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Over the counter medicines and homely remedies
Over the counter (OTC) medicines can be purchased from a pharmacy or other outlets such as petrol stations, convenience stores or supermarkets.
These include products that:
- alleviate the symptoms of a condition that is self-limiting as it will heal/be cured of its own accord
- treat a condition which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care or treatment for the condition
A homely remedy is a medicinal preparation used to treat minor ailments; it is purchased over the counter and does 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.
If you are offering residents treatment for minor ailments with homely remedies, you should have a process for how to do this safely. Include this process in the care home medicines policy.
Take advice from a healthcare professional, such as a GP or pharmacist, on the use of homely remedies. You should do this for each resident in advance or at the time of need.
Usually a limited range of minor ailments are treated with a short duration of treatment stipulated, for example, up to 48 hours.
The NICE guideline SC1 on the managing of medicines in care homes recommends that:
- which medicinal product may be administered and for what indication it may be administered
- which residents may be excluded from receiving specific homely remedies - for example paracetamol is not to be given to a resident who is already prescribed products which contain paracetamol
- the dose and frequency
- maximum daily dose
- recording administration of the homely remedy, such as on the medicines administration record (MAR) chart
- duration of use before referring the resident to a GP
NICE SC1 also recommends that care home staff, who give non-prescription medicines or other over the counter products (homely remedies) to residents, should be named in the homely remedies process. They should sign the process to confirm they have the skills to administer the homely remedy and acknowledge that they will be accountable for their actions.
- all homely remedies should be clearly identifiable as a ‘homely remedy’
- they should be stored securely and kept separate to the residents prescribed medication
Supporting people to self-care
People who receive social care should be supported to access OTC products to enable them to self-care, with the appropriate safeguards put in place.
Access to OTC medicines to self-care is an issue of equality and providers should have policies in place to support people who wish to access OTC products in a timely manner.
This is different to the use of homely remedies.
Guidance for Clinical Commissioning Groups (CCGs) on conditions for which OTC medicines should not routinely be prescribed in primary care was published in March 2018.
This new guidance has the potential to impact on individuals receiving social care. CCGs should have local arrangements in place to support the implementation of this guidance.
These conditions include but are not limited to the following:
- infrequent constipation
- minor conditions associated with pain, discomfort and fever (such as aches, sprains, headache and back pain)
- ringworm/athlete’s foot
- dry eyes/sore tired eyes
- oral thrush
- head lice
- insect bites and stings
- mild irritant dermatitis
- acute sore throat
- mild dry skin
- infrequent cold sores of the lip
- mild cystitis
- mouth ulcers
- warts and verrucae
- coughs, colds and nasal congestion
- excessive sweating (hyperhidrosis)
- mild acne
- minor burns and scalds
- indigestion and heartburn
NHS England has advised that there are exceptions to the guidance such as:
- patients being treated for a long term conditions
- circumstances where the product license does not allow the medicine to be bought over the counter (e.g. pregnant women)
- “individual patients where the clinician considers that their ability to self-manage is compromised because of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care”
Providers will therefore need to liaise closely with clinicians to identify people who are affected and make appropriate arrangements.
What this means
A GP may recommend the person, relatives or care staff to purchase a specific product to treat a minor ailment for a particular person, such as olive oil for treatment of ear wax. Verbal or written instructions must be recorded in the individual care plan.
Healthcare professionals can use their clinical judgement with regards to products that are available OTC but are prescribed for the treatment or prevention of long-term or serious conditions. These should be monitored and reviewed at appropriate intervals.
All purchased medicines must be checked for potential interactions with prescribed medicines with an appropriate healthcare professional before use.
People (or their relatives) may provide their own OTC products following consultation with the GP or Pharmacist. In a care home setting these are not for general use and must remain specific to that person. In all care settings receipt should be documented. If the care staff are responsible for administration, this should be recorded on a MAR chart and good practice should be followed.
All OTC products purchased on behalf of the service user or brought into a care setting should be checked, to make sure they are suitable for use, in date and stored according to the manufacturer guidance.
Issues for providers to consider
There should be a policy to support people who wish or need, to self-care. The policy should outline the necessary safeguards to support people to self-care when carers or relatives provide OTC products. For example, how people who may lack mental capacity to make decisions are protected.
It is good practice on admission to the care home or when a domiciliary service is commissioned to discuss health needs and medicines with the person and their family. This should also include the use of OTC products.
There should be a clear care plan including how reviews will be triggered to ensure that medicines given are safe and still appropriate.
Mapping to the CQC key lines of enquiries
- S4 - How does the provider ensure the proper and safe use of medicines?
- S4.2 - How does the service make sure that people receive their medicines (both prescribed and non-prescribed) as intended (including controlled drugs and ‘as required’ medicines), and that this is recorded appropriately?
- E1 - Are people’s needs and choices assessed and care, treatment and support delivered in line with current legislation, standards and evidence based-guidance to achieve effective outcomes?
- E5 - How are people supported to live healthier lives, have access to healthcare services and receive ongoing healthcare support?
- C2 - How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
- Last updated:
- 27 January 2020