Prepared by Sandra Juniper Home Manager May 2013 Reviewed by John Cotterill Director of Care May 2013 Approved in monthly SMT meeting

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1 ADMINISTRATION AND RECORDING OF TOPICAL MEDICINES Approvals The signatures below certify that this procedure has been reviewed and accepted, and demonstrates that the signatories are aware of all the requirements retained herein and are committed to ensuring their provision. Name Signature Position Date Prepared by Sandra Juniper Home Manager May 2013 Reviewed by John Cotterill Director of Care May 2013 Approved in monthly SMT meeting Amendment Record Page No Context Revision Date 1

2 Administration and Recording of Topical Medicines Administration & Recording of Topical Medicines May 2013 Good Practice Guidance - (to be followed when completing confident to practice record) Prescription only medications that are for a specific treatment of a condition and are being used for a short period, e.g. steroid or antibiotic creams should only be applied a Person Competent in Administrating Medication. These medications must be stored in the medication pod unless indicated they should be refrigerated and applied by a Person Competent in Administering Medication. Creams, lotions and ointments that are for skin care, prevention of skin breakdown etc may be applied by an appropriately trained care assistant. These items should be stored in suitable locked container. Creams, ointments, shampoos and bath preparations can be kept in the service user s rooms If kept in the service user s room, safe secure storage must be available and the resident should be asked if they are happy for the products to be kept in their room. Their consent should be recorded in their care plan and reviewed each month. These containers must be locked. All keys to cabinets will be kept in a key safe in each clinic. Carers will either take keys with them to rooms and return after use or the client may wish to have the key in their room in a designated area, which will be identified in their individual care plan. It is not necessary to dispose of all creams one month after opening, a Person Competent in Administering Medication must check creams monthly for expiry dates. Creams should not be stored in areas where the temperature exceeds 25 degrees centigrade The date of opening external preparations should be recorded on the MAR chart and transferred each month this in case the outer box is thrown away The date of disposal of the external preparation must be recorded on the MAR chart Procedure for service users who are unable to self medicate their prescribed topical medication. A Person Competent in Administering Medication should complete a Topical Medications Application Body Map (TM1)for each topical preparation prescribed. This should be countersigned by a second Person Competent in Administering Medication If instructions such as use as directed are unclear advice must be sought and information recorded on the MAR and in the care plan. 2

3 The TM1 should be kept in the servicer s user s room and with the MAR chart. The Body map should show clearly the name of the preparation to be applied, the area it is to be applied to, the amount to be used, the frequency and timing of the applications. The carer applying the topical preparation should sign the TM1. Any carers applying topical preparations should first complete a Preparing for and Undertaking Clinical Activity, Confident to Practice Record under direct supervision of a Registered Nurse. The Registered Nurse should write on the original MAR sheet code F and at the bottom of the MAR sheet alongside code F = other (define) enter the reason, e.g. Applied in service users room see care plan. Carers applying topical preparations must add their signature to the medication signature record once competent to do so without direct supervision. The Confident to Practice Matrix must be updated to identify carers who have completed their assessments and can apply topical preparations unsupervised. The Body Map must be reviewed monthly by a Registered Nurse at the end of the 28 day cycle or if a change to the MAR is made. At the end of 28 day cycle the TM1 should be attached to the corresponding MAR sheet to provide a full record of administration. A care plan should be written for every client requiring topical preparations. Clearly documenting why these products have been prescribed, how they should be used and when. Topical preparations should be kept in safe and secure storage at the appropriate room temperature. The Registered Nurse is responsible for ensuring that the relevant topical medicines Patient Information Leaflet is available The Registered Nurse is responsible for ensuring that topical medications which need to be kept at fridge temperatures are retained in the fridge and not kept in the service user s rooms. The TM1should be audited in line with the audit cycle. Confident to Practice Record A registered nurse must use this procedure to complete a confident to practice record Each carer must complete a Preparing for Clinical Activity Assessment Each Carer must complete an Undertaking Clinical Activity Assessment The Registered Nurse must ensure the record clearly indicates the activity being assessed is Application of Topical Preparations Sufficient information on what has been discussed or demonstrated must be added to the confident to practice records to ensure clear record of what the carer is confident to do and what they are not authorised to do. Before delegating the task of applying topical preparations a Person Competent in Administering Medications must check carer has completed Confident to Practice Records. 3

4 Steroid Creams Topical steroids are used for various skin conditions. The amount of topical steroid that should be applied is commonly stated as apply thinly and can be measured by fingertip units (FTU S) A FTU is the amount of topical corticosteroid needed to squeeze a line from the tip of an adult finger to the first crease of the finger. It should be enough to treat an area of skin that is double the size of the flat of your hand with your fingers together. The recommended dosage of FTU S will depend on what part of the body is being treated. This is because the skin is thinner in certain parts of the body is being treated. This is because the skin is thinner in certain parts of the body and more sensitive to the effects of the corticosteroids. For adults the recommended FTU s to be applied in a single dose are: 0.5 FTU for genitalia 1 FTU for hands, elbows and knees 1.5 FTUs for the feet, including the soles 2.5 FTUs for the face and neck 3 FTUs for the scalp 4 FTUs for the hands, arms and buttocks 8 FTUs for the legs and trunk (the main section of the body, excluding the arms, legs and head. References CQC Essential Standards of Quality and Safety The Handling of Medicines in Social Care Royal Pharmaceutical Society The Nursing and Midwifery guidance / codes National Patient Safety Agency Information on dosage of topical corticosteroids can be found on the web site Appendices 1. Preparing for Clinical Activity Assessment 2. Undertaking Clinical Activity Assessment 3. Topical Medicines Application Record (form TM1) 4

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7 Appendix 3 Administration & Recording of Topical Medicines May 2013 Topical Medicines Application Record Hands should be washed and gloves worn for the application of topical medicines. Apply the medication according to the directions to the areas outlined on the diagram. Record on the Application Record For information Purposes: Apply sparingly/thinly means only a thin layer should be applied. Apply liberally means a more generous layer should be applied. Only carers who have completed confidence to practice can apply creams. Client Name Date of Birth Room No Type of Topical Preparation e.g.- Lotion, cream, Ointment Allergies Name of Product e.g. Betnovate Directions as written on the prescription Name of Transcriber Countersigned By 7

8 Topical Medicines Application Record Date Time Applied by Print Name Signature 8