External medicines

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

These are often prescribed to people living in care homes or receiving care at home. Information should be available to staff to help them to apply these medicines effectively.

People should be able to apply their own external medicines if they choose. You should assess whether the person has the capacity and capability to do so safely and review these decisions regularly.

Creams, ointments and lotions

Keeping records

Either staff or the person who needs the medicine can apply it. Whoever applies the medicine should be able to access information about:

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

Keep records to show:

• which creams you used
• when you applied them
• where you put them on the person’s body
• who applied them, for example, nurses and, if applicable, care workers.

This could be in the form of an external or topical medicine administration record.

Storage and disposal

In residential services, you should store creams securely. There should be an appropriate risk assessment if you keep creams in people’s rooms.

Some external medicines are subject to environmental contamination. Store and discard these according to the manufacturer’s directions. Record the date of opening if the manufacturer says it expires more quickly after opening.

Discard any product if its appearance suggests it is unfit for use. If unsure, seek appropriate advice.

Fire risk

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

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

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

There is a fire risk with all emollients that contain paraffin, regardless of the concentration of paraffin. There is also a risk with paraffin-free emollients. Other skin products may also cause this fire risk. This is especially true if you use a lot of the product or use it over large areas of skin for several days.

Even washing clothes or fabric at a high temperature may not remove all the emollient build-up, though it can help reduce it.

When supporting people using emollients, consider the increased fire risk and develop an appropriate risk assessment.

Transdermal (skin) patches

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

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

• painkillers
• hormones
• medicines to treat Parkinson’s disease
• medicines to support stopping smoking
• medicines to control nausea and vomiting.

Applying patches

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

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

See guidance on Using transdermal patches safely in healthcare settings (Specialist Pharmacy Service).

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

If using more than one patch, put them in the same area of the body but do not let them overlap.

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

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

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

Staff should know the signs of overdose and get medical help if they think a person has been overdosed.

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

Observe people with a fever for signs of toxicity. 

Disposing of patches

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

Used patches contain some residual medicine. After use, fold the patch so that the adhesive side sticks to itself, then dispose of it safely. Keep used patches out of sight and reach of children as they may contain some medicine that may harm children and may even be fatal.

Some patches may need to be disposed of in accordance with controlled drugs regulations.

Records, checks and communication

Staff should record the application of a patch. Include the specific location on the body, for example, front, right side of the chest. You can use a body map to record this. This is important so other staff can check that the patch is still in place.

Regularly check that patches are being applied correctly and are still in place. Follow local procedure to document this.

Old patches are occasionally left in place when applying a new patch. Record when you remove the old patch just as you record when you apply new patches. When a person moves between settings, staff must communicate information about their patches. This should include:

• when you applied the patch (date and time)
• where you put it on their body.