Frequently asked questions:  What are the requirements for external medicines? 

(Prepared by the CQC Medicines Optimisation Team, including Simon Hill – February 2017)

This FAQ has been produced to provide you with information on requirements relating to the use of external medicines eg. creams, lotions and patches in adult social care settings. Please do not hesitate to contact medicines.enquiries@cqc.org.uk, if you require additional advice.

Background

Creams, patches and other external medicines are often prescribed to people living in their own homes.  Information should be available to staff to ensure that these medicines are applied effectively in a way that keep people safe.  Records should be completed to show when these medicines were applied, where and by whom.

People should be able to apply their own external medicines if they choose and this decision should be assessed and regularly reviewed to ensure that they are safe and have the capacity and dexterity to do so.

Guidance for creams, ointments and lotions.

• Information about the frequency of use, thickness of application and areas of the body to which the cream is applied, should be readily available to the person applying (staff member of person for whom the medicine is prescribed).
• This could be in the form of an external or topical Medicine Administration Record.
• Records should be kept of any creams applied by nurse or carers.
• Creams should be stored securely and dated when opened. Some are subject to environmental contamination and should be discarded after a period of use.  Any product whose appearance suggests it is unfit for use should be discarded.
• Staff should be aware of the fire hazard associated with paraffin based emollient creams.

Guide for patches

• Patches are thin pads with an adhesive back that are applied to the skin. They contain a reservoir or matrix of medicines that passes through the skin into the bloodstream.
• Different types of medicines available in patch form, including pain killers, medicines to treat Parkinsons’s Disease, hormones, smoking cessation and medicines to control nausea and vomiting.

Application and disposal

• Staff should ensure that they use the correct application technique and that patches are applied at the frequency determined by the prescriber. The interval between patches can vary from once a day to once a week, so staff should have access to information and guidance to ensure that patches are applied effectively.
• Patches should normally be applied to a dry, flat area of skin, usually the upper are, chest or back. Hair can be clipped to give better adhesion.
• If more than one patch is needed they should be applied in the same area of the body but should not overlap.
• Reservoir style patches should not be cut or damaged as this will cause the medicine to leak from the patch. Matrix patches are sometimes cut but this makes their use off-license, so staff should obtain clear guidance from the prescriber and pharmacist before use.
• The site of application of a patch should be rotated with each application in accordance with the manufacturer’s instructions. This varies from patch to patch.  Some patches can cause a thinning of the skin and if routinely applied to the same are the rate of absorption into the bloodstream can be higher, potentially leading to overdose.
• Heat can increase the absorption of some medicines through the skin into the bloodstream. Patches should not be applied immediately after a person has had a bath or shower and people with a fever should be observed for signs of toxicity.
• Old patches should be removed and safely disposed of before a new patch is applied. This reduces the risk that the old patch is left in place.
• Used patches contain some residual drug, so should be folded in half and safely disposed of via the client’s usual pharmaceutical waste arrangements.

Records, checks and communication

• Staff should record the application of a patch and include the specific location eg. front, right, chest: this could be recorded on a body map. This is important so other staff can check to make sure the patch is still in place.
• Regular checks should be made to ensure that patches are applied correctly and are still in place.
• Staff should ensure that information is communicated when a person is transferred between settings. This should include the date and time of patch application and the site.

Date: January 2024

Version: 3 (Review)