s upporting t he use of m edication in c are...

48
SUPPORTING THE USE OF MEDICATION IN CARE SETTINGS carer edition

Upload: leminh

Post on 02-Jul-2018

215 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

SUPPORTING THE USE OF MEDICATION IN CARE SETTINGS carer edition

Page 2: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

CONTENTS

Chapter 1MEDICATION lAw

04 The Medicines Act04 ���Legal classification of medicines 04 Controlled Drugs05 Common Controlled Drugs05 Data Protection Act05 Best Practice

Chapter 2SERVICE USER PRESCRIPTIONS

06 Acute prescriptions06 Repeat prescriptions 06 Ordering repeat prescriptions07 ���Who orders the prescriptions?07 Medication Reviews07 Managed repeats

Chapter 3SAFE STORAGE & HANDlING OF MEDICATION

08 Temperature/light/moisture 09 Fridge items 10 Use of gloves10 ‘When required’ medicines 11 Monitored Dose System

Chapter 4ADMINISTERING MEDICATION SAFEly

12 Safe working practice 13 Basics of administering medication14 Pharmacy labels

Chapter 5wHEN PATIENTS DEClINE MEDICATION

18 Recording declined medication 18 Putting back medication in the pack19 ���Covert administration

Chapter 6INFORMATION AbOUT MEDICINES

21 Drug interactions

Page 3: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

Chapter 7ADMINISTERING SOlID ORAl MEDICINES

22 Swallowing difficulties23 Crushing tablets and opening capsules23 Enteric coating24 What if patients chew medication? 25 What if patients vomit after

taking medication?25 Lozenges and pastilles25 Sublingual tablets 26 Buccal tablets

Chapter 8ADMINISTERING ORAl lIqUIDS

27 Medicines spoon27 Measuring cups 28 Oral syringes

Chapter 9APPlyING TOPICAl MEDICATION

30 Creams/lotions/ointments/gels30 Medicated and non-medicated topicals31 ���Wearing gloves 32 Applying barrier creams 32 Applying moisturisers33 Soap substitutes 33 Applying non-medicated ointments34 Bath oils34 Applying medicated topicals35 Applying medicated patches

Chapter 10ADMINISTERING INHAlED MEDICINES

36 Relievers36 Preventers 38 Combination inhalers38 COPD 38 ���Models of inhaler 39 ���Spacer devices 40 ���Administering an inhaler

with a spacer device

Chapter 11ADMINISTERING MEDICATION TO THE EyE, EAR & NOSE

42 ���Eye drops43 Administering eye ointments43 ���Patients who find it hard to

keep their eye open43 If a second drop is needed afterwards44 Administering eye drops 44 Administering nasal drops45 Administering ear drops

Chapter 12IMPORTANT MEDICATIONS OFTEN TAkEN by THE ElDERly & HOw TO ADMINISTER

46 Alendronic Acid46 Calcium supplements

47 references

Page 4: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

04

MEDICATION lAw

Chapter 1

THE MEDICINES ACT 1988

+���Anyone�can�administer�a�prescribed�medicine�to�another�person�but�must�follow�instructions�from�prescriber�–��i.e.�what�is�on�the�label�

+���Prescription�medicines�must�only�be�administered�to�the�person�they�are�prescribed�for,�they�remain�the�property��of�the�patient�and�must�not�be�shared�with�others

CONTROllED DRUGS

+���CDs�are�ordered�on�prescription�in�the�same�way�as�all�other�medicines

+���Care�professionals�are�allowed�to�collect�CDs�from�the�dispensary�but�you�must�provide�some�form�of�identification�–�you�will�be�asked�to�provide�your�name�and�sign�to�say�you’ve�received�the�CDs.

+���If�you�are�receiving�a�delivery�of�CDs�from�the�dispensary�then�you�are�normally�asked�to�sign�something��to�say�you�have�received�them.

+���Generic�name�=�Name�of�the�drug�e.g.�ibuprofen

+����Brand�name�=�Name�each�manufacturer�gives�that�drug�e.g.�ibuprofen comes�as�Nurofen

lEGAl ClASSIFICATION OF MEDICINES

GSl: General Sales list Can�be�bought�without�prescription�from�any�shop/supermarket.

P: Pharmacy Only Medicine Can�only�be�bought�in�pharmacies�under�pharmacist�supervision,�often�kept�behind�counter.

CD: Controlled Drug Has�the�potential�to�be�abused/stolen.�Stored�in�a�metal�cabinet,��recorded�in�CD�register�and�with�a�witness�present.

POM: Prescription Only Medicine Can�only�be�obtained�with�a�prescription�and�only�for�the�patient�stated.

Page 5: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

DATA PROTECTION ACT

+���Describes�the�information�you�can�share�about�patients�e.g.�medication�details,�health�problems�etc.

+���Ensures�patient�confidentiality�and�privacy.�+���The�act�states�that�you�should�only�share�

sensitive�information�about�patients�with�people�who�need�to�know�if�it’s�in�the�patient’s�best�interest.�For�example�with�colleagues,�doctors,�nurses,�pharmacists,�social�workers�etc.

+���You�should�not�disclose�details�about�patients�to�friends,�family�or�anyone�else�who�doesn’t�need�to�know.

bEST PRACTICE

+���Means�the�current�best�way�of�working�to�get�the�best�results

+���For�medicines�–�guidance�is�issued�by�Royal�Pharmaceutical�Society�of�Great�Britain�who�published�‘The�Handling�of�Medicines�in�Social�Care’�in�2007.

GENERIC NAME USES bRAND NAMES/FORMUlATIONS

Temazepam Sleeping�tablet Generic�tablets,�oral�solution

Morphine Pain�killerOramorph�liquid,�MST�tablets,�MXL�capsules,��Zomorph�capsules

Diamorphine Pain�killer Generic�tablets,�syrup,�injection

Dipipanone Pain�killer Diconal�tablets

Fentanyl Pain�killerAbstral�tablets,�Effentora�tablets,�Instanyl�nasal�spray,��Actiq�lozenges,�Durogesic�DTrans�patches

Hydromorphone Pain�killer Palladone�capsules

Methadone Pain�killer Physeptone�liquid�and�capsules

Oxycodone Pain�killer Oxynorm�capsules,�Oxycontin�tablets

Pethidine Pain�killer Generic�tablets�and�injections

Buprenorphine Pain�killer Temgesic�tablets

Pentazocin Pain�killer Fortral�tablets

Methylphenidate ADHD Ritalin�tablets,�Concerta�XL�tablets

COMMON CONTROllED DRUGS

05

Page 6: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

SERVICE USER PRESCRIPTIONS

Chapter 2

Two�types�of�prescription�produced�by�the�surgery:�acute�and�repeat.

ACUTE PRESCRIPTION

+���For�acute�illnesses�that�occur�suddenly�over�a�short�period�of�time�e.g.�cough,�cold,�athletes�foot,�infection.�An�acute�prescription�is�a�one�off�prescription�for�a�short�course�of�medication�–�once�it�is�finished�there’s�usually�no�need�to�order�any�more�unless�the�illness�hasn’t�cleared�up.�In�this�case�the�doctor�will�need�to�be�contacted�and�may�want�to�see�the�patient�again.

REPEAT PRESCRIPTION

+���Repeat�prescriptions�are�for�chronic�illnesses�which�are�long�lasting�and�can’t�normally�be�cured.�Examples�include:�asthma,�high�blood�pressure�and�arthritis.�If�a�patient�needs�to�take�a�particular�medication�for�a�long�time�the�doctor�can�issue�a�repeat�prescription.�There�is�no�need�to�make�an�appointment�to�see�the�doctor�each�time�they�need�more�of�that�particular�medication.�

+���Repeat�prescriptions�are�usually�for�28�days�worth�of�medication,�however�the�patient�can�ask�the�doctor�for�more�than�28�days�worth�if�need�be.

ORDERING REPEAT PRESCRIPTIONS

+����Each�repeat�prescription�comes�with�a�white�tear-off�repeat�slip�attached�to�it.�This�is�a�form�used�to�order�another�prescription.�Each�item�of�medication�that�the�person�can�have�is�listed�on�the�repeat�slip�–�to�order�more�of�an�item�the�box�needs�to�be�ticked�and�the�slip�dropped�into�the�box�in�the�surgery

+�����To�order�a�repeat�prescription,�the�dispensary�needs�a�written�request.�

+�����In person:�simply�drop�your�repeat�slip�into�the�practice.�If�you�have�lost�this,�ask�and�we�will�print�you�off�another�one.

+����by fax:�fax�your�repeat�slip�to�the�practice+����by email:�go�onto�the�practice�website�

and�follow�the�link�on�the�front�page�that�says�‘prescriptions’�

+����by post:�send�your�repeat�slip�to�the�practice.�

Allow a minimum of two working days for a prescription to be sent to the chemist. Please note we do not take requests over the phone due to the risk of errors occurring and overloading an already busy phone line.

06

Page 7: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

wHO ORDERS THE PRESCRIPTIONS?

+�����It�needs�to�be�clear�who�is�responsible�for�ordering�the�medication�and�should�be�recorded�in�the�care�plan.�It�may�be�a�family�member�or�a�carer.�If�there�are�a�number�of�different�carers�going�in�to�see�the�patient�everyone�needs�to�be�clear�about�who�will�be�doing�the�ordering.�

+����Don’t�just�re-order�the�same�items�each�month�–�always�check�to�see�which�items�are�needed.�Medicines�taken�on�a�‘when�required’�basis�are�not�always�taken�every�day,�therefore�there�may�be�enough�left�over�from�last�month.�

+�����If�the�patient�has�run�out�of�medication�ask�for�‘urgent’�to�be�written�on�the�repeat�slip�and�it�will�be�put�towards�the�top�of�the�pile�–�the�medication�will�possibly�be�ready�for�collection�the�same�day.

MEDICATION REVIEwS

+�����Medication�reviews�are�required�to�ensure�the�patient’s�medication�is�correct�and�up�to�date.�These�may�be�at�a�clinic�(LTMC),�with�a�GP/nurse/pharmacist�and�may�be�conducted�via�a�phone�call�appointment.�

MANAGED REPEAT MEDICATION FOR DISPENSARy

+����We�offer�a�managed�repeat�service�where�you�can�order�what�you�need�for�next�month�when�collecting�your�prescription.�This�makes�ordering�easier�as�it�is�one�less�trip�to�make�and�helps�you�to�only�order�what�you�need.�Please�enquire�at�the�Stowhealth�complementary�shop�regarding�this�service.

This�half�is�your��prescription�to�obtain��

your�medication.

This�half�is�your�repeat��list�which�you�should��keep�to�enable�you�to��

order�more.

REVIEW�DATE�-�your�medication�needs�reviewing�by�this�date.��

See�“Review�Dates”.

Tick�the�box�if�you�need�more��of�this�item.�If�you�don’t�need��

any,�leave�it�blank

GUIDANCE

Filling�in�a�repeat�prescription

07

Page 8: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

SAFE STORAGE & HANDlING OF MEDICATION

Chapter 3

Medicines�are�affected�by�the�environment�in�which�they�are�kept�and�can�be�affected�by:

TEMPERATURE

+�����Most�medicines�need�to�be�stored�at�room�temperature�(below�25°C)

+�����Too�hot�=�the�active�ingredient�can�degrade�(go�off)�or�liquid�medicines�can�grow�microbes.�Some�medicines�are�so�sensitive�to�heat�that�they�need�to�be�refrigerated

+�����Too�cold�=�medicines�can�also�degrade�especially�if�they�are�allowed�to�freeze�or�drop�below�a�certain�temperature

lIGHT

+����Light�can�also�cause�medicines�to�degrade.�This�is�why�bottles�that�pharmacies�dispense�into�are�made�of�brown�plastic�in�order�to�reduce�the�amount�of�light�that�gets�in.

MOISTURE

+����Moisture�can�reduce�a�tablet’s�ability�to�dissolve�or�even�break�down�the�active�ingredient.�Sodium�valproate�tablets�(an�epilepsy�drug)�are�sensitive�to�moisture.

+����Places�to�avoid�storing�medicines�include�the�cupboard�above�a�kettle�–�heat�and�steam�could�damage�them,�on�a�window�sill�–�sunlight�and�heat�could�again�damage�them.�Dressings,�food�supplements,�urine�bags�and�catheters�should�not�be�stored�directly�on�the�floor�as�any�spillages�can�get�them�wet.�

+�����There�are�occasions�when�a�self-medicating�patient�may�place�themselves�at�risk�by�taking�too�much�of�their�medication.�If�this�happens�often�a�risk�assessment�can�be�carried�out�to�decide�if�it�is�safe�for�them�to�carry�on�self-medicating.�If�not,�it�may�be�safer�to��store�the�medication�directly�away�from�the�patient.�

+�����Medications�should�be�ideally�be�kept�in�the�patient’s�locked�medicine�cabinet.

+�����If�there�is�a�risk�that�the�patient�will�still�gain�access�to�their�medicines�then�it�is�acceptable�to�store�them�in�the�manager’s�office�or�somewhere�else�away�from�the�patient.�However�this�must�be�an�exception�rather�than�the�norm�and�a�risk�assessment�must�have�concluded�that�this�way�is�in�the�patient’s�best�interest.�Staff�must�ensure�that�medicines�are�kept�securely,�at�the�correct�temperature,�with�keys�that�are�held�securely�and�that�fridges�are�monitored.�

08

Page 9: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

09

ITEMS THAT NEED TO bE STORED IN A FRIDGE

+����You�would�know�that�a�medicine�needs�to�be�stored�in�the�fridge�by�the�presence�of�a�bag�label�saying�‘fridge’,�on�the�label�or�in�the�patient�information�leaflet.

+����Some�items�which�are�normally�kept�in�the�fridge�are�stable�at�room�temperature�for�short�periods�of�time�and�can�be�kept�out�of�the�fridge�for�the�time�they’re�being�used.�For�example,�some�types�of�eye�drops�such�as�Xalatan�and�Xalacom�(used�for�glaucoma)�are�usually�stored�in�the�fridge�but�can�be�stored�at�room�temperature�for�four�weeks.

+����Always�write�the�date�you�first�open�the�eye�drops�on�the�bottle�and�box.

+�����Avoid�placing�medicines�at�the�back�of�the�fridge�as�they�can�get�pushed�against�the�back�plate�of�the�fridge�and�freeze�which�can�damage�medicines.�

Page 10: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

+����Drugs that cause rashes and cytotoxics: Chlorpromazine�(used�in�mental�health)�can�sometimes�cause�rashes�in�people�who�frequently�handle�the�uncoated�tablet�or�spill�the�liquid�on�them.�It�is�a�COSHH�requirement�to�wear�gloves�in�the�handling�of�uncoated�methotrexate�(used�in�treatment�of�arthritis�and�psoriasis).

MEDICINES PRESCRIbED AS ‘wHEN REqUIRED’

+����Also�known�as�PRN�and�are�medicines�that�are�only�taken�when�needed.�Examples�include�pain�killers,�laxatives,�indigestion�treatments�etc.�

+����PRN�medicines�should�be�offered�to�the�patient�–�if�they�do�not�want�or�need�them�then�you�do�not�have�to�let�the�doctor�or�supervisor�know.�They�are�not�refusing�them;�they�just�don’t�need�any�at�that�particular�time.�

10

USE OF GlOVES

No need to wear gloves for the following:

+����Coated tablets and capsules:�most�tablets�are�coated�in�a�film/sugar�coating�so�you�don’t�touch�the�drug�inside.�Capsules�are�coated�in�plastic�so�there�is�no�risk�of�absorbing�any�medication�through�your�own�skin.

wear gloves for the following:

+����Topical creams, ointments etc: Wear�gloves�or�wash�hands�after�application�of�medicated�topical�to�prevent�any�medication�absorbing�through�your��own�skin

+�����Uncoated tablets (if you are allergic or pregnant): Unlikely�that�any�medication�would�absorb�through�your�own�skin�but�a�small�theoretical�risk�–�only�problematic�if�you�were�allergic�to�that�particular�drug

+����Oral liquids (if you think spillage onto your own skin could occur): If�you�spilled�liquid�medication�onto�your�skin�and�failed�to�wash�it�off�you�could�get�a�small�amount�showing�up�in�your�blood�stream.

Page 11: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

MONITORED DOSE SySTEM

+����Also�known�as�MDS,�blister�packs�or�NOMAD�trays�and�contain�a�whole�week’s�worth�of�medication�

+����Always�check�you�have�the�current�week’s�pack�and�check�the�patient’s�name�carefully

+����You�cannot�give�medicines�from�MDS�packs�that�have�been�filled�by�friends�or�family�as�there�would�be�no�pharmacy�labels�attached.�As�well�as�labels�there�should�also�be�a�written�description�of�the�tablets/capsules

MDS�pack Dosette�box

11

ExAMPlES

Medicines�that�need�to�be�refrigerated�

Examples of medication that is unsuitable for MDS packs:

+����Some�types�of�tablet�and�capsule�are�not�stable�enough�to�be�placed�in�MDS�packs�as�moisture�can�enter�and�cause�the�active�ingredient�to�degrade.�Also�the�tops�of�the�packs�are�clear�–�allowing�light�in�which�can�damage�certain�medicines.�Medicines�in�MDS�packs�are�only�stable�for�eight�weeks.�

+����Soluble�tablets,�dispersible�tablets�or�sublingual�tablets�(under�the�tongue)�or�anything�that�cannot�be�swallowed�whole.

+����PRN�medicines�–�if�they�are�placed�in�an�MDS�pack�they�tend�to�be�given�to�patients�regularly�instead�of�only�being�given�when�they�are�needed.�

Page 12: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

12

ADMINISTERING MEDICATION – SAFE wORkING PRACTICES

Chapter 4

SAFE wORkING PRACTICE

RIGHT MEDICATION

TO THE RIGHT PATIENT

AT THE RIGHT DOSE

AT THE RIGHT

TIME

IN THE RIGHT

wAy

SAFE wORkING PRACTICES ARE TO PROVIDE:

The�right�medication�to�the�right�patient�at�the�right�dose�in�the�right�way�at�the�right�time

Page 13: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

1 If�unfamiliar�with�the�patient�read�the�care�plan�to�find�out�which�tasks�you�need�to�carry�out�and�any�personal�preferences�they�have

2 Check�you�have�the�current�medicines�chart�and�any�other�paperwork�needed

3 Wash�your�hands�or�wear�gloves�if�needed

4 Check�if�the�patient�has�already�taken�or�been�given�any�doses�check�the�medicines�chart�or�check�with�patient

5 For�PRN�medication�check�any�when�required�protocols�or�ask�the�patient�if�they�need�the�item

6 If�you�are�giving�from�MDS�packs�check�that�you�have�the�correct�weeks�pack�for�the�right�patient.�Check�the�medicines�chart�to�see�how�many�items�are�due.�Check�the�MDS�pack�and�make�sure�the�blister�you�are�about�to�pop�out�has�the�right�number�of�items�in.�Check�for�any�items�listed�on�the�medicine�chart�not�in�the�MDS�pack

8 Read�any�warning/cautionary�and�advisory�labels�on�the�pharmacy�label�e.g.�take�with�food�and�act�on�them

9 Administer�each�item�according�to�‘best�practice’

10 Observe�the�patient�take�each�item

11 Enter�the�correct�code/your�initials�on�the�medicine�chart�only�when�you�personally�have�seen�the�patient�take�or�use�the�item�or�decline�it

bASICS OF ADMINISTERING MEDICATION

GUIDANCE

7 If�you�are�giving�any�medicines�not�in�an�MDS�pack,�compare�the�pharmacy�label�with�the�entry�on�the�medicines�chart.�Make�sure�the�following�details�agree:��1�Drug�name��2�Drug�strength��3�Form�of�the�drug��4�Directions��5�Patient’s�name��6�Expiry�date

13

Page 14: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

1 NAME OF THE DRUG

The�same�drug�can�have�two�names�the�generic�(e.g.�diclofenac)�and�the�brand�name�(e.g.�Voltarol).�Make�sure�the�name�on�the�label�matches�the�name�on�the�medicines�chart.�If�the�medicines�chart�has�the�brand�name�and�the�label�has�the�generic�name�(or�vice�versa)�it�may�still�be�okay�to�administer�the�medicine�(you�can�check�with�a�pharmacist�for�clarification).

PHARMACy lAbElS

2 STRENGTH

The�same�medicine�can�come�in�many�different�strengths,�so�check�you’ve�got�the�correct�one.�Strengths�are�written�in�various�ways�for�example:�

+��Grams�(g)+���Milligrams�(mg)�there are 1000

milligrams in one gram+���Micrograms�(mcg)�there are 1000

micrograms in one milligram

Typical�pharmacy�label

Asprin��������75mg��������dispersible�tablets������28

Take�ONE�tablet�Daily

Dissolve�or�mix�with�water�before�taking��Take�with�or�after�food�Contains�aspirin

Mr John Greene 23 March 2012

1 Name 2 Strength

4 Direction

5 Patient’s name

6 quantity

7 Cautionary and advisory labels

8 Date of dispensing

14

GUIDANCE

3 Form

Page 15: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

15

For�example:�

+��Warfarin�0.5mg�tablets+��Warfarin�1mg�tablets+��Warfarin�3mg�tablets+��Warfarin�5g�tablets+��Digoxin�62.5mcg�tablets+��Digoxin�125mcg�tablets+��Digoxin�250mcg�tablets

The�strengths�of�liquids�and�creams�are�sometimes�written�as�a�percentage,��for�example:

+��Hydrocortisone�0.5%�cream+��Hydrocortisone�1%�cream

Some�medicines�are�only�available�in�one�strength�(e.g.�lactulose)�in�which�case�the�strength�isn’t�always�written�on�the�label�or�medicines�chart.��

3 FORM

Form�means�formulation.�Medicines�come��in�various�formulations,�for�example:+��Diclofenac�dispersible�tablets+���Diclofenac�gel+���Diclofenac�suppositories+��Diclofenac�injection+��Diclofenac�tablets+���Diclofenac�slow�release�tablets+��Diclofenac�capsules

4 DIRECTIONS

Sometimes�directions�are�written�as�‘Take�ONCE�daily’�on�the�label,�but�state�‘Take�ONCE�in�the�morning’�on�the�medicines�chart�(or�vice�versa).�This�is�okay�as�long�as�the�two�sets�of�directions�don’t�contradict�each�other.�Directions�such�as�‘take�as�directed’�(or�similar�wording)�are�not�acceptable�for�you�to�work�from.�The�dispensary/pharmacy�should�be�asked�to�seek�directions�from�the�prescriber�and�add�them�to�the�label.�

There�are�exceptions�for�this�rule:�drugs�whose�doses�vary�frequently�such�as�warfarin�or�insulin�can�be�labelled�‘Take�as�directed’.�However�there�should�be�a�way�of�finding�out�what�the�dose�is.�With�warfarin�you�should�always�check�the�laboratory�test�results�(INR�results)�before�you�give�the�dose.�These�INR�results�will�tell�you�how�many�milligrams�of�warfarin�to�give�the�patient.�Don’t�just�give�the�same�dose�of�warfarin�as�yesterday�without�checking�the�results�first�as�the�dose�may�have�changed.�

Page 16: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

5 PATIENT’S NAME

Make�sure�the�patient’s�name�on�the�label�matches�the�patient’s�name�on�the�medicines�chart.�

6 qUANTITy

The�amount�of�medication�in�the�pack

7 CAUTIONARy AND ADVISORy lAbElS

These�warnings�are�put�on�the�label�automatically�by�the�dispensary’s�computer�system.�They�contain�important�information�such�as�whether�the�drug�needs�to�be�given�with�food�or�on�an�empty�stomach,�or�whether�the�drug�causes�drowsiness�as�well�as�other�important�information.�These�warnings�are�not�always�printed�on�the�medicines�chart�and�so�you’ll�need�to�check�these�on�the�label�before�administering�the�item�to�the�patient.�

8 THE DATE OF DISPENSING

Not�the�expiry�date,�the�date�when�the�item�was�dispensed,�i.e.�on�the�23rd�March�2012.�

16

ExPIRy DATES (MEDICINES OFTEN HAVE TwO)

+���The�expiry�date�before�the�pack�is�opened:�medicines�supplied�in�the�manufacturer’s�original�packaging�will�have�an�expiry�date�printed�on�the�pack�or�on�any�foil�strips.�Unfortunately�if�the�dispensary�repacks�the�item�into�another�container,�then�this�expiry�date�is�sometimes�lost.�When�this�happens�the�advice�from�the�regulators�is�to�assume�medicines�are�still�in�date�6�months�after�the�date�of�dispensing.�

+���The�expiry�date�once�the�product�has�been�opened:�most�medicines�contain�preservatives�but�they�don’t�protect�the�product�forever.�Once�you�open�a�pack�of�medication�it�starts�to�‘go�off’�(the�active�ingredient�degrades�and�becomes�less�effective.�Bacteria�can�also�start�to�contaminate�liquid�medicines.)�The�table�below�shows�examples�of�the�shelf�life�on�some�liquids.�

Page 17: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

ITEM SHElF lIFE ONCE OPENED

Chlorpromazine�syrup� 6�months

Ditropan�elixir 28�days

Folicare 4�weeks

Frusol�liquid 3�months

Gastrocote�liquid 1�month

Largactil�syrup 1�month

Neoral�oral�solution 2�months

Oramorph�oral�

solution90�days

Phenergan�elixir 1�month

Risperdal�liquid 3�months

Antibiotic�liquids 7-10�days�(needs�to�be�refrigerated)

lIqUID SHElF lIFE

ITEM SHElF lIFE ONCE OPENED

Oral�liquids 6�months

Creams�in�tubes 3�months

Creams�in�jars/pots 1�month

Ointments�in�tubes 6�months

Ointments�in�jars/pots

3�months

Eye�drops 28�days

OTHER ITEMS SHElF lIFE

17

Page 18: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

wHEN PATIENTS DEClINE THEIR MEDICATION

Chapter 5

+����We�all�have�the�right�to�refuse�medication��and�you�should�never�pressure�a�patient�into�taking�their�medicines�but�gentle�encouragement�is�okay

+����If�you�have�more�time�to�spend�with�the�patient�you�could�leave�their�medicines�chart�blank,�walk�away�and�try�again�later.�Patients�with�dementia�often�forget�they�declined�medication�so�you�may�be�able�to�offer�them�the�item�again

+����It�would�be�helpful�to�spend�some�time�talking�with�the�patient�to�find�out�why�they�don’t�want�their�medication�e.g.�they�find�tablets�hard�to�swallow�–�a�pharmacist�could�recommend�another�formulation.�They�also�may�not�know�why�they�take�the�item�-�in�cases�like�this�a�MUR�(medication�usage�review)�may�be�helpful.�If�you�have�a�patient�who�is�hiding�medication�from�you�instead�of�taking�it,�remind�them�that�they�have�the�right�to�refuse�medication.�They�don’t�need�to�pretend�that�they’ve�taken�doses�they�don’t�want.�

RECORDING wHEN MEDICINES ARE DEClINED

+����There�comes�a�point�when�you�have�to�code�the�medicines�chart�that�the�dose�was�declined�–�check�and�see�what�code�to�use.�Also�check�what�your�policy�is�on�declined�medication�–�some�people�contact�the�prescriber�straight�away,�some�contact�them�after�the�patient�has�refused�for�more�than�24�hours,�some�wait�longer.�It�also�depends�on�the�drug�declined.�The�time�period�can�be�agreed�with�prescribers.�

CAN I PUT A TAblET OR CAPSUlE bACk IN THE PACk?

+����If�a�tablet/capsule�has�come�from�a�blister�strip�or�MDS�then�you�won’t�be�able�to�put�it�back.�Don’t�be�tempted�to�try�and�re-seal�it�with�tape.�However�if�it�has�come�from�a�bottle�it�may�be�okay�to�put�it�back�although�take�great�care�to�check�you�are�putting�the�same�tablet/capsule�back.�

+����Check�that�the�patient�will�take�the�item�of�medication�before�you�remove�it�from�the�pack�so�you�won’t�have�to�deal�with�any�doses�you�have�taken�out.�

18

Page 19: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

COVERT ADMINISTRATION+����If�the�patient�has�adequate�mental�

capacity�then�they�have�the�right�to�decline�their�medicines,�but�what�about�patients�with�limited�mental�capacity?�Laws�and�guidance�state�that�if�a�person’s�mental�capacity�is�under�doubt�than�an�assessment�of�their�mental�capacity�may�be�needed.�

+����In�cases�where�patients�lack�the�mental�capacity�to�take�and�understand�their�medications�there�are�certain�situations�when�we�can�hide�medicines�in�food�and�drink,�i.e.�give�a�person�their�medication�without�them�realising�it�(covert�administration).�However�one�of�the�difficulties�with�this�is�that�you�need�to�ensure�the�patient�swallows�the�entire�drink�or�meal�to�get�the�full�dose.�If�the�patient�shares�the�living�space�with�others�you�need�to�think�about�how�you’d�prevent�someone�else�finishing�their�meal�or�drink�and�inadvertently�swallowing�their�medicine.�

19

+����Don’t�confuse�covert�administration�with�putting�medicines�in�food/drink�to�help�someone�swallow.�If�the�patient�understands�that�their�medication�is�mixed�with�a�drink�or�food�then�this�is��not�covert�administration.�

+����The�doctor,�a�social�work�team,�family�members�and�a�pharmacist�would�all�have�to�be�consulted�before�covert�administration�could�take�place.�

Page 20: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

20

INFORMATION AbOUT MEDICINES

Chapter 6

+����The�amount�of�knowledge�you�are�expected�to�have�about�the�medicines�you�administer�depends�on�how�many�different�types�you�encounter�on�a�day-to�day�basis.

+����It’s�very�important�you�have�the�right�forms�in�place�e.g.�care�plans,�medicines�charts,�PRN�protocols�etc.�These�forms�should�contain�all�the�information�you�need�to�give�medicines�safely�and�appropriately.�

THE lATEST AND bEST INFORMATION SOURCES THAT ARE AVAIlAblE TO yOU INClUDE:

+����Patient information leaflets:�pharmacies�are�required�to�supply�a�patient�information�leaflet�with�each�medicine�they�dispense�–�it�should�contain�all�the�information�you�and�the�patient�need.�Make�sure�the�leaflet�you�are�reading�is�up�to�date�as�information�about�medicines�sometimes�changes.�Patient�information�leaflets�should�be�made�available�for�the�patient�to�read�–�you�may�have�to�help�patients�with�limited�mental�capacity�understand�the�leaflets�by�reading�them�out�and�explaining�them�using�more�simple�language.

+����bNF: the�British�National�Formulary�is�designed�to�be�used�by�pharmacists/nurses/doctors�and�therefore�contains�quite�a�lot�of�medical�jargon�and�terminology.�However�it�contains�a�lot�of�detailed�information�on�medicines.�

+����www.bnf.org�the�British�National�Formulary�is�also�available�online�

+����New Guide to Medicines & Drugs book: The�British�Medical�Association�produces�a�useful�book�aimed�at�the�general�public�and�has�advice�about�what�to�do�if�a�particular�medicine�is�given�late.�

+����www.medicines.org/guides the�Electronic�Medicines�Compendium�(EMC)�provides�up-to-date,�reliable�and�understandable�information�about�medicines.�It�also�allows�you�to�download�patient�information�leaflets�for�many�different�drugs�simple�language.

BNF New�Guide�to�Medicine�&�Drugs

ExAMPlES

Page 21: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

21

DRUG INTERACTIONS

+����Multiple�items�of�medication�can�interact�in�other�ways�to�produce�a�range�of�side�effects.�Some�examples�are:�some�cough/cold�treatments�contain�paracetamol�which�when�given�with�co-codamol�could�cause�a�paracetamol�overdose.�Ibuprofen�can�interact�with�a�number�of�medicines�such�as�lithium�with�sometimes�quite�serious�consequences.�

+����It’s�best�to�advise�any�patient�where�there’s�a�risk�that�medication�bought�over�the�counter�can�interact�with�their�prescribed�medications�or�hide�symptoms�that�might�need�investigating.�It’s�best�to�check�with�a�pharmacist�or�the�patient’s�GP�to�see�if�they�can�be�taken�together�safely.�

+����Some�policies�state�that�you�are�only�to�assist�with�medication�that�has�been�prescribed.�This�is�because�prescribed�items�will�already�have�been�checked�by�a�doctor�and�pharmacist�and�so�shouldn’t�interact�with�each�other.�If�you�are�giving�patients�items�of�over�the�counter�medication�then�these�should�be�added�to�their�medicines�chart.

Page 22: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

ADMINISTERING SOlID ORAl MEDICINES

Chapter 7

SwAllOwING DIFFICUlTIES

+����Many�people�find�swallowing�tablets�and�capsules�difficult

+����The�wider�the�cup�the�better�as�the�patient�won’t�need�to�tip�their�head�back�to�get�to�the�liquid�-�makes�swallowing�more�difficult

+����Make�sure�you�have�filled�the�cup�to�the�top�with�liquid�otherwise�they’ll�need�to�tip�their�head�back

+����Some�people�find�it�easier�to�swallow�if�they�suck�the�liquid�up�with�a�straw

+����Swallowing�problems�can�also�occur�if�patients�suffer�from�a�dry�mouth�–�you�could�give�them�a�drink�to��wet�their�mouth�with�before�they�put�the�tablets�in�their�mouth.�

+����Many�people�find�it�easier�to�swallow�capsules,�sugar�coated�tablets,�or�a�liquid�formulation.�Talk�to�the�dispensary�to�see�if�they�can�change�the�formulation��if�necessary.�

+����Most�people�need�a�drink�in�order�to�swallow�tablets/capsules.�You�can�always�add�some�cordial�if�the�patient�prefers.�

+����Milk�can�affect�certain�types�of�medication�by�reducing�the�amount�of�drug�that�gets�absorbed.�Check�the�cautionary�and�advisory�warnings�on�the�label�if�it�says�‘do�not�take�with�milk’�then�you’ll�need�to�advise�the�patient�about�this.�

+����Most�types�of�fruit�juice�are�okay�however�grapefruit�juice�can�interact�with�nifedipine,�simvastatin�and�carbamazepine.�Cranberry�juice�can�also�be�a�problem�in�some�patients�taking�warfarin�–�there�should�be�a�warning�on�the�label�or�within�the�patient�information�leaflet.�

+�����The�caffeine�in�tea�and�coffee�can�interact�with�theophylline.�Another�problem�with�hot�drinks�is�that�patients�cannot�take�a�big�enough�‘gulp’�to�make�sure�the�tablet�is�swallowed�properly.�There�have�also�been�cases�where�soft�gelatine�capsules�have�melted�in�the�mouth�when�taken�with�a�hot�drink,�releasing�the�drug�into�the�mouth�which�can�taste�quite�bitter.�If�the�patient�has�milk�with�their�tea�or�coffee�check�the�label�to�see�if�it�says�‘do�not�take�with�milk’.�

+����Alendronic�acid�should�only�be�given�with�water�(no�cordial�and�not�mineral�water).�There�are�multiple�warnings�such�as�‘take�on�an�empty�stomach’��surrounding�alendronic�acid�which�can�be�found�in�the�patient�information�leaflet

22

Page 23: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

CRUSHING TAblETS AND OPENING CAPSUlES

+����Some�tablets�are�designed�to�be�chewed�e.g.�Natecal

+����Some�tablets�are�designed�to�be�crushed�e.g.�Epilim�crushable�tablets�

+����You�could�find�this�information�by�reading�the�patient�information�leaflet.�However�if�the�tablets�you�are�administering�have�not�been�designed�to�be�crushed/chewed�then�don’t�crush�them�unless�you’ve�had�permission�from�the�pharmacist�and�doctor.�Permission�should�be�recorded�in�care�notes.��

+������Some�capsules�are�designed�to�be�opened�up�e.g.�Zomorph.�However�unless�it�states�in�the�patient�information�leaflet�that�you�can�do�this,�don’t�open�up�any�capsules�unless�you’ve�had�permission�from�a�pharmacist�and�doctor.�

You�have�to�be�cautious�when�determining�whether�tablets�can�be�crushed/chewed�for�the�following�reasons:

+����Some tablets are coated as�there�are�some�drugs�that�can�be�damaged�by�acid�in�the�stomach.�To�protect�them�they�are�coated�in�a�film�that�doesn’t�dissolve�in�acid�known�as�an�enteric�coating.�This�coat�will�dissolve�to�release�the�drug�in�a�more�neutral�or�alkaline�environment�once�it�passes�through�the�stomach�into�the�intestines.�Some�drugs�also�have�an�enteric�coat�to�stop�the�drug�in�them�irritating�the�stomach�lining.�

+����With�enteric�coated�tablets�and�capsules�there�is�always�a�warning�on�the�label�saying�‘swallow�whole,�do�not�crush��or�chew’.�

+������Some�tablets�have�a�sugar�(or�film)�coating�which�is�not�the�same�as�an�enteric�coat.�The�sugar�(or�film)�coating�is�just�there�to�make�the�tablet�easier�to�swallow.�These�coatings�will�dissolve�in�the�stomach�along�with�the�tablet.�The�pharmacist�might�give�you�permission�for�you�to�crush�sugar�or�film�coated�tablets.�

+����Some tablets and capsules are slow release which�is�a�mechanism�designed�to�release�the�drug�inside�slowly�throughout�the�day�(or�night).�This�means�that�instead�of�having�to�give�the�medicine�a�number�of�times�throughout�the�day,�the�tablet�or�capsule�can�be�given�less�frequently,�i.e.�only�once�or�twice�a�day.�By�crushing�slow�release�tablets/capsules�you�may�end�up�giving�the�person�an�overdose�as�the�entire�day’s�dose�is�released�in�one�go.�

23

Page 24: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

+����With�slow�release�tablets�and�capsules�there�is�always�a�warning�on�the�label�saying�‘swallow�whole,�do�not�crush��or�chew’.

+����You�cannot�crush�tablets�or�open�up�capsules�that�are�not�coated�or�slow�release�unless�you�have�had�permission�from�a�pharmacist�and�the�doctor.�Giving�medicines�in�a�way�that�the�manufacturer�didn’t�intend�them�to�be�given�is�called�a�drug�‘off�licence’�or�giving�it�as�an�un-licensed�drug.�The�prescriber�has�to�be�asked�permission�if�any�drug�is�to�be�given�in�an�unlicensed�way.�

+�����It�is�okay�to�break�tablets�in�half�if�they�have�a�‘score�line’�on�them.�You�don’t�need�permission�from�the�pharmacist/doctor�because�the�manufacturer�has�designed�scored�tablets�to�be�broken�in�half�if�need�be.

wHAT IF THE PATIENT CHEwS THEIR TAblETS OR CAPSUlES?

+����Can�sometimes�occur�in�patients�with�dementia�where�swallowing�difficulties�can�occur.�It’s�only�enteric�coated�or�slow�release�tablets/capsules�that�you�need�to�worry�about.�This�is�important�because�if�a�patient�chews�a�slow�release�tablet,�they�could�end�up�having�an�entire�day’s�dose�in�one�go�which�could�be�dangerous.�Chewing�enteric�coated�tablets�might�stop�them�working�or�cause�stomach�irritation.�

+����If�any�of�the�medicines�patients�are�chewing�have�these�warnings�on�them�(swallow�whole,�do�not�crush�or�chew)�you’d�need�to�warn�the�patient�of�the�risks�and�let�the�pharmacist/doctor�or�another�health�professional�know�as�soon�as�possible.�

+�����If�the�tablets�that�they�are�chewing�are�not�slow�release/enteric�coated�then�there�will�be�no�warning�on�the�label,�however�you�could�still�contact�the�pharmacist��as�they�may�be�able�to�change�the�item�to�a�liquid�or�something�that�is�easier�to�swallow.�The�patient�would�not�be�putting�themselves�in�immediate�harm�by�chewing�tablets�that�are�not�slow�release�though.

24

Breaking�scored�tablets�

GUIDANCE

Page 25: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

wHAT IF THE PATIENT VOMITS AFTER TAkING ANy ORAl MEDICATION?

�Unlikely�but�if�this�does�happen�then�contact��a�health�professional�(such�as�a�pharmacist)��they�may�advise�you�to�give�another�dose�if�you�can�see�the�intact�tablet/capsule�in�the�vomit�but�do�not�do�this�unless�you�have�checked�with�a�health�professional.�

lOzENGES AND PASTIllES

+����Occasionally�prescribed�by�doctors,�lozenges�and�pastilles�are�designed�to�be�sucked�and�should�be�held�in�the�mouth�for�as�long�as�possible�and�allowed�to�slowly�dissolve.�

+����Patients�taking�any�medication�that�needs�to�be�sucked�or�chewed�should�avoid�eating�or�drinking�anything�until�the�pastille�or�lozenge�has�fully�dissolved.�

SUblINGUAl TAblETS

+����Sublingual�tablets�are�designed�to�be�placed�under�the�tongue�instead�of�swallowed.�From�there�the�drug�absorbs�directly�into�the�bloodstream�and�so�it�is�able�to�work�more�quickly.�One�example�of�a�sublingual�tablet�is�glyceryl�trinitrate�(GTN)�used�to�treat�angina.

+����Once�used,�GTN�should�ease�chest�pain�within�1-5�minutes.�If�needed,�the���patient�can�have�another�GTN�tablet�after�5�minutes.�If�they�have�taken�3�doses�within�15�minutes�and�the�chest�pain�is�either�no�better�or�worse�then�you�should�call�a�doctor,�or�dial�999�as�the�patient�may�be�having�a�heart�attack.�GTN�can�sometimes�cause�a�headache�–�a�recognised�side�effect�and�although�uncomfortable�is�nothing�to�worry�about.

+����GTN�tablets�expire�8�weeks�after�opening�the�bottle�so�it’s�important�to�keep�them�in�their�original�container,�as�a�metal�seal�in�the�lid�and�the�glass�bottle�is�designed�to�protect�the�tablets.�Any�tablets�remaining�after�8�weeks�need�discarding�and�a�fresh�supply�is�required.�

25

Page 26: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

26

Administering�buccal�tablets�

+����GTN�also�comes�as�a�spray�for�under�the�tongue.�The�spray�does�not�expire�after�8�weeks�and�may�be�used�until�its�empty�or�has�reached�its�expiry�date.�When�patients�feel�chest�pain,�they�should�spray�one�or�two�puffs�under�their�tongue.�It’s�important�that�the�canister�is�held�upright�when�spraying.�After�spraying,�the�patient�should�close�their�mouth;�otherwise�the�spray�can�evaporate�out�of�the�mouth.�GTN�tablets�and�spray�can�tingle�or�burn�under�the�tongue,�which�is�normal.�

Sublingual�tablets

bUCCAl TAblETS

+����Designed�to�be�placed�between�the�upper�cheek�(or�lip)�and�the�top�gum�where�they�sit�and�dissolve.�The�drug�then�gets�absorbed�directly�into�the�bloodstream�and�therefore�works�very�quickly.

+�����If�the�patient�has�a�dry�mouth,�you�can�moisten�the�inside�of�it�with�some�wet�cotton�wool.�If�you�have�a�patient�who�needs�this�type�of�tablet�regularly,�it’s�best�to�vary�the�place�where�the�tablet�goes�a�little�(to�stop�irritation).�Some�types�of�GTN�tablet�come�as�buccal�tablets.�Some�tablets�used�to�treat�nausea�and�sickness�are�also�available�in�this�form.�

GUIDANCE

ExAMPlES

Page 27: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

27

ADMINISTERING ORAl lIqUIDS

Chapter 8

When�measuring�out�oral�liquids,�you�have�three�choices�of�what�to�use:

MEDICINES SPOON

Only�a�5ml�medicines�spoon�is�designed�to�accurately�hold�5mls�of�liquid�–�not�a�metal�teaspoon�or�any�other�type�of�spoon.�However,�most�people�tend�to�pour�out�less�than�5ml�–�only�3�or�4ml.�Whilst�this�may�be�less�important�if�measuring�out�items�such�as�cough�medicines�or�treatments�for�indigestion,�this�could�lead�to�more�serious�under-dosing�if�you�are�measuring�out�items�such�as�antiepileptics,�treatments�for�the�heart,�or�antibiotics�etc.�

To�pour�out�5ml�you�need�to�pour�a�heaped�spoonful�of�liquid.�

Although�spoons�are�not�good�for�measuring�out�liquids,�they�can�be�easy�to�administer�from.�If�the�patient�finds�it�hard�to�swallow�from�a�measuring�cup�or�oral�syringe,�you�can�always�transfer�the�medicine�to�a�spoon�after�measuring�it�out�accurately�using�another�device.�

MEASURING CUPS

Many�care�professionals�use�graduated�medicines�cups�to�measure�out�liquids.�If�you�are�using�these,�it’s�important�to�place�them�on�a�level�surface�to�check�you�have�the�right�dose.�If�you�hold�the�cup�up�to�eye�level,�you�can�end�up�holding�it�at�an�angle�resulting�in�you�measuring�out�the�wrong�dose.�

Medicines�cups�are�more�accurate�than�spoons,�but�many�people�tend�to�pour�too�much�into�them�(sometimes�6�or�7ml�when�aiming�for�5ml).�Also,�thick�medicines�can�be�left�behind�in�the�measuring�cup.�

Measuring�cups�are�better�for�larger�volumes�of�liquid,�e.g.�15�or�20ml.�This�is�because�over�measuring�by�1ml�when�aiming�for�20ml�gives�you�a�5%�error,�whereas�over�measuring�by�1ml�when�aiming�for�5ml�gives�you�a�20%�error.�

Generally�speaking,�most�people�manage�to�swallow�liquids�okay�from�measuring�cups.�However,�you�often�have�to�tip�your�head�back�to�get�the�last�of�the�medicine�from�the�cup.�Tipping�your�head�back�and�looking�up�can�make�swallowing�difficult.�This�might�be�a�problem�if�the�patient�has�a�swallowing�difficulty,�in�which�case�spoons�might�be�easier�(after�using�a�syringe�to�measure�out�the�dose�accurately).�

Page 28: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

ORAl SyRINGES

Oral�syringes�are�the�most�accurate�method�of�measuring�out�liquids.�They�come�with�a�plastic�adaptor�which�you�push�into�the�bottle.�You�then�push�the�syringe�into�the�adaptor�and�turn�the�bottle�upside�down.�You�need�to�get�rid�of�the�air�gap�that�you�get�when�you�first�draw�the�liquid�up.�Push�this�air�gap�back�into�the�bottle.�A�few�small�air�bubbles�are�okay,�but�not�an�air�gap.�

If�you�are�holding�the�syringe�pointing�upwards,�make�sure�it’s�the�top�edge�of�the�black�ring�that’s�just�touching�the�underside�of�the�correct�mark.�

If�possible,�it’s�best�to�let�the�patient�use�the�oral�syringe�themselves.�This�way�they�have�control�over�how�quickly�they�push�the�liquid�into�their�mouth�and�it’s�also�more�dignified.�If�the�patient�can’t�do�this�on�their�own,�then�you�may�have�to�do�it�for�them.�Take�care,�as�choking�incidents�have�occurred�when�staff�have�pushed�liquid�in�too�quickly.�

It’s�good�if�you�have�found�a�technique�that�works�for�you�and�the�patient.�As�long�as�medication�does�not�dribble�out�of�their�mouth�and�they�find�the�technique�comfortable,�then�you�can�use�whichever�technique�suits�you�both.�However�the�technique�does�need�to�minimise�the�risk�of�choking.��

Rather�than�pushing�the�whole�of�the�syringe�into�the�mouth,�place�just�the�tip�of�the�syringe�between�the�front�lips�(which�remain�closed)�in�front�of�the�teeth.�If�you�push�the�syringe�in�between�their�teeth,�the�patient�won’t�be�able�to�clench�their�teeth�to�swallow.�

Some�people�place�the�whole�syringe�in�the�side�of�the�cheek,�between�the�teeth�and�the�inside�cheek.�Although�the�patient�can�clench�their�teeth�to�swallow,�they�can’t�form�a�seal�around�the�syringe,�and�liquid�can�leak�out.�Also,�you�can’t�see�how�much�liquid�you�are�squirting�in�at�a�time.�This�is�also�not�the�most�dignified�way�to�treat�the�patient�–�hence�just�place�the�tip�between�the�front�lips.

Not�all�patients�can�take�5ml�in�one�go.�If�this�is�the�case,�squirt�about�2.5ml�in�at�a�time�then�allow�them�to�swallow�this.�Once�they�have�swallowed�it,�push�another�2.5ml�in.�In�time,�you�may�find�that�the�patient�is�able�to�take�a�whole�syringe-worth�of�medication�in�one�go,�however�just�be�cautious�to�begin�with.�If�you�find�that�the�patient�doesn’t�get�on�with�syringes,�you�can�always�squirt�the�medicine�bit-by-bit�from�the�syringe�onto�the�spoon�and�give�it�that�way.�

28

Page 29: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

Medicines�spoon� Measuring�cups

Oral�syringes

ClEANING ORAl SyRINGES

Clean�the�syringe�after�each�use�with�fresh,�warm�soapy�water.�Draw�the�plunger�in�and�out�several�times�until�the�inside�of�the�syringe�is�clean.�Separate�the�barrel�and�plunger�and�wash�both�in�soapy�water.�Do�the�same�to�the�adapter.�Rinse�under�cold�water�and�leave�un-assembled�to�dry.�

You�can�use�a�dishwasher,�but�that�doesn’t�clean�the�medicine�out�of�the�tip.�If�you�use�a�dishwasher,�flush�the�medicine�out�first�with�fresh�water.�If�you�are�administering�into�the�mouth,�oral�syringes�need�to�be�clean,�but�not�necessarily�sterile.�

Carry�on�using�the�oral�syringes�until�the�markings�fade.�

29

ExAMPlES

Page 30: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

APPlyING TOPICAl MEDICATION

Chapter 9

Topical�products�are�products�applied�to�the�skin.�In�general�terms�this�means�creams,�lotions,�ointments�and�gels.�

+����Creams are�a�combination�of�oil�and�water.�They�also�contain�extra�ingredients�such�as�emulsifying�agents�which�allow�the�oil�and�water�to�mix,�and�preservatives�to�stop�microbes�growing�in�the�water�that�creams�contain.�Medical�creams�don’t�tend�to�contain�colours�or�perfumes�as�these�can�sometimes�irritate�the�skin.�

+�����lotions are�like�creams�but�are�designed�to�be�applied�over�larger�areas�of�skin.�For�this�reason�they�are�often�thinner�and�contain�more�water.�

+����Ointments are�mostly�made�of�oil�or�grease.�They�contain�either�no�water,�or�just�very�small�amounts.�Since�most�ointments�contain�no�water,�they�do�not�need�emulsifying�agents�added�or�even�much�in�the�way�of�preservatives.�Therefore�they�contain�fewer�ingredients,�which�means�they�are�much�less�likely�to�cause�skin�irritation.�Because�they�contain�more�oil,�they�moisturise�the�skin�for�longer,�This�is�because�the�oil�seals�the�water�in�the�skin,�preventing�the�skin�from�drying�out.�Some�patients�don’t�like�the�greasy�feel�of�them�although�they�do�make�excellent�moisturisers.�

+����Gels are�a�much�more�recent�invention�and�can�be�made�of�almost�99%�water�or�any�combination�of�oil�and�water.They�remain�fairly�solid�whilst�they�are�in�their�container,�but�become�softer�when�applied�to�the�skin.�

All of the above can have drugs added to them which would make them ‘medicated’ or they can be used as they are i.e. left as ‘unmedicated’ in which case they are often used as moisturisers.

+����Non-medicated�creams,�ointments,�gels�and�lotions�are�most�often�used�as�moisturisers.�An�example�is�aqueous�cream.�Moisturising�creams�are�normally�applied�quite�thickly.�With�moisturising�ointments,�less�is�needed�as�they�contain�more�oil.

+����Barrier�creams�and�ointments�are�in�a�class�of�their�own.�Examples�include�Sudocrem,�Conotrane�and�Cavilon�cream.�They�contain�a�type�of�silicon�which�sits�on�the�skin�and�acts�as�a�repellent,�keeping�irritants�such�as�sweat,�saliva,�urine�and�faeces�off�the�skin.�The�silicon�doesn’t�get�absorbed,�so�they�aren’t�really�‘medicated’�topicals,�but�because�some�of�them�also�contain�mild�antiseptics�they�aren’t�really�non-medicated�either.�

30

Page 31: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

wEAR GlOVES wHEN APPlyING TOPICAl MEDICINES

It’s�best�to�wear�gloves�when�applying�any�medicated�cream/ointment/lotion/gel.�This�prevents�the�drug�absorbing�through�your�own�skin.�There�is�only�a�small�risk�of�this�happening,�especially�as�you’d�wash�your�hands�afterwards,�but�it�is�possible.�

It’s�best�to�spread�topical�products�(medicated,�non-medicated�and�barriers)�onto�the�skin,�rather�than�trying�to�rub�them�in.�Spread�them�down�the�limb�using�a�sweeping�motion�in�the�direction�of�hair�growth�(always�down,�away�from�the�body).�This�is�important�if�the�patient�has�hairy�skin�as�otherwise�you�end�up�brushing�the�hairs�the�wrong�way�which�can�be�uncomfortable�for�them.

Don’t�try�and�rub�topical�products�in�vigorously,�as�this�can�irritate�the�skin�and�will�take�a�long�time.�Skin�is�a�barrier�and�it�can�take�a�while�for�things�to�soak�through�(depending�on�what�is�applied).�As�far�as�creams�are�concerned,�they�are�mostly�made�of�water.�Most�of�this�water�dries�into�the�air,�rather�than�soaking�through�the�skin.�The�active�ingredient�is�then�left�behind�on�the�skin�to�soak�in.�Rubbing�creams�around�the�skin�just�heats�up�the�skin�and�causes�the�water�to�evaporate�more�quickly.�

31

Non-medicated�cream Medicated�cream

Barrier�cream

ExAMPlES

Page 32: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

32

APPlyING MOISTURISERS

A�good�moisturiser�doesn’t�just�add�water�to�dry�skin,�it��adds�plenty�of�oil�to�it�in�order�to�fill�all�the�gaps�between�skin�cells�and�restore�the�skin’s�natural�barrier�function.�With�moisturising�creams,�the�oil�they�contain�has�been�diluted�with�water.�This�is�why�you�need�to�apply�so�much,�as�shown�below:

Most�patients�will�probably�not�want�you�to�put�this�much�on.�You�could�ask�them�to�try�it�for�a�week�to�see�what�difference�it�makes.�Depending�on�how�dry�the�skin�is,�it�takes�about�10-30�minutes�for�the�water�to�dry�off�(some�of�the�water�soaks�into�the�skin,�most�of�it�evaporates�into�the�air).�After�the�water�has�gone,�you�are�left�with�a�thin�layer�of�oil�on�the�skin.�The�oil�then�soaks�into�the�skin�over�the�next�few�hours.�It�fills�the�gaps�between�the�skin�cells,�which�seals�in�the�water�already�present�in�the�skin.�Once�you�have�applied�all�of�this�moisturising�cream,�the�patient�can�get�dressed�over�the�top�of�it�with�an�old�dressing�gown�or�clothes�which�they�don’t�mind�getting�a�little�greasy.�It�doesn’t�stain�most�clothing�(apart�from�silk)�as�the�oil�normally�remains�in�the�skin�rather�than�soaking�into�the�fabric.�Any�product�will�come�off�the�fabric�in�the�wash.�

Moisturisers�work�even�better�when�applied�to�wet�skin�as�they�lock�the�moisture�in.�It’s�best�to�pat�the�skin�dry�a�little�first�to�avoid�diluting�the�cream�too�much�with�water.�

Therefore�the�advice�is�to�stroke�topical�products�across�the�skin�and�leave�them�there�to�soak�in.�However,�although�it�is�usually�pointless�trying�to�rub�the�cream�in,�some�patients�enjoy�the�massaging�action�when�creams�are�applied.�If�massaging�the�skin�is�not�causing�any�irritation�and�the�patient�enjoys�it�then�carry�on.�It�won’t�cause�the�product�to�soak�in�more�quickly�but�it�might�help�the�patient�to�relax.�

APPlyING bARRIER CREAMS

Many�people�apply�barrier�creams�too�thickly.�You�should�stroke�a�small�amount�thinly�across�the�skin,�but�still�be�able�to�see�the�skin�through�the�cream.�If�the�skin�is�very�white,�then�you’ve�applied�too�much.�This�can�be�difficult�to�wash�off�and�the�patient�can�end�up�with�layer�upon�layer�of�barrier�cream�building�up.�The�result�is�that�their�skin�never�gets�cleaned�underneath�which�can�cause��skin�irritation.�

Therefore�the�advice�is�to�stroke�topical�products�across�the�skin�and�leave�them�there�to�soak�in.�However,�although�it�is�usually�pointless�trying�to�rub�the�cream�in,�some�patients�enjoy�the�massaging�action�when�creams�are�applied.�If�massaging�the�skin�is�not�causing�any�irritation�and�the�patient�enjoys�it�then�carry�on.�It�won’t�cause�the�product�to�soak�in�more�quickly�but�it�might�help�the�patient�to�relax.�

Page 33: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

33

Some�patients�may�have�a�limited�understanding�of�why�you�have�to�apply�this�much�(e.g.�patients�with�a�learning�disability�or�dementia).�It�might�be�easier�to�use�moisturising�ointments�with�these�people�as�they�are�less�visible�on�the�skin�and�less�likely�to�get�rubbed�off.�

MOISTURISING CREAMS CAN bE USED AS SOAP SUbSTITUTES

The�water,�oil�and�emulsifying�agents�in�creams�means�they�can�act�as�a�kind�of�soap.�They�can�be�kinder�to�the�skin�than�normal�soaps�which�often�strip�the�skin�of�its�natural�oils.�People�with�dry�skin�or�eczema�tend�to�use�moisturising�creams�(such�as�aqueous�creams)�as�soap�substitutes.�

APPlyING NON-MEDICATED OINTMENTS

Examples�include�Vaseline,�Epaderm�ointment,�Emollient�50,�Diprobase��ointment�etc.�

Moisturising�ointments�don’t�need�to�be�applied�as�thickly�as�moisturising�creams,�as�they�are�made�almost�entirely�of�oil,�so�a�thin�layer�is�fine.�It�wouldn’t�do�any�harm�to�apply�them�too�thickly;�you�just�don’t�need�that�much.�

Unfortunately,�people�don’t�always�like�the�greasy�feel�of�ointments�on�their�skin,�so�although�ointments�are�fantastic�moisturisers,�people�often�prefer�water�based�(and�often�less�effective)�creams�and�lotions.�Because�ointments�contain�less�water,�they�don’t�need�as�many�preservatives�in�them.�Therefore�with�ointments,�there’s�less�chance�that�people�will�experience�the�stinging�sensations�they�can�get�with�creams.�

Applying�moisturisers

GUIDANCE

Page 34: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

Moisturising�ointment Bath�oil Medicated�topical

bATH OIlS

Examples�include�Oilatum�and�Balneum��bath�oils.�

These�are�oil�based�products�added�in�small�quantities�to�the�bath�water.�They�float�on�the�surface�of�the�water�and�coat�the�skin�in�oil.�They�don’t�dry�the�skin�like�traditional�bath�soaps�can.�People�often�use�bath�oils�and�moisturising�soap�substitutes�together.�Take�care�when�using�bath�oils�as�they�can�make�the�bath�slippery�which�could�lead�to�a�fall.�A�rubber�bath�can�help�prevent�this.�

APPlyING MEDICATED TOPICAlS

Medicated�topicals�contain�drugs�such�as�antibiotics,�anti-fungals,�and�steroids�etc.�They�come�as�creams,�ointments,�lotions�and�gels.�

They�need�to�be�applied�thinly.�If�you�apply�too�much,�the�patient�could�get�an�overdose�of�the�drug�which�could�cause�side�effects.�Medicated�topicals�are�often�applied�to�a�small�patch�of�skin�–�wherever�the�problem�is.�The�information�leaflet�inside�should�tell�you�exactly�how�much�to�apply.�You’ll�usually�find�a�warning�on�the�label�that�states�‘to�be�spread�thinly’.�A�fingertip’s�worth�of�medicated�topical�covers�two�hand’s�worth�of�skin.�

Fingertip�units�are�there�as�a�guide�and�are�probably�most�useful�for�applying�steroids�(as�they�are�often�applied�over�larger�areas�of�skin).�When�we�say�apply�thinly,�this�means�you�should�be�able�to�see�the�skin�through�the�topical�product.�There�should�be�hardly�any�topical�product�visible�on�the�surface�of�the�skin.

IF yOU NEED TO APPly A NON-MEDICATED TOPICAl AND A MEDICATED TOPICAl TO THE SAME PATCH OF SkIN, wHICH wOUlD yOU APPly FIRST?

The�most�sensible�advice�is�to�apply�the�non-medicated�topical�first,�then�apply�the�medicated�topical�on�top.�This�is�because�if�you�applied�a�lot�of�non-medicated�topical�on�top�of�a�little�patch�of�medicated�topical,�you�could�end�up�washing�the�medicated�topical�off.�

DO I NEED TO ADD TOPICAlS TO THE MEDICINES CHART?

The�care�regulators�recommend�that�all�topicals�(whether�medicated�or�non-medicated)�should�be�added�to�the�medicines�chart�(including�moisturisers�and�bath�oils).�This�is�to�show�that�they�have�been�applied�or�used�regularly.��The�only�exception�to�this�is�moisturising�creams�used�as�soap�substitutes.�

34

ExAMPlES

Page 35: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

APPlyING MEDICATED PATCHES

Examples�include�nicotine,�Fentanyl�and��glyceryl�trinitrate�patches.�

Some�medicines�can�be�given�as�a�skin�patch.�These�patches�are�like�large�sticking�plasters,�with�the�drug�contained�inside�them.�The�drug�absorbs�through�the�skin�straight�into�the�bloodstream.�Patches�can�be�applied�to�various�parts�of�the�body.�Exactly�where�depends�on�the�type�of�drug�contained�in�the�patch�(this�will�be�explained�on�the�leaflet�inside�the�box).�Usual�places�include:

4 Back4 Stomach4 Top�of�the�arms4 Thighs

Places�to�avoid�sticking�patches�include:

6 ���Very�hairy�skin6 ���Oily�skin6 ���Sunburned�skin6 ���Scarred�skin6 ���Rough�skin6 ���Damaged�skin6 �����Areas�that�get�sweaty�–�e.g.�underarms6 �����Places�where�the�patch�could�get�rubbed�

off�–�e.g.�under�bra�strap,�on�the�waist6 �����Bony�areas�–�e.g.�shoulders�or�hips

The�area�of�the�skin�where�the�patch�will�be�applied�needs�to�be�clean�and�dry.�You�may�need�to�wash�off�any�moisturiser�or�body�lotion�that�the�patient�has�used,�and�pat�the�area�dry�first�of�all.�

Peel�off�the�backing�paper�and�stick�the�patch�onto�the�skin.�Press�the�patch�on�firmly�so�it�sticks�well,�especially�around�the�edges.�So�long�as�you�are�careful�and�avoid�touching�the�sticky�side,�you�wouldn’t�necessarily�need�to�wear�gloves�when�applying�patches.�

Some�patches�are�only�worn�during�the�day;�some�are�also�worn�at�night.�Some�patches�are�kept�on�for�as�long�as�three�days.�Check�to�see�what�the�instructions�say.�Some�people�write�the�date�when�the�patch�was�applied�onto�the�actual�patch�itself�to�remind�them�when�a�new�one�is�needed.

Remove�the�previous�patch�before�applying�a�new�one.�Fold�the�old�patch�in�half,�sticking�it�to�itself�before�discarding�it.�When�applying�a�new�patch,�stick�it�near�to�where�the�last�one�was,�but�not�directly�over�the�same�patch�of�skin.�This�prevents�the�same�patch�of�skin�getting�irritated.

35

Applying�medicated�patches

GUIDANCE

Page 36: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

36

ADMINISTERING INHAlED MEDICINES

Chapter 10

Inhalers�are�given�to�patients�suffering�from�lung�diseases�–�the�two�most�common�ones�you’ll�see�are�asthma�and�COPD�(chronic�obstructive�pulmonary�disease).�Asthma�is�called�a�variable�and�reversible�condition�which�means�the�symptoms�can�come�and�go;�it�is�often�caused�by�allergies.�COPD�is�called�a�‘fixed’�disease�which�means�it�doesn’t�tend�to�get�better.

RElIEVERS

Everyone�with�asthma�should�have�a�reliever�inhaler�(usually�blue).��The�most�common�reliever�drug�is�salbutamol.�Relievers�don’t�reduce�the�inflammation�and�mucus,�they�just�open�the�narrowed�bronchioles�quickly�(within�a�few�minutes)�making�it�easier�to�breathe.�Salbutamol�inhalers�normally�last�about�four�hours.�

With�asthma,�relievers�should�be�used�when�the�patient�either�gets�symptoms�or�expects�them�to�come�(i.e.�before�exercise�or�being�exposed�to�anything�that�triggers�their�asthma).�Side-effects�include�a�slight�tremor�in�the�hands�–�this�isn’t�normally�anything�to�worry�about.�It’s�important�patients�are�able�to�self�medicate�with�their�relievers,�as�you�might�not�be�around�when�they�get�symptoms.�Assuming�the�patient�has�a�good�technique�with�their�reliever�inhaler�but�still�

needs�it�frequently,�the�next�step�is�to�add�a�preventer�inhaler.�If�a�patient�needs�to�use�their�reliever�inhaler�more�than�three�times�a�week,�they�may�need�an�asthma�review.�

PREVENTERS

Preventer�inhalers�contain�steroids�(the�most�common�being�beclometasone).�Steroids�reduce�inflammation�and�mucus,�and�makes�the�lungs�less�sensitive�to�triggers�so�the�patient�is�less�likely�to�suffer�an�asthma�attack.�Preventers�are�brown,�orange�or�burgundy.�Light�brown�inhalers�contain�less�steroid;�darker�brown,�orange�and�burgundy�inhalers�contain�higher�doses.�In�asthma,�preventers�are�added�when�patients: +����Cough,�or�have�chest�tightness�or�

breathing�difficulties�more�than�three�times�a�week

+����Need�to�use�their�reliever�inhaler�more�than�three�times�a�week

+����Get�breathless�because�of�a�chest�infection�or�smoky�atmosphere

It�is�important�patients�use�their�preventers�regularly,�once�or�twice�a�day.�Preventers�take�up�to�14�days�to�work�fully,�hence�they�are�taken�every�day�even�if�the�patient�feels�well.�Forgetting�the�occasional�dose�won’t�usually�bring�symptoms�back�straight�away,�but�forgetting�doses�for�several�days�can�cause�symptoms�to�return�and�make�their�asthma�more�unstable.

Page 37: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

Many�people�rely�on�their�relievers�too�much�and�don’t�use�their�preventers�regularly.�This��is�often�because�they�feel�an�immediate�effect�from�their�reliever,�whilst�their�preventer�takes�longer�to�work.�However,�this�isn’t�good�for�their�asthma.�Relievers�don’t�treat�the�underlying�symptoms,�so�their�asthma�can�become�unstable�and�worsen.�If�patients�have�frequent�symptoms�and�aren’t�getting�the�right�treatment,�they�can�end�up�in�hospital�with�a�serious�asthma�attack.�

People�worry�about�side�effects�with�steroids.�However,�preventers�only�have�small�amounts�of�steroid�in�them�and�if�they�are�used�properly,�it’s�unlikely�patients�will�suffer�serious�side�effects.�One�side�effect�with�steroids�is�thrush�(a�yeast�infection)�in�the�mouth.�If�a�patient�using�steroid�preventer�inhalers�has�a�sore�mouth�or�throat,�the�doctor�can�prescribe�something�to�treat�it.�To�reduce�the�risk�of�thrush,�patients�must�rinse�their�mouth�out�with�water�(and�spit�the�water�out)�after�using�their�preventer�inhaler.�Alternatively,�they�can�brush�their�teeth�after�using�their�preventer�inhaler.�A�spacer�device�can�also�reduce�the�build-up�of�steroid�in�the�mouth�to�prevent�thrush�and�other�side�effects.�

Relievers Preventers

37

ExAMPlES

Page 38: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

38

HOw DO THE TREATMENTS FOR COPD DIFFER FROM ASTHMA?

Just�like�with�asthma,�everyone�with�COPD�needs�a�short-acting�reliever�inhaler.�However,�the�relievers�are�often�prescribed�on�a�regular�basis�rather�than�‘when�required’.�

Instead�of�adding�a�preventer�next,�prescribers�tend�to�add�a�protector�instead.�If�the�relievers�and�protectors�aren’t�enough,�then�preventers�are�added.�Preventers�are�used�last�because�they�are�less�effective�in�COPD�(as�there�is�less�inflammation�present�than�with�asthma).�

Patients�with�COPD�can�have�another�type�of�inhaler�called�an�‘anticholinergic’.�Examples�include�Atrovent�(contains�ipratropium)�and�Spiriva�(contains�tiotropium).�

THE VARIOUS DIFFERENT MODElS OF INHAlER

There�are�many�different�inhaler�devices�used�to�deliver�the�drugs�we’ve�looked�at.�Asthma�UK�has�produced�an�animated�guide�showing�how�to�use�these�at�www.asthma.org.uk.�The�patient�information�leaflet�should�also�show�the�patient�how��to�use�their�inhaler�device.�

If�the�patient�self�administers�inhalers,�check�that�they�are�using�them�correctly.�If�you�see�mist�coming�from�the�top�of�the�inhaler�or�their�mouth,�they�won’t�be�getting�much�benefit�from�it.�You�could�always�suggest�they�see�a�health�care�professional�who�can�review�their�treatment.�

PROTECTORS

If�reliever�and�preventer�inhalers�are�still�not�controlling�the�asthma,�the�next�step�is�to�add�a�third�inhaler�called�a�protector.�Protector�inhalers�are�usually�green�or�turquoise.�These�are�basically�long-acting�reliever�drugs.�They�act�for�around�12�hours�so�are�usually�prescribed�twice�a�day.�

In�asthma,�it�is�very�important�that�patients�continue�to�use�their�steroid�inhalers�even�if�they�have�also�been�prescribed�a�protector.�If�they�stop�using�their�preventer�and�just�rely�on�the�protector�inhaler,�it�can�make�their�asthma�very�unstable�and�lead�to�a�life-threatening�asthma�attack.�

COMbINATION INHAlERS

Combination�inhalers�contain�a�protector�and�a�preventer.�Combination�inhalers�should�be�taken�regularly:�once�or�twice�daily.�They�are�usually�purple,�red�or�white.�

Protectors Combination�inhaler

ExAMPlES

Page 39: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

39

SPACER DEVICES

A�spacer�is�a�plastic�container�that�is�added�to�a�standard�inhaler.�There�are�many�different�designs,�including�smaller�ones�such�as�the�Aerochamber�Plus�or�larger�spacers�such�as�the�Volumatic.�Aerochambers�have�a�soft�rubber�end�so�they�can�fit�different�types�of�inhaler,�whereas�Volumatics�can�only�fit�inhalers��with�a�square�mouthpiece.�

Aerochambers�also�have�a�whistle�on�them�to�let�you�know�if�the�patient�is�breathing�in�too�fast.�It’s�okay�to�hear�a�quiet�whistle,�not�a�loud�one.�If�the�whistle�is�loud,�ask�the�patient�to�try�again�with�a�gentler�in-breath.�It’s�not�a�good�idea�to�change�the�type�of�spacer�without�checking�with�the�prescriber.�

Most�spacer�devices�also�have�a�version�with�a�soft�silicon�face�mask.�Patients�who�are�unable�to�form�a�good�seal�around�the�mouthpiece�(which�can�sometimes�happen�after�a�stroke)�might�benefit�from�a�face�mask.�Patients�who�keep�breathing�through�their�nose�might�also�benefit�from�a�mask.�

With�spacers,�there�are�two�techniques:

1��Taking�in�one�long�breath�from�the�spacer�device�and�holding�it�for�10�seconds�or

2��Taking�5�breaths�in�and�out�from�the�spacer�device�(called�tidal�breathing)

Both�techniques�are�effective�but�patients�often�prefer�the�second�technique�as�some�find�it�difficult�holding�their�breath.

TAkING CARE OF SPACER DEVICES

Spacer�devices�should�be�cleaned�regularly�by�washing�them�in�soapy�water.�After�you�have�given�the�spacer�a�good�clean,�rinse�the�soap�off�the�outside�of�the�spacer,�but�leave�the�soap�bubbles�on�the�inside.�When�the�spacer�is�dry,�the�bubbles�will�have�burst�leaving�an�invisible�coating�of�soap�on�the�inside�of�the�spacer.�This�reduces�static�build�up�so�less�of�the�drug�mist�sticks�to�the�sides�of�the�spacer�and�more�of�the�drug�reaches�the�lungs.�Don’t�dry�the�spacer�with�a�towel�or�tissue,�as�the�rubbing�action�adds�static.�Volumatics�need�to�be�washed�once�a�month�and�Aerochambers�every�1-2�weeks.�If�used�regularly,�spacer�devices�should�be�replaced�every�6-12�months.

Spacer Aerochamber Spacer�with�face�mask

ExAMPlES

Page 40: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

1 Remove�the�lid.�Check�there�are�no�foreign�objects�inside�the�mouthpiece

2 Test�the�inhaler.�If�it�hasn’t�been�used�for�7�days�shake�it�and�then�spray�two�puffs�into�the�air;�this�ensures�the�patient�gets�a�full�dose�of�the�drug

3 Insert�the�inhaler�into�the�spacer.�If�you�are�using�an�Aerochamber,�you�might�need�to�twist�the�rubber�end�around�(where�the�inhaler�fits�into�the�spacer)�so�that�the�inhaler�is�pointing�upwards�at�12�o’clock�

4 Shake�the�inhaler�whilst�it�is�in�the�spacer,�4�or�5�times

5 The�patient�should�be�sat�up�straight�or�standing.�Where�possible,�their�chin�should�be�lifted�up�to�open�the�airways.�This�is�the�ideal�position,�but�might�not�be�possi-ble�with�some�patients�with�a�physical�disability

6 Establish�which�technique�the�patient�prefers:�taking�in�one�breath�and�holding�it�for�10�seconds�or�taking�5�breaths�in�and�out.�It’s�a�good�idea�to�record�which�technique�they�prefer�on�the�medicines�chart

7 Put�the�spacer�in�their�mouth�and�check�their�lips�form�a�tight�seal.�Check�that�they�are�breathing�through�the�spacer�device�correctly�before�you�fire�a�puff�in�(if�you�are�using�an�Aerochamber,�you�shouldn’t�hear�a�loud�whistle).�Make�sure�they�are�breathing�through�their�mouth�rather�than�their�nose

ADMINISTERING AN INHAlER wITH A SPACER DEVICE

40

GUIDANCE

Page 41: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

8 If�the�patient�cannot�form�a�good�seal�with�their�lips�around�the�spacer,�they�may�need�to�use�a�spacer�with�a�mask�attached�instead.�Make�sure�that�the�spacer�is�level�(hori-zontal)�otherwise�they�might�not�receive�a�full�dose

9 HOlDING bREATH TECHNIqUE:�get�the�patient�to�blow�out�into�the�spacer�device�which�empties�their�lungs.�Tell�them�to�take�a�slow,�deep�breath�in.�As�they�breathe�in,�fire�a�puff�into�the�spacer.�Encourage�them�to�carry�on�breathing�in.�Keep�the�spacer�in�their�mouth�as�they�breathe�in.�Once�they�have�breathed�in�fully,�take�the�spacer�out�and�ask�them�to�hold�their�breath�for�as�long�as�is�comfortable��(10�seconds�if�possible)

9 bREATHS IN AND OUT TECHNIqUE:�as�the�patient�is�breathing�in�and�out,�fire�in�one�puff.�Keep�the�spacer�in�their�mouth�for�5�breaths�in�and�out.�You�can�always�help�the�patient�by�breathing�in�and�out�5�times�with�them.�This�can�help�some�patients�with�dementia�or�learning�disabilities�understand�what�to�do.�When�you�do�this,�the�patient�often�copies�your�own�breathing�pattern.�This�also�means�that�you�can�count�your�own�breaths�rather�than�trying�to�see�if�the�patient��is�breathing�in�and�out�5�times

10 If�a�second�puff�is�needed,�wait�30�seconds�then�repeat�the�whole�procedure.�Don’t�put�more�than�one�puff�into�the�spacer�at�a�time,�as�the�droplets�can�end�up�joining�together�to�form�larger�droplets�which�cannot�get�deep�into�the�lungs,�and�so�reduces�the�amount�of�drug�you�are�helping�to�administer

11 Replace�the�mouthpiece�and�record�on�the�medicines�chart.�If�using�a�preventer,�ensure�the�patient�rinses�their�mouth�out�with�water�(rinse,�gargle�and�spit)�or�cleans�their�teeth�afterwards

41

Page 42: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

42

ADMINISTERING MEDICATION TO THE EyE, EAR & NOSE

Chapter 11

Medicines�can�be�applied�to�the�eye,�ear�and�nose�in�the�form�of�drops,�creams,�gels,�ointments�and�sprays.�According�to�the�care�regulators,�care�professionals�can�administer�these�types�of�medicines�after�their�‘basic�medicines�training’�(i.e.�you�don’t�need�to�have�a�registered�health�professional�provide�personalised�training).�However�having�said�this,�some�employers�have�stricter�policies�than�this.�Check�your�medication�policy�to�see�if�your�employer�lets�you�administer�medications�to�the�eye,�ear�or�nose.�

If�patients�have�had�a�recent�eye�operation�(such�as�having�cataracts�removed)�some�employers�will�not�allow�care�workers�to�administer�eye�drops,�insisting�instead�that�nurses�do�this.�This�is�because�there�is�a�higher�risk�of�getting�eye�infections�after�surgery�and�nurses�are�trained�to�pick�up��the�signs�and�symptoms�of�eye�infections.�

EyE DROPS

There�are�many�different�ways�of�administering�eye�drops,�the�most�important�thing�is�to�get�a�drop�into�the�patient’s�eye�in�a�way�that�doesn’t�cause�them�discomfort.�Some�patients�will�sit�patiently�and�let�you�administer�eye�drops�and�are�usually�patients�who�have�had�them�before.�They�may�have�had�conditions�like�glaucoma�or�dry�eyes.�There�will�also�be��those�patients�who�have�not�had�eye�drops�before�and�may�find�it�harder�to�keep�their�eyes�open�as�you�put�drops�in.�

Many�people�stand�above�the�patient�and�let�the�drop�fall�onto�the�eyeball.�If�this�technique�works�for�you�and�the�patient,�carry�on.�However�this�can�be�uncomfortable�for�patients.�It�also�makes�them�more�likely�to�blink,�as�they�see�the�drop�hanging�above�their�eye.�Older�patients�and�those�in�high-backed�wheelchairs�may�also�find�it�difficult�tipping�their�head�back.�

An�alternative�used�by�many�opticians,�is�to�place�the�drop�onto�the�lower�eyelid�whilst�the�patient�looks�away.�By�touching�the�drop�against�the�lower�lid,�it�gets�‘sucked’�into�the�eye.�You�only�need�to�touch�the�drop�on�the�lower�lid,�not�the�bottle�tip.�Some�people�worry�that�bacteria�will�be�transferred�onto�the�tip�of�the�bottle�it�touches�the�lower�lid.�However,�the�drops�are�only�used�for�28�days;�they�contain�preservative�and�are�not�swapped�between�patients�so�this�shouldn’t�be�a�problem.�

Page 43: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

ADMINISTERING EyE OINTMENTS

With�eye�ointments�you�can�use�the�same�technique.�You�need�to�squeeze�about�1cm�of�ointment�inside�the�lower�eyelid.�The�ointments�can�make�the�vision�blurred�as�they�can�be�quite�greasy.�

ADMINISTERING EyE DROPS TO PATIENTS wHO FIND IT HARD TO kEEP THEIR EyES OPEN

Despite�your�best�efforts,�some�patients�might�find�it�hard�to�keep�their�eyes�open�as�you�administer�drops.�There�is�another�technique�you�can�use.�

Have�the�patient�lie�on�their�back�and�close�their�eyes.�Gently�place�a�few�drops�(3�or�4)�into�the�eye�socket�near�the�side�of�the�nose.�Make�sure�the�drops�run�along�the�eyelashes.�Next,�ask�the�patient�to�open�their�eye(s),�you�might�need�to�help�them�do�this.�The�drops�will�then�enter�their�eye(s).�Wipe�away�any�excess�drops�with�a�clean�tissue.�Remember,�the�eye�will�only�retain�what�it�needs�(about�one�drop).�The�patient�will�need�to�then�close�their�eyes�for�about�30�seconds�for�the�drop�to�absorb.�

IF A SECOND TyPE OF EyE DROP OR OINTMENT IS NEEDED AFTERwARDS

Some�patients�have�more�than�one�type�of�medication�administered�to�the�same�eye.�Wait�3�or�4�minutes�for�the�first�drop�to�absorb�before�administering�another�eye�drop.�If�you�have�to�administer�an�eye�ointment�and�a�drop�to�the�same�eye,�it’s�best�to�administer�the�drop�first,�wait�3�or�4�minutes,�then�administer�the�ointment�afterwards.�If�you�try�administering�an�eye�drop�after�an�eye�ointment,�the�drop�will�find�it�hard�to�absorb�through�the�greasy�ointment.��

Some�eye�preparations�can�sting�(e.g.pilocarpine).�If�these�are�needed�with�other�drops,�then�administer�the�pilocarpine�afterwards,�because�the�patient�will�find�it�hard�to�keep�their�eyes�open�if�they�sting.�If�an�ointment�is�then�needed,�wait�for�the�stinging�to�stop�before�administering�the�ointment�last�of�all.

Eye�drops Eye�ointmentsLower�eyelid�application

43

ExAMPlESGUIDANCE

Page 44: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

ADMINISTERING NASAl DROPS

THE TECHNIqUE OF ADMINISTERING EyE DROPS

PREPARE THE PATIENT:�The�patient�can�be�sat�upright�in�a�chair.�They�do�not�necessarily�need�to�tip�their�head�back�with�this�technique

PREPARE THE RIGHT DOSE OF MEDICATION:�Wash�your�hands,�shake�the�bot-tle,�unscrew�the�lid�and�put�it�somewhere�clean.�Gloves�are�not�always�needed�when�administering�drops

ADMINISTER THE MEDICATION:Push�out�a�drop�and�leave�it�hanging�from�the�tip�of�the�dropper�bottle.�With�your�free�hand,�pull�the�lower�lid�down�gently�away�from�the�eyeball�to�make�a�pocket�in�which�you�can�place�the�drop.

Tell�the�patient�to�look�towards�the�bridge�of�their�nose�and�then�upwards.�Looking�up�takes�the�upper�eyelid�and�lashes�out�of�the�way�and�gives�you�more�room�to�put�the�drop�in.Gently�touch�the�drop�onto�the�lower�lid�to�release�it.�Don’t�worry�if�you�accidently�put�more�than�one�drop�in�the�eye�–�the�eye�can�only�hold�onto�one�drop,�so�any�others�will�flow�away�harmlessly�down�the�cheek�Give�the�patient�a�clean�tissue�to�wipe�away�any�excess.�Once�you’ve�put�in�the�drops,�tell�the�patient�to�close�their�eyes�for�about�30�seconds.�This�spreads�the�drops�over�the�eyeball.�Check�for�any�redness,�pain,�itching�or�swelling�in�the�eye�–�a�little�stinging�and�itching�is�okay�as�long�as�it’s�not�too�uncomfortable

GET READy:�Check�the�drops�haven’t�passed�their�expiry�date.�When�breaking�the�seal�on�new�drops,�write�the�expiry�date�on�the�bottle�(28�days)

GET READy:�Check�the�drops�haven’t�passed�their�expiry�date.�When�breaking�the�seal�on�new�drops,�write�the�expiry�date�on�the�bottle�(28�days)

PREPARE THE PATIENT:�The�patient�can�either�lie,�or�sit�down�with�their�head�tilted�backwards.�If�the�patient�lies�down,�put�a�pillow�under�their�shoulders.�This�way�their�head�tilts�back�a�little,�over�the�edge�of�the�pillow

44

GUIDANCE

Page 45: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

PREPARE THE RIGHT DOSE OF MEDICATION:�Wash�your�hands,�shake�the�bottle�and�unscrew�the�lid

GET READy:�Check�the�drops�haven’t�passed�their�expiry�date.�When�breaking�the�seal�on�new�drops,�write�the�expiry�date�on�the�bottle�(28�days)

PREPARE THE PATIENT:�Help�the�patient�lie�down�on�the�bed,�with�the�ear�being�treated�uppermost.�Alternatively,�they�can�sit�with�their�head�tilted�so�that�the�treated�ear�is�upright

PREPARE THE RIGHT DOSE OF MEDICATION:�Wash�your�hands,�shake�the�bottle�and�unscrew�the�lid

ADMINISTER THE MEDICATION:Pull�the�ear�upward�(away�from�the�neck)�and�backwards�a�little�(away�from�the�face).�This�straightens�the�ear�canal�so�that�the�drops�flow�right�down�into�the�ear�where�they�need�to�work.�Gently�squeeze�the�correct�number�of�drops�down�the�side�of�the�ear�canal,�not�straight�down�the�centre�as�they’ll�hit�the�ear�drum�(which�is�loud�and�sometimes�painful).�Try�not�to�let�the�dropper�touch�any�part�of�the�ear�or�ear�canal.��Ask�the�patient�to�stay�lying�or�sitting,�with�their�head�tilted�for�about�5�minutes�after�you�have�instilled�the�medication�(this�allows�the�drops�to�soak�in).Wipe�away�any�drops�that�have�dribbled�down�the�neck�with�a�clean�tissue.If�both�ears�need�drops,�wait�for�about�5�minutes�for�the�first�drop�to�absorb�and�then�get�the�patient�to�turn�over�and�repeat�the�procedure.

ADMINISTERING EAR DROPS

ADMINISTER THE MEDICATION:Hold�the�dropper�just�above�the�patient’s�nostril�and�gently�squeeze�a�drop�down�the�centre�of�the�nostril�(you�can�make�the�nostril�a�little�wider�by�pressing�your�thumb�against�the�tip�of�the�nose,�which�opens�them�up)Ask�the�patient�to�inhale�slowly�and�deeply�through�the�nose,�hold�their�breath�for�several�seconds,�then�breathe�out�slowly.�All�the�while�they�should�stay�with�their�head�back,�or�lying�down�for�one�minute.�This�lets�the�drops�soak�in.�If�you’ve�used�a�dropper,�squirt�out�any�medication�left�in�the�dropper�into�a�clean�tissue�before�putting�the�dropper�back�in�the�bottle.

45

Page 46: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

IMPORTANT MEDICINES OFTEN TAkEN by THE ElDERly & HOw TO ADMINISTER

Chapter 12

AlENDRONIC ACID: USED IN TREATMENT OF OSTEOPOROSIS

+����This�drug�is�usually�taken�only�once�a�week�on�the�same�day.�

+�����Taken�about�30�minutes�before�breakfast�(8am)

+����Swallow�whole�do�not�chew+�����Take�with�a�full�glass�of�water+�����Stand�or�sit�upright�for�at�least�30�minutes�

after�swallowing�the�tablet�and�do�not�lie�down�until�after�you�have�eaten�breakfast.

+����If�a�weekly�dose�is�missed�take�the�next�morning�and�continue�as�normal.�

CAlCIUM SUPPlEMENTS

+�����Calcium�is�an�important�element�to�build�&�keep�bones�strong.�It�is�often�taken�in�conjunction�with�Alendronic�acid.

+����If�on�Alendronic�acid�do�not�take�calcium�on�the�same�day�as�taking�this.�

+����Take�calcium�carbonate�supplements�with�meals�to�assure�high�stomach�acid�for�maximum�absorption.�

+����Taking�calcium�supplements�in�divided�doses�throughout�the�day�is�important�if�the�total�daily�dose�of�calcium�is�500g�or�more.

+����Avoid�carbonated�soft�drinks�and�antacids�containing�aluminium�as�they�can�interfere�with�the�absorption�of�calcium.

46

Page 47: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

IMPORTANT MEDICINES OFTEN TAkEN by THE ElDERly & HOw TO ADMINISTER

REFERENCES

��The�Royal�Pharmaceutical�Society�of�Great�Britain�‘The�Handling�of�Medicines�in�Social�Care’�2007

��Care�Quality�Commission�Outcome:�Management�of�Medicines

��Commission�for�Social�Care�Inspection�‘Professional�Advice:�The�Administration�of�Medicines�in�Care�Homes’

��Commission�for�Social�Care�Inspection�‘Professional�Advice:�Safe�Management�of�CD’s�in�Care�Homes’�Jan�2008

��Peterborough�Primary�Care�Trust�oral�administration�guidelines�for�good�practice�and�NOMAD�system�operating

�Patient.co.uk:�How�to�use�eye�drops�Asthma.org.uk:�Using�your�inhaler�British�National�Formulary�MIMS

Designed by cobalt id | cobaltid.co.ukCover image by Andrzej Tokarski (fotoila.com)

Page 48: S UPPORTING T HE USE OF M EDICATION IN C ARE …stowhealth.com/indigo/ckfinder/userfiles/files/Stowhealth... · GENERIC NAME USES bRAND NAMES/FORMUlATIONS Temazepam Sleeping tablet

Violet�Hill�HouseViolet�Hill�RoadStowmarketSuffolk�IP14�1NL

stowhealth

stowhealth.co.uk