawer or cupboard.
Access to homely remedies should be restricted to staff with medicines management responsibilities.

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 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 would need to 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 resident’s MAR chart is ideal if it is possible to do so; the entry should be annotated ‘homely remedy’. It should be clear what was given, when it was given, who administered and why it was given it 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.

The document used to record the purchase of the medicinal product should be updated to indicate that it has been administered to a resident (see attachment 4).
Homely remedies should be given for a limited period, usually 48 hours or the period stated in the medicines
Once opened, all liquids should have the date opened recorded on the Note some products may have a shorter shelf–life once opened, check the manufacturer’s literature.

Audit

The balance and expiry dates of the homely remedies must be checked regularly, it is good practice to check these monthly. Note some products may have a shorter shelf–life once opened, check the manufacturer’s literature.

Disposal

Expired stock should be disposed of in line with the care home’s policy on the disposal of medication.

Information for GPs

This information can be found in an adaptable Word document (attachments 2, 3 & 4) here: https://www.prescqipp.info/our-resources/bulletins/bulletin-72-care-homes-homely-remedies/

The NICE Guideline Development Group (GDG) for the management of medicines in care homes states that where a care home provider offers residents treatment for minor ailments with homely remedies, advice from a healthcare professional, such as a GP or pharmacist on the use of homely remedies should be taken for each resident in advance, or at the time of need.

If the advice is taken in advance, it should be clearly documented and reviewed periodically (especially if there is a change to the prescribed medication). The record should identify which homely remedies are appropriate for individual residents. See attachment 3 (on link above) for an example of an advance agreement which may be completed by the GP.

This can be done when the resident initially goes to reside at the care home. This should be kept either with their care plans or with their current medicine administration record (MAR) chart.
It is left to the healthcare professional’s discretion whether certain drugs are excluded from the list.
If the advice is sought at the time of need, there should be an agreement with the care home of how this can be done in a timely manner.
If a homely remedy protocol is in use it is good practice for the GP to be aware of this and to agree the duration of time treatment with the homely remedy can continue before the resident needs to be referred to the GP.
No products requiring invasive administration, g. suppositories should be included nor is it appropriate to include products that take up to 48 hours to work, e.g. lactulose.
External preparations are best excluded from the homely remedy policy as they should ideally be used by an individual to avoid cross contamination.
Dressings and items for first aid are not classed as homely remedies neither are vitamin supplements, herbal or homeopathic preparations. (Note residents who wish to purchase vitamin supplements, herbal or homeopathic preparations for their own use long-term, should discuss these with the GP).

Review

The resident should be reviewed if the homely remedy is required beyond the agreed period, usually 48 hours (or 24 hours if symptoms of diarrhoea are present and fluid intake is poor).
If the resident is not examined by the GP but it has been agreed that treatment should continue, the GP should confirm in writing (e.g. email) that treatment is to continue.
If the homely remedy is required for regular treatment, a prescription should be provided.

Care Homes: homely remedies

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