External medicines

External medicines can include creams, ointments, lotions and patches.

These are often prescribed to people living in care homes or receiving care at home. To keep people safe, these medicines need to be applied effectively. Information should be available to staff to help them to do this. 

People should be able to apply their own external medicines if they choose. You should assess whether the person is safe and has the capacity and dexterity to do so and review such decisions regularly.

Creams, ointments and lotions

Keeping records

The person applying the external medicine could be a member of staff or the person for whom the medicine is prescribed. Whoever applies the medicine should be able to access information about:

• the frequency of use
• the thickness of application
• where to apply the medicine on the body.

You need to keep records to show which creams were applied, when they were applied, where on the person’s body and who applied them, for example staff, nurses, and if applicable, carers. This could be in the form of an external or topical medicine administration record.

Storage and disposal

In residential services, you should store creams securely with an appropriate risk assessment if they are kept in people’s rooms.

Some external medicines are subject to environmental contamination. Discard these according to the manufacturer’s directions. Record the date of opening if the manufacturer indicates the expiry date is reduced after opening.

Discard any product if its appearance suggests it is unfit for use.

Fire risk

You must be aware of the fire risk associated with emollients.

People and carers need to understand the fire risk associated with the build-up of residue on clothing and bedding and take action to minimise the risk.

When you apply emollient products for a person, you should instruct them not to smoke or go near naked flames. This is because clothing or fabric such as bedding or bandages that have been in contact with an emollient or emollient-treated skin can rapidly ignite.

There is a fire risk with all emollients that contain paraffin, regardless of the concentration of paraffin. There is also a risk with paraffin-free emollients. A similar risk may apply for other products that are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days.

You also need to be aware that although washing clothing or fabric at a high temperature may reduce emollient build-up, it may not totally remove it.

When supporting a person using emollients, you should consider the increased fire risk and develop an appropriate risk assessment.

Transdermal (skin) patches

Patches are thin pads with an adhesive back that are applied to the skin. They contain a reservoir or matrix of medicines that pass through the skin into the bloodstream.

Different types of medicine are available in patch form. These include:

• pain killers
• hormones
• medicines to treat Parkinson’s Disease
• medicines to support smoking cessation
• medicines to control nausea and vomiting.

Applying patches

You must make sure your staff use the correct application technique.

Staff must apply patches at the frequency determined by the prescriber. The interval between applying new patches can vary from once a day to once a week. Make sure your staff have access to information and guidance on how often to apply patches.

See Specialist Pharmacy Service (SPS) guidance on using transdermal patches safely in healthcare settings (May 2022). 

Staff should refer to the manufacturer’s patient information leaflet for advice on how to prepare the skin and apply the patch. 

Where more than one patch is needed, these should be applied to the same area of the body but should not overlap.

Do not cut or damage reservoir style patches. This will cause the medicine to leak from the patch.

However, matrix patches can sometimes be cut. This means they are being used ‘off-licence’. Staff should get clear guidance from the prescriber and pharmacist before cutting patches.

Some patches can cause the skin to become irritatedif they are routinely applied to the same area. This means the rate of absorption into the bloodstream can be higher and could lead to overdose.To reduce this, you need to use a new site each time you apply a new patch. It’s important to read the manufacturer’s instructions, as these can vary for different types of patches.

Care staff should be aware of the signs of overdose and seek medical attention if an overdose is suspected.

Heat can increase the absorption of some medicines through the skin into the bloodstream. You should not apply a patchimmediately after a person has had a bath or shower. People should also avoid soaking in a hot bath or using a sauna when using a patch.

If people have a fever, you should observe them for signs of toxicity. 

Disposing of patches

Remove and dispose of old patches before applying a new patch. This reduces the risk of leaving the old patch in place.

Used patches contain some residual medicine. After use, patches should be folded so that the adhesive side of the patch sticks to itself before being discardedof safely. 

Records, checks and communication

Staff should record the application of a patch and include the specific location on the body, for example front, right, chest. This could be recorded on a body map. This is important so other staff can check that the patch is still in place.

Regularly check that patches are being applied correctly and are still in place. This should be documented in accordance with local procedure.

Old patches are occasionally left in place when applying a new patch, therefore staff need to write a record that the old patch has been removed in a similar way to recording when the patch is applied.

Staff must communicate information about patches when a person is transferred between settings. This should include the date, time and where on the body the patch was applied.