HOMELY REMEDIES (DISCRETIONARY MEDICINE) POLICY FOR … Remedies... · Last review date . July 2014...

HOMELY REMEDIES (DISCRETIONARY MEDICINE) POLICY FOR MINOR INJURIES UNIT AND INPATIENT UNITS

Guideline Reference: SCH Serco CP16 Version: 2.0 Status: Final Type: Clinical Guideline applies to : Inpatient Units and Minor Injury Unit Guideline applies to (Staff Groups): Registered Nursing Staff

Required compliance: This policy must be complied with fully at all times by the appropriate staff. Where it is found that this policy cannot be complied with fully, this must be notified immediately to the owner through the waiver process

Guideline owner: Director of Nursing, Therapies & Governance

Guideline author: Ipswich Hospital Pharmacy Support, Clinical Effectiveness Manager

Other contact:

Clinical Quality & Safety Assurance Group

Date this version adopted September 2014 Last review date July 2014 Next review date September 2017 Location of electronic master SCH Intranet

AGREED GUIDELINE REVIEW / RATIFICATION / ADOPTION PATH:

Level 1: Agreed by: Modern Matrons Group Date: 6/6/14

Level 2: Agreed by: Clinical Policy Group Date: 29/7/14

Level 3:

Agreed by: Clinical Quality & Safety Assurance Group Date: 25/8/14 & 23/9/14

S/Internal/HomelyRemediesPolicy/Sept14/V2.0

1. INTRODUCTION 1

2. PURPOSE OF POLICY 1

3. SCOPE 1

4. POLICY AGREEMENT PATH 1

5. ADMINISTRATION AND SUPPLY 1

6. STAFF COMPETENCIES 2

7. WARNING AND ADVERSE REACTIONS/INTERACTIONS 3

8. DOCUMENTATION 3

9. AUDIT 3

10. CROSS REFERENCE TO OTHER RELATED POLICES 3

11. FURTHER INFORMATION 3

12. REFERENCES 4


Appendix 1: Administration Guidelines or Homely Remedies 5

Drug Page ALLERGY/CONGESTION Chlorphenamine tablets 4mg/liquid 2mg/5ml 5 Cetirizine tablets 10mg 6 TOPICAL/EAR/MOUTH and EYE DROPS Benzydamine mouthwash (Difflam®) 7 Chlorhexidine mouthwash 0.2% 8 Choline salicylate dental gel 8.7% (Bonjela® ADULT) 9 Emolients and barrier preparations 10 Hydrocortisone cream 1% 11 Hypromellose eye-drops 0.3% 12 Sodium bicarbonate 5% ear drops 13 COUGH/SORE THROAT Antiseptic lozenges 14 Simple linctus (sugar-free) 15 CONSTIPATION Bisacodyl tablets 5mg 16 Docusate capsules 100mg 17 Glycerol (glycerin) suppositories 10mg 18 Lactulose 19 Senna tablets 7.5mg 20 Sennoside syrup 7.5mg/5ml 21 DIARRHOEA Oral rehydration salts 22 Loperamide capsules 2mg 23 INDIGESTION and REFLUX Alginate raft-forming suspension (Peptac®/Gaviscon®) 24 PAIN and FEVER Paracetamol tablets 500mg 25 Paracetamol suppositories 60mg, 125mg, 250mg, 500mg 26 Paracetamol suspension 120mg/5ml, 250mg/5ml 27 Ibuprofen tablets 200mg 28 Ibuprofen suspension 100mg/5ml 29


HOMELY REMEDIES (DISCRETIONARY MEDICINES) POLICY FOR MINOR INJURIES UNIT AND INPATIENT UNITS

STATEMENT OF OVERARCHING PRINCIPLES All Policies, Procedures and Guidelines of the SCH are formulated to comply with the overarching requirements of legislation, policies or other standards relating to equality and diversity.

1. INTRODUCTION

1.1. The Homely Remedies Policy is a written instruction that enables a registered nurse to administer a medicine from an agreed list of simple medications without a prescription from a prescriber or a Patient Group Direction (PGD), in situations where a delay in administration would be detrimental to the patient.

1.2. The medicines are known as 'homely remedies' or ‘simple medications’. The list includes General Sales List (legal status GSL) and Pharmacy (P) medicines which are used to alleviate minor symptoms.

1.3. The policy can be used by registered nurses working in the Inpatient Unit setting or within the Minor Injuries Unit (MIU) in accordance with the Standards for Medicines Management (NMC, 2010).

1.4. The policy covers a number of medications, but not all will be available in all units. Any medicines on the list can be added to stock lists by request if deemed suitable for a unit.

2. PURPOSE OF POLICY

2.1. To benefit patients by increasing access to certain simple medicines when they are in need of symptom relief until a full assessment can be made by a prescriber.

2.2. Improve patient experience within MIU and Inpatient Units.

3. SCOPE

3.1. The policy applies to all registered nurses working in Inpatient Units and MIU who can demonstrate their competence in the administration of medicines.

3.2. The registered nurse must only administer the appropriate medicines included in the attached Administration Guideline for Homely Remedies (Appendix 1).

3.3. The policy does not cover Prescription Only Medicines (POM) which may only be administered under a Patient Specific Direction (prescription), or under a Patient Group Direction (if available).

4. POLICY AGREEMENT PATH

4.1. Refer to front sheet for policy agreement path.

5. ADMINISTRATION AND SUPPLY

5.1. The decision to administer a homely remedy should be made by a registered nurse at the request of a patient/carer and/or as a response to symptoms.

S/Internal/HomelyRemediesPolicy/Sept14/V2.0 1

5.2. The nurse must ensure that there are no contra-indications or exclusions before giving the medicine and no known hypersensitivity reactions to any of the constituents. Allergies should be checked.

5.3. Before administration of a homely remedy the registered nurse must check that the medicine or a similar medicine is not already prescribed on the drug chart. For patients in MIU check with the patient whether the medicine or similar has been taken before visiting the unit. Homely remedies can still be administered if the dosing interval is suitable and the maximum daily dose has not been exceeded.

5.4. Inpatient Units – Community Hospitals

• Administration of the remedies must be limited to a maximum period of 72 hours (or 4 days on bank holidays).

5.5. Minor Injuries Unit – Felixstowe

• Administration of these remedies is limited to ONE dose.

• People attending at MIU must be advised as appropriate regarding further doses when they get home. A pre-labelled pack for the patient to take home can only be supplied if a PGD is available.

• If the patient is being admitted to an acute hospital, please ensure that the admitting hospital is aware of any doses administered in MIU.

• The specified homely remedies will normally be available as ward or MIU stock.

• The administration process will be the same for all other medicines in accordance with the Suffolk Community Health Safe Administration of Medicines Policy.

• All in-patients must have the doses recorded on the drug chart by the registered nurse. On MIU a record should be made on the patient’s Casualty Record Card.

5.6. The following details must be completed:

• Date administered

• Name of drug administered

• Dose

• Route

• Nurses Signature

• Time Given

5.7. The patient’s symptoms should be assessed regularly to determine whether the medicine is still required before giving further doses. If there are any concerns that the patient has a more serious underlying cause for their symptoms or if the medicine is felt to be ineffective then a doctor should be called to make an assessment as soon as possible.

5.8. The homely remedies are detailed in the appendix to this policy. The clinical condition/situation is outlined under which the medicine may be and only be administered, with inclusion/exclusion criteria to be applied in each case.

6. STAFF COMPETENCIES

6.1. When administering homely remedies, it is the professional responsibility of the individual registered nurse, this includes: -


• Awareness of the Safe Administration of Medicines Policy.

• Appropriate recognition of symptoms and appropriate judgement as to when to seek medical assessment.

• Understanding of this procedure including the limitations of use of any of the specified medicines.

• Knowledge and use of the British National Formulary (BNF).

• On-going induction of new staff to the Homely Remedies Policy by Unit Manager or Deputy.

• NMC Standards for medicines management.

• Have fully understood The Homely Remedies Policy.

7. WARNING AND ADVERSE REACTIONS/INTERACTIONS

7.1. Before administration of a homely remedy the registered nurse must check that there are no contraindications to the administration of the medicine to the patient ensuring that the allergy section of the casualty or inpatient notes is checked.

7.2. Medical advice must be sought if any adverse reactions are experienced by the patient and recorded in their notes.

7.3. Any adverse reactions experienced by the patient should be reported in accordance with the Yellow Card system for the reporting of Adverse Drug Reactions. Yellow Cards may be found in the back of the current edition of the British National Formulary (BNF) or at www.yellowcard.gov.uk

8. DOCUMENTATION

8.1. The administration of homely remedies must be recorded on the relevant section of the in-patient prescription chart or patients notes.

8.2. If a patient declines to accept a recommended medicine, this must be documented in the notes

9. AUDIT

9.1. Monthly drug chart audit to ensure medications entered as given in the homely remedies section are contained within the policy

10. CROSS REFERENCE TO OTHER RELATED POLICES

• Safe and Secure Handling of Medicines

• Incident Reporting Policy

• Consent Policy

11. FURTHER INFORMATION

• The Nurses and Midwives (Parts of and Entries in the Register) Order of Council 2006 No.1015

• The Medicines for Human Use (Prescribing) (Miscellaneous Amendments) Order 2006 No.915

• The Medicines (Sale or Supply) (Miscellaneous Amendments) Regulations 2006 No.914

• The NHS (Miscellaneous Amendments Relating to Independent Prescribing) Regulations 2006 No.913


http://www.yellowcard.gov.uk/

• The Misuse of Drugs (Amendment) Regulations 2006

• This policy should be read in conjunction with the relevant Professional Body’s guidance around the administration and management of medicines:

• Nursing & Midwifery Council: Guidelines for the Administration of Medicines (NMC 2007) www.nmc-uk.org/

• Royal College of Nursing

• Royal Pharmaceutical Society of Great Britain: www.rpsgb.org.uk/

• Health Profession Council: www.hpc.org.uk

12. REFERENCES

• British National Formulary, current edition

• Electronic Medicines Compendium

• Worcestershire Health and Care NHS Trust, Simple Medications Policy and Procedures for Administration, August 2012


http://www.nmc-uk.org/

http://www.rpsgb.org.uk/

http://www.hpc.org.uk/

Appendix 1: Administration Guidelines or Homely Remedies

ALLERGY

Administration Guideline for the administration of

Chlorphenamine Maleate Tablets/Liquid

Drug (approved Name)

Dose Route Frequency Maximum Administration

Chlorphenamine 4mg tablets or 2mg/5ml liquid

4mg Oral 4-6 hourly Maximum 6 tablets (24mg) daily.

Clinical conditions / indications(s) for use: Symptomatic relief of minor allergic reactions e.g. rash, itching, insect bites, hay fever type symptoms. Only use when sedating antihistamine is preferable to a non-sedating antihistamine. Patients eligible for inclusion in the policy: Individuals 12 years old and over presenting with minor allergic conditions without fever. Patients excluded from treatment under the policy:

• Children under the age of 12. • Known hypersensitivity reactions to any constituents of the product. • Patients who have taken monoamine oxidase inhibitors (moclobemide, phenelzine,

tranylcypromine, isocarboxacid) within the last 14 days. • Patients taking anxiolytics, hypnotics, opioid analgesics or recent alcohol intake that could increase

sedation. • Epilepsy, glaucoma, urinary retention, and prostatic hypertrophy, gastric obstruction • Severe hypertension or cardiovascular disease • Liver disease • Patients who have already taken chlorphenamine or other sedating antihistamine in the previous 4

hours or a non-sedating antihistamine in the preceding 12 hours. • Patients who have already taking chlorphenamine or an alternative antihistamine without obtaining

relief. • Patients who are pregnancy or breastfeeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. All patients with a generalised allergic reaction must be referred for further management. Side Effects Sedation varying from slight drowsiness to deep sleep. The following may also commonly occur: blurred vision, GI disturbances, urinary retention, headaches, dry mouth, dizziness, palpitation. Advice to patient Avoid alcohol, do not drive or operate machinery.


ALLERGY


Cetirizine Tablets 10mg



Cetirizine Hydrochloride

10mg oral Once daily 10mg daily

Clinical conditions / indications(s) for use: Symptomatic relief of minor allergic reactions e.g. rash itching, insect bites, hay fever type symptoms. Patients eligible for inclusion in the policy: Individuals 12 years old and over presenting with minor allergic conditions without fever. Patients excluded from treatment under the policy:

• Children under the age of 12 • Known hypersensitivity reactions to any constituents of the product, or hydroxyzine or any

piperazine derivatives. • Patients with severe renal impairment • Patients who have taken chlorphenamine or other sedating antihistamine in the previous 4 hours

or a non sedating antihistamine in the previous 12 hours. • Patients who have already taken cetirizine or an alternative antihistamine without obtaining relief. • Patient is pregnancy or breastfeeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. All patients with a generalised allergic reaction must be referred for further management. Side Effects Sedation with cetirizine is rare, but may occur. The following may also commonly occur: blurred vision, GI disturbances, urinary retention, headaches, dry mouth, dizziness, palpitations. Advice to patient Avoid alcohol, do not drive or operate machinery. Seek medical advice if symptoms worsen or do not improve within 24 hours.


TOPICAL/EAR/MOUTH and EYE-DROPS


Benzydamine Oral Mouthwash (Difflam®)



Benzydamine Mouthwash

15ml Oral rinse/ gargle

Every 1.5 to 3 hours Uninterrupted treatment should not exceed seven days, except under medical supervision

Clinical conditions/ indications for use:

Difflam Oral Rinse is a locally acting analgesic and anti-inflammatory treatment for the relief of painful inflammatory conditions of the mouth and throat including:

• Traumatic conditions: Pharyngitis following tonsillectomy or the use of a naso-gastric tube.

• Inflammatory conditions: Pharyngitis, aphthous ulcers and oral ulceration due to radiation therapy.

• Dentistry: For use after dental operations. Patients excluded from treatment under the policy:

• Children under 12 years of age. • Patients unable to rinse. • Patient is pregnant or breastfeeding.

Action for patients excluded from treatment under this policy: Any patients excluded should be referred to a member of the medical staff or dental staff according to the severity of the condition. Side effects: Oral numbness/ stinging. The mouthwash is generally used undiluted, but if stinging occurs, the mouthwash can be diluted. Ingestion of large quantities can lead to gastrointestinal symptoms: most common are nausea, vomiting, abdominal pain and oesophageal irritation. Notes: The mouthwash should be expelled from the mouth after use. Do not swallow.



Administration for the supply/administration of

Chlorhexidine Mouthwash


Dose Route Frequency

Chlorhexidine Digluconate 0.2%w/v

10ml

Oromucosal Thoroughly rinse the mouth for about one minute, twice daily. Do not swallow.

Clinical conditions / indications(s) for use: As an aid in the treatment and prevention of gingivitis and in the maintenance or oral hygiene. The management of aphthous ulceration and oral candidal infections (e.g. denture stomatitis and thrush). Patients excluded from treatment under the policy:

• Children unable to rinse • Known hypersensitivity reactions to chlorhexidine.

Action for patients excluded from treatment under the policy: Any patients excluded should be referred to a member of the medical staff or dental staff according to the severity of the condition. Side Effects Discolouration: A superficial discolouration of the tongue may occur which disappears after treatment has discontinued. Discolouration of the teeth, silicate or composite restorations may also occur which is not permanent and can largely be prevented by brushing with toothpaste daily before using the mouthwash or in case of dentures, cleaning with a denture cleanser. However, in certain cases professional scaling and polishing may be required to remove this stain completely. Taste: Transient disturbance of taste sensation/burning sensation of the tongue. Usually diminishes with continued use. Notes:

• The mouthwash should be expelled from the mouth after use. Do not swallow. • Chlorhexidine digluconate may be incompatible with some ingredients in toothpaste; leave an

interval of at least 30 minutes between using the mouthwash and toothpaste. • In the case of aphthous ulceration and oral candidal treatment should be continued for 48 hours

after clinical resolution. For the treatment of dental stomatitis, the dentures should be cleansed and soaked in the mouthwash for fifteen minutes, twice daily.

• If the mouthwash comes into contact with the eyes, wash out promptly and thoroughly with water.



Administration Guideline for the administration of Choline Salicylate Dental Gel, 8.7% (Bonjela® ADULT)



Choline salicylate & cetalkonium chloride gel

Apply 1cm of gel with gentle massage

Topical to oral mucosa

Not more often than every 3 hours

6 applications daily

Clinical conditions / indications(s) for use: Relief of pain and discomfort of common mouth ulcers and mild oral and preioral lesions. Patients eligible for inclusion in the policy: Patients presenting with the above symptoms Patients excluded from treatment under the policy:

• Children under 16 years of age. • Known hypersensitivity reactions to any constituents of the product including aspirin. • Patients receiving anticoagulant therapy e.g. warfarin. • If mouth ulcer has been present for more than a week, and if it is pain free. • If associated weight loss. • Involvement of other mucous membranes such as eyes or genitals. • Where symptoms are particularly painful or disabling. • Frequent occurrence of mouth ulcers. • Patient is immuno-compromised. • Patient is pregnant or breastfeeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff or according to the severity of the condition. Notes: Do not apply directly to or under dentures - leave at least 30 minutes before re-insertion of dentures. Not to be used on ulcers of hard palate, nor lesions greater than 5mm – refer to dentist/ doctor. Advice to patient Seek medical advice if symptoms worsen or if symptoms do not improve after 48 hours. Maintain oral hygiene.




Emollients and Barrier Creams

Drug (approved Name) Dose Route Frequency Proshield Plus/Proshield Foam and Spray (barrier and emollient) Aqueous Cream (as soap substitute) Diprobase® Cream (emollient) Drapolene® Cream (barrier cream) Sudocrem® (barrier cream)

Apply in the direction of hair growth

Topical to skin To be applied to the affected areas frequently

Clinical conditions / indications(s) for use: Emollients soothe, smooth and hydrate the skin and are indicated for dry and scaly skin. Aqueous cream is not suitable for use as an emollient however, can still be used as a soap substitute. Barrier creams can be used to protect vulnerable pressure areas e.g. sacrum from diarrhoea and incontinence. Proshield may be used as a preventative barrier on healthy, intact skin and as a protective layer on injured skin and moist wounds (partial thickness wounds up to grade II). Patients eligible for inclusion in the policy: Patients presenting with the above symptoms Patients excluded from treatment under the policy:

• Known hypersensitivity reactions to any constituents of the product. • Where symptoms are particularly painful or disabling. • Injuries that are greater than partial thickness wounds.

Possible side effects Occasional allergic reactions (e.g. stinging, burning, itching and redness). Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Notes Use frequently. When using Proshield reapply after each incontinence episode. Reapply if no sheen is visible on the surface of the skin. For use as a soap substitute, rub onto the skin before rinsing off completely. Advise patient not to scratch itchy skin as this will make it worse. Instead rub skin and apply a cold wet flannel to alleviate itch.



Administration Guideline for the administration of Hydrocortisone 1% Cream



Hydrocortisone cream 1%

Apply thinly (sparingly) to the affected area ONLY

topical once/twice a day

Clinical conditions/ indication for use:

Hydrocortisone has topical anti-inflammatory activity of value in the treatment of irritant dermatitis, contact allergic dermatitis, insect bite reactions and mild to moderate eczema. Patients excluded from the treatment under the policy:

• Children under 10 years of age • Pregnancy • Caution in lactating mothers: do not apply to the chest area • Any patient with bacterial (e.g. impetigo), viral (e.g. Herpes simplex) or fungal (e.g. candidal or

dermatophyte) infections of the skin. • Patients with hypersensitivity to any of the ingredients. • Additional contraindications for P supply: Not to be used on the eyes and face, ano-genital region,

on broken or infected skin including cold sores, acne and athlete's foot. Action for patients excluded from the treatment under the policy: Any patients excluded should be referred to a member of the medical staff according to the severity of the condition. Side effects: If any signs of hypersensitivity appear, application should stop immediately. Additional information: Do not use under an occlusive dressing.




Hypromellose eye drops 0.3%



Hypromellose eye-drops 0.3%

One or two drops Affected eye(s) Three times a day as needed

Clinical conditions / indications(s) for use: Artificial tears to relieve dry eye conditions Patients eligible for inclusion in the policy: Adults and children presenting with the above symptoms Patients excluded from treatment under the policy:

• Known hypersensitivity reactions to any constituents of the product. • Patients with known or suspected eye infection. • Patients wearing contact lenses. Can remove contact lenses before using the eye-drops and wait at

least 15 minutes before re-inserting. Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff or according to the severity of the condition. Side-effects Temporary blurring of vision. Allergic reactions. Stinging of the eyes.

Additional information

If patient is already using other eye drops, wait 5-15 minutes before applying hypromellose.




Sodium bicarbonate 5% ear drops



Sodium bicarbonate 5% ear drops

Three to four drops

Into the affected ear

Twice a day Up to 10 days

Clinical conditions / indications(s) for use: For softening and removal of ear wax. Patients excluded from treatment under the policy: Children under 18 years. Evidence of otitis media or ear drum perforation. Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff or according to the severity of the condition. Additional information The patient should lie with the affected ear uppermost for 5 to 10 minutes after instillation of the drops.


COUGH/SORE THROAT

APPENDIX 1 Administration Guideline for the administration of

Antiseptic Lozenges



Antiseptic lozenges

One lozenge oral to be dissolved slowly in the mouth every 2-3 hours.

up to a maximum of 12 lozenges in 24 hours.

Clinical conditions / indications(s) for use: Relief of pain and discomfort of mouth and throat infections. Patients eligible for inclusion in the policy: Adults and children 6 years and over presenting with the above symptoms Patients excluded from treatment under the policy:

• Children under 6 years of age. • Known hypersensitivity reactions to any constituents of the product. • Where symptoms are particularly painful or disabling.

• Frequent occurrence of mouth ulcers. • Patients who are immunocompromised.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff or according to the severity of the condition. Advice to patient May sometimes irritate and cause sore tongue and lips.


COUGH/SORE THROAT


Simple linctus (sugar free)



Simple linctus (sugar free)

5ml oral 3 – 4 times daily Maximum of 4 doses (20ml) in 24 hours

Clinical conditions / indications(s) for use: Cough Patients eligible for inclusion in the policy: Adults and children 12 years and over presenting with dry, tickly, irritating non-productive cough with no other symptoms. Patients excluded from treatment under the policy:

• Children under 12 years of age. • Known hypersensitivity reactions to any constituents of the product.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff or according to the severity of the condition. Additional information Patients presenting with a dry persistent cough who are receiving angiotensin-converting enzyme Inhibitors (e.g. ramipril, lisinopril) should be referred to medical staff.


CONSTIPATION


Bisacodyl Tablets 5mg



Bisacodyl tablets 5mg

Adults & children over 10 years: One or two tablets Children 4-10 years: One tablet

oral at bedtime One or two tablets daily (one tablet for 4-10 years)

Clinical conditions / indications(s) for use: Constipation in adults and children 4 years and over. Patients eligible for inclusion in the policy: Stimulant laxative for those who are assessed as being suitable for short term treatment for constipation. Patients excluded from treatment under the policy:

• Constipation accompanied by other symptoms such as abdominal pain, vomiting or rectal bleeding. • Severe dehydration. • Have or are suspected to have intestinal obstruction, inflammatory or ulcerative bowel disease or

perforation. • Patients under 4 years of age. • Known hypersensitivity reactions to any constituents of the product. • Patient is pregnant or breast feeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects Dizziness, nausea. Abdominal cramps/pain. Advice to patient Take an hour before or after milk, antacids or proton pump inhibitors (e.g. omeprazole) as they will stop the bisacodyl working properly.

Notes: Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity.


CONSTIPATION


Docusate capsules 100mg


Dose Route Frequency Maximum administration

Docusate Sodium capsules 100mg

One or two capsules

Oral Three times daily (but not more than 5 in total)

500mg daily

Clinical conditions/ indication for use: Constipation. Stimulant laxative and faecal softener for hard, dry stools in order to ease defaecation and reduce straining at stool. Patients eligible for inclusion: Individuals 12 years of age and older presenting with the above symptoms. Patients excluded from the treatment under the policy:

• Children under 12 years of age. • Previous sensitivity reaction to product. • Constipation accompanied by other symptoms such as abdominal pain, vomiting or rectal bleeding. • Have or are suspected to have intestinal obstruction, inflammatory or ulcerative bowel disease or

perforation. • Recent bowel anastamosis. • Severe dehydration. • Fructose intolerance. • Patient is pregnant or breastfeeding.

Action for patients excluded from the treatment under the policy: Any patients excluded should be referred to a member of the medical staff according to the severity of the condition. Side effects: Rarely diarrhoea, nausea, abdominal cramps or skin rash Notes: Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity Docusate may take 1 to 3 days to have an effect i.e. several doses may be needed.


CONSTIPATION


Glycerol (Glycerin) suppositories 4g



Glyceryl suppositories 4g

One suppository rectal In the morning One suppository in 24 hours

Clinical conditions / indications(s) for use: Stimulant laxative for constipation. Patients eligible for inclusion in the policy: Those who are assessed as being constipated where oral medication has been ineffective or would be inappropriate. Where rapid relief from rectal loading is required. Patients excluded from treatment under the policy:

• Constipation accompanied by other symptoms such as abdominal pain, vomiting or rectal bleeding. • Have or are suspected to have intestinal obstruction, inflammatory or ulcerative bowel disease or

perforation. • Have a rectal fissure, haemorrhoids or recent rectal surgery. • Have acute gastrointestinal symptoms including severe abdominal pain, nausea, vomiting or blood

or mucous in their stools. • Patient is under 12 years of age. • Known hypersensitivity reactions to any constituents of the product. • Patient is pregnant.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects: Rectal soreness or irritation is possible.

Additional information: The suppository should be removed from the foil or plastic packaging and moistened with water before insertion. Acts within 1 hour. A toilet/commode must be within easy reach of the patient. Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity.


CONSTIPATION


Lactulose


Dose Route

Lactulose Up to 15ml twice daily oral Clinical conditions / indications(s) for use: Bulk forming laxative for constipation. Patients eligible for inclusion in the policy: Adults and children over 12 years presenting with the above symptoms. Patients excluded from treatment under the policy:

• Have or are suspected to have intestinal obstruction, inflammatory or ulcerative bowel disease or perforation.

• Patient is under 12 years of age. • Known hypersensitivity reactions to any constituents of the product. • Have lactose, intolerance, galactosaemia or lactose intolerance.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects: Nausea (can be reduced by administration with water, fruit juice or with meals), vomiting, flatulence, cramps and abdominal discomfort.

Additional information: May take up to 48 hours to act. Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity.


CONSTIPATION


Senna tablets 7.5mg


Dose Route

Senna tablets 7.5mg

2-4 tablets at night oral

Clinical conditions / indications(s) for use: Stimulant laxative for constipation. Patients eligible for inclusion in the policy: Adults and children over 12 years presenting with the above symptoms. Patients excluded from treatment under the policy:


• Patient is under 12 years of age. • Known hypersensitivity reactions to any constituents of the product. • Have lactose, intolerance, galactosaemia or lactose intolerance. • Have acute gastrointestinal symptoms including severe abdominal pain, nausea, vomiting or blood

or mucous in their stools. • Recent bowel anastomosis. • Patient is pregnant.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects: May cause mild griping cramps.

Additional information: May take up to 8-12 hours to act. Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity.


CONSTIPATION


Sennoside liquid 7.5mg/5ml


Dose Route

Senna liquid 7.5mg/5ml

10-20ml at night oral

Clinical conditions / indications(s) for use: Stimulant laxative for constipation. Patients eligible for inclusion in the policy: Adults and children over 12 years presenting with the above symptoms. Patients excluded from treatment under the policy:


• Patient is under 12 years of age. • Known hypersensitivity reactions to any constituents of the product. • Have lactose, intolerance, galactosaemia or lactose intolerance. • Have acute gastrointestinal symptoms including severe abdominal pain, nausea, vomiting or blood

or mucous in their stools. • Recent bowel anastomosis. • Patient is pregnant.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects: May cause mild griping cramps.

Additional information: May take up to 8-12 hours to act. Many drugs can cause drug-induced constipation e.g. opioids, tricyclic antidepressants, aluminium salts, antidiarrhoeal drugs, calcium salts, iron salts and diuretics. Patients with drug-induced constipation should be referred to medical staff for review of their medication. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example: • Increased intake of fluids and dietary fibre (unless contra-indicated). • Advice on appropriate physical activity.


DIARRHOEA


Oral rehydration salts



Oral rehydration salts

Children over the age of 1 year: One sachet in 200ml water

Adults (including the elderly): One or two sachets in 200ml/400ml water

Oral As needed after each loose bowel motion

Six sachets in 24 hours

Clinical conditions/ indication for use: Replacement of water and salt loss associated with acute diarrhoea. Patients eligible for inclusion Patient is 1 year and older presenting with diarrhoea. Patients excluded from the treatment under the policy:

• Patient has inflammatory bowel disease. • Patient has active ulcerative colitis. • Patient has antibiotic-associated colitis. • Patient has severe hepatic impairment. • Patient has bloody diarrhoea. • Patient has known hypersensitivity reactions to any of the constituents of the product. • Patient has severe pain in abdomen or rectum indicating possible intestinal obstruction. • Children under 1 year. • Patient has a high fever.

Action for patients excluded from the treatment under the policy: Any patients excluded should be referred to a member of the medical staff according to the severity of the condition. Continue rehydration. ADDITIONAL INFORMATION:

• For oral administration only, reconstitute as per manufacturer’s instructions and discard no later than 1 hour after preparation unless stored in a refrigerator when it may be kept for up to 24 hours. Use freshly boiled and cooled water for infants.

• If vomiting is present the solution should be given in small frequent doses in sips.

• If no improvement is seen within 24-48 hours or diarrhoea is accompanied by a high temperature, it is recommended that the patient be seen by a doctor.

• If the patient has recently travelled abroad, rehydration salts may be used, but the patient should be referred to medical staff for further investigation.


DIARRHOEA


Loperamide capsules 2mg



Loperamide capsules 2mg

2 capsules initially followed by one capsule after every loose stool.

Oral As needed after each loose motion.

Maximum daily dose should not exceed 16mg (eight capsules). Maximum treatment time up to 48 hours.

Clinical conditions/ indication for use: Acute diarrhoea in conjunction with oral rehydration therapy. Patients eligible for inclusion Patents 12 years of age and older presenting with acute diarrhoea with no fever. Patients excluded from the treatment under the policy:

• Not to be used in those with Clostridium difficile infection. • Patients with inflammatory bowel disease. • Patients with active ulcerative colitis. • Antibiotic-associated colitis, patients who have had a course of antibiotics within the past 7 days. • Sever hepatic impairment. • Patients with bloody diarrhoea. • Known hypersensitivity reactions to any of the constituents of the product. • Severe pain in abdomen or rectum indicating possible intestinal obstruction. • Patients under 12 years of age. • Pregnancy. • High fever.

Action for patients excluded from the treatment under the policy: Any patients excluded should be referred to a member of the medical staff according to the severity of the condition. Continue rehydration. SIDE EFFECTS: Abdominal cramps, dizziness, drowsiness, dry mouth and skin reactions. ADDITIONAL INFORMATION:

• If no improvement is seen within 24 - 48 hours or diarrhoea is accompanied by a high temperature, it is recommended that the patient be seen by a doctor.

• General advice for patients with mild diarrhoea includes encouraging clear fluids, avoiding milk and returning to normal diet when tolerated.


INDIGESTION and REFLUX


Alginate raft-forming suspensions (Peptac®/Gaviscon®)


Age Dose Frequency Maximum administration

Peptac® suspension Gaviscon® suspension

6-12 years

5-10ml

Single dose (MIU only) Up to four times a day. After meals and before bed.

Over 12 years

10-20ml Maximum dose of 80ml daily.

Clinical conditions / indications(s) for use: Gastric reflux, heartburn. Patients eligible for inclusion in the policy: Adults and children over 6 years presenting with the above symptoms. Patients excluded from treatment under the policy:

• Patient is under 6 years of age. • Known hypersensitivity reactions to any constituents of the product. • Patient is on a sodium restricted diet, with heart failure or hypertension.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Possible side effects: Abdominal distension may occur.

Additional information: This is an alginate-containing antacid, which forms a ‘raft’ that floats on the surface of the stomach contents to reduce reflux and protect the oesophageal mucosa.


PAIN


Paracetamol tablets 500mg


Age Dose Route Frequency Maximum Admini-stration

Paracetamol tablets 500mg, soluble tablets 500mg

12 years and over

Two tablets

Oral 4 to 6 hourly

Four doses in 24 hours (up to 4g daily)

Clinical conditions / indications(s) for use:

• Generalised pain. • Symptomatic pyrexia.

Patients eligible for inclusion in the policy: Adults and children over the age of 12 years with mild to moderate pain. Patients with pyrexia above 37.50C. Patients excluded from treatment under the policy:

• Children under 12 years of age. • Paracetamol administered within the last 4 hours. • Patients who have taken 4 or more doses of paracetamol-containing products within the

previous 24 hours. Check that any painkillers the patient is prescribed or may be taking do not also contain paracetamol.

• Current hepatic impairment and/or renal impairment. • Patients with alcohol dependence. • Recent overdose (within the last week) of substances containing paracetamol. • Known hypersensitivity reactions to any of the constituents of the product.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Side effects: Rarely rash. Additional Information: Soluble tablets have a high sodium content; may be unsuitable for patients with high blood pressure.


PAIN


Paracetamol suppositories 60mg, 125mg, 250mg and 500mg


Age Dose Route Frequency Maximum Administration

Paracetamol suppositories60mg, 125mg, 250mg and 500mg

3 months - 1 year

60 – 125mg

rectal Single dose (MIU only)

Four doses in 24 hours

1 - 5 years 125mg-250mg

Single dose (MIU only)

6 - 12 years 250mg-500mg

Single dose (MIU only)

Adult 500mg – 1g

Single dose or every 4 hours

2 - 3 months for post-immunisation pyrexia

60mg Single dose (MIU only)


• Generalised pain in patients unable to take oral preparations. • Symptomatic pyrexia in patients unable to take oral preparations.

Patients eligible for inclusion in the policy: Patients over 3 months of age with mild to moderate pain or pyrexia. Can be given to infants over 2 months of age for post-immunisation pyrexia. Patients excluded from treatment under the policy:

• Children under 3 months for pain or pyrexia. • For post immunisation pyrexia, infants less than 2 months. • Paracetamol administered within the last 4 hours. • Patients who have taken 4 or more doses of paracetamol-containing products within the previous

24 hours. Check that any painkillers the patient is prescribed or may be taking do not also contain paracetamol.

• Current hepatic impairment and/or renal impairment. • Patients with alcohol dependence. • Recent overdose (within the last week) of substances containing paracetamol. • Known hypersensitivity reactions to any of the constituents of the product. • Known abnormality of the anus, rectum or any bowel disorder. • Sore anal area and/or signs of bleeding. • Impacted constipation. • Diarrhoea.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Side effects: Rarely rash.


PAIN


Paracetamol suspension 120mg/5ml and 250mg/5ml


Age and Dose Route Frequency Maximum Admin-istration

Paracetamol Suspension 120mg/5ml and 250mg/5ml

120mg/5ml 3 - 6 months 2.5ml (60mg) 6 - 24 months 5ml (120mg) 2 - 4 years 7.5ml (180mg) 4 - 6 years 10ml (240mg) 250mg/5ml 6 - 8 years 5ml (250mg) 8 - 10 years 7.5ml (375mg) 10 - 12 years 10ml (500mg) 12 - 16 years 10-15ml (500- 750mg) >16 years 10-20ml (500-1000mg) For post immunisation pyrexia for 2-3 months give 60mg (2.5ml of 120mg/5ml) stat repeat once after 6 hours if necessary

Oral Single dose (MIU only) 4 – 6 hourly Single dose (MIU only)

Four doses in 24 hours (up to 4g daily)


• Generalised pain. • Symptomatic pyrexia.

Patients eligible for inclusion in the policy: Patients over 3 months of age with mild to moderate pain or pyrexia. Can be given to infants over 2 months of age for post-immunisation pyrexia. Patients excluded from treatment under the policy:

• Children under 3 months for pain or pyrexia. • For post immunisation pyrexia, infants less than 2 months. • Paracetamol administered within the last 4 hours. • Patients who have taken 4 or more doses of paracetamol-containing products within the previous

24 hours. Check that any painkillers the patient is prescribed or may be taking do not also contain paracetamol.

• Current hepatic impairment and/or renal impairment. • Patients with alcohol dependence. • Recent overdose (within the last week) of substances containing paracetamol. • Known hypersensitivity reactions to any of the constituents of the product.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Side effects: Rarely rash.


PAIN


Ibuprofen tablets 200mg


Dose Route Frequency Maximum Admin-istration

Ibuprofen tablets 200mg

One or two tablets Oral Up to three times a day (4 hours between doses)

For adults and children over 12 years: Maximum 6 tablets in 24 hours.

Clinical conditions / indications(s) for use: Relief of pain and fever. Patients eligible for inclusion in the policy: Patients 12 years of age and over presenting with: Mild to moderate pain including muscular pain, neuralgia, migraine, headache, dental pain, dysmenorrhoea. Minor injuries such as sprains and strains. Feverishness and symptoms of cold and influenza. Patients excluded from treatment under the policy:

• Children under 12 years. • Patients taking others NSAIDs regularly (including aspirin 75mg) or who have taken a NSAID within

the previous 6 hours. • Patients who have taken any drugs listed as interacting with ibuprofen in the current BNF

Appendix 1 under NSAIDs, such as lithium, anticoagulants, zidovudine, diuretics, methotrexate, digoxin, ciclsporin, tacrolimus or ciprofloxacin.

• Known hypersensitivity to aspirin or NSAIDs. • History of or active GI disease e.g. peptic ulcer, bleeding, Crohn’s disease or colitis. • Liver, renal or cardiac impairment. • Heart failure or hypertension. • Asthmatics (unless previously known to have tolerated NSAIDs). • Patient is pregnancy or breastfeeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Side effects: Gastro-intestinal: abdominal pain, nausea and dyspepsia. Occasionally peptic ulcer, perforation or gastrointestinal haemorrhage, particularly in the elderly. Non-specific allergic reactions and anaphylaxis. Respiratory tract reactivity comprising asthma, aggravated asthma, bronchospasm or dyspnoea. Rashes.


PAIN


Ibuprofen suspension 100mg/5ml


Age and Dose Route Frequency

Ibuprofen suspension 100mg/5ml

3 months - 1 year 50mg (2.5ml) 1 - 4 years 100mg (5ml) 4 - 7 years 150mg (7.5ml) 7 - 10 years 200mg (10ml) 10 - 12 years 300mg (15ml) 12 - 18 years 200-400mg (10-20ml) 18 years 200-400mg (10-20ml)

Oral Single dose (MIU only) 6 - 8 hourly 3 - 4 times a day

Clinical conditions / indications(s) for use: Relief of pain and fever. Patients eligible for inclusion in the policy: Patients 3 months of age and over and >5kg presenting with: Mild to moderate pain including muscular pain, neuralgia, migraine, headache, dental pain, dysmenorrhoea. Minor injuries such as sprains and strains. Feverishness and symptoms of cold and influenza. Patients excluded from treatment under the policy:

• Children under 3 months of age. • Infants weighing <5kg. • Patients taking others NSAIDs regularly (including aspirin 75mg) or who have taken a NSAID within

the previous 6 hours. • Patients who have taken any drugs listed as interacting with ibuprofen in the current BNF Appendix

1 under NSAIDs, such as lithium, anticoagulants, zidovudine, diuretics, methotrexate, digoxin, ciclsporin, tacrolimus or ciprofloxacin.

• Known hypersensitivity to aspirin or NSAIDs. • History of or active GI disease e.g. peptic ulcer, bleeding, Crohn’s disease or colitis. • Liver, renal or cardiac impairment. • Heart failure or hypertension. • Asthmatics (unless previously known to have tolerated NSAIDs). • Patient is pregnancy or breastfeeding.

Action for patients excluded from treatment under the policy: Any patients with a contra-indication should be reviewed by medical staff according to the severity of the condition. Side effects: Gastro-intestinal: abdominal pain, nausea and dyspepsia. Occasionally peptic ulcer, perforation or gastrointestinal haemorrhage, particularly in the elderly. Non-specific allergic reactions and anaphylaxis. Respiratory tract reactivity comprising asthma, aggravated asthma, bronchospasm or dyspnoea. Rashes.


Title of Policy: Homely Medicines Policy Description: The policy is intended to minimise risk and maximise good practice in the safe storage, transport and administration of drugs within inpatient and community settings within SCH Part 1: Assessment of Impact a) How will the policy meet the needs of different communities and groups? • Age: It is not considered that the age will have

any impact on the application of this policy. • Religion or Belief: This organisation is aware of

different religions and belief systems but this policy is considered to apply equally to all groups

• Disability: It is anticipated that this policy will impact on all patients in equal measure

• Sexual Orientation: It is considered that this policy should apply equally to all patients whatever their sexual orientation

• Ethnicity: This organisation is aware of different practices and different ethnic groups but this policy is considered to meet the needs all such groups

• Socio-economic disadvantage: This policy should not impact to cause any socio-economic disadvantage

• Gender (including transgender): this policy is gender neutral and will meet the needs of all such groups.

• People living in rural areas: This policy should be applied equally regardless of place of residence and should not impact on people living in rural areas

Other: This organisation recognises that some members of society generally have difficulty accessing health services such as people who are homeless, prisoners or street workers. However, this policy relates to the safe & secure handling/ administration of medicines & as such should be applied equally b) Positive Impact: Reducing Inequalities: How is the policy likely to have a significant positive impact on equality by reducing inequalities that already exist? Explain how it will meet our duty to: • Promote equal opportunities: This policy will

ensure that new & newly qualified staff will have equal access education and training relating to the administration of medicines and it will therefore be applied equally.

• Promote good community relations: As with other policies and guidelines within the organisation, this one aims to ensure that SCH provides quality services to the community of Suffolk ensuring that the whole community has access to a safe healthcare environment. Fostering good relations with partner organisations will be enhance by the application of this policy.

• Get rid of discrimination: if staff are working within this policy and within professional guidelines this should avoid discrimination at any level.

• Promote positive attitudes towards, encourage participation in and enable more favourable treatment of, disabled people: This policy applies to all patients equally irrespective of any disability and staff will make all reasonable adjustments to accommodate any disability.

• Get rid of harassment: There are policies in place which prevent harassment both within the organisation and between the staff and patients (e.g. Whistle Blowing Policy, Disciplinary Policy, Adverse Incidents, Code of Conduct, Confidentiality Code of Practice

• Promote and protect human rights: SCH recognises that some patients are by definition vulnerable and this policy is designed to ensure their human rights are not affected in any way

c) Negative Impact – Potential Discrimination: Could the Policy have a significant impact on equality in relation to each of the following groups or characteristics? • Age: Age will not have a negative impact on this

policy • Religion or Belief: Staff are expected to be aware

of the possibility of differing views by religious S/Internal/HomelyRemediesPolicy/Sept14/V2.0 31

groups but this should not impact on the application of the policy.

• Disability: This policy can be adhered to regardless of any disability

• Sexual Orientation: This policy will apply equally regardless of sexual orientation.

• Ethnicity: It is not considered that ethnicity will have a negative impact on this policy

• Socio-economic groups: It is not anticipated that this will have a negative impact.

• Gender (including transgender): This policy will be applied equally regardless of gender.

• People living in rural areas: It is not anticipated that this will have a negative impact.

Other: This organisation recognises that some members of society generally have difficulty accessing health services such as people who are homeless, prisoners or street workers. However, this policy relates to the safe & secure handling/ administration of medicines & as such and is not expected to have any negative impact Part 2: Evidence d) What is the evidence for your answers above? • Age: It is the intention and aim of this policy that,

in consultation with statutory and non-statutory bodies, reflects current best practice and fulfils current statutory obligations under law.

• Religion or Belief: It is the intention and aim of this policy that it shall be applied equally according to best practice and not discriminate unfairly based on religion or belief.

• Disability: It is the intention and aim of this policy that it will reflect best evidence based practice and not discriminate based on a physical or mental disability

• Sexual Orientation: It is the intention and aim of this policy that it shall be applied equally according to best practice and not discriminate unfairly based on sexual orientation.

• Ethnicity: It is the intention and aim of this policy that it shall be applied equally according to best practice and legal obligations and not discriminate unfairly based on ethnicity.

• Socio-economic groups: It is the intention and aim of this policy that it shall be applied equally according to best practice and not discriminate unfairly based on socio-economic status

• Gender (including transgender): It is the intention and aim of this policy that it shall be applied equally according to best practice and not discriminate unfairly based on gender.

• People living in rural areas: It is the intention and aim of this policy that it shall be applied equally according to best practice and not discriminate unfairly based on ethnicity.

Other: This organisation recognises that some members of society generally have difficulty accessing health services such as people who are homeless, prisoners or street workers. However, this policy to the safe & secure handling/ administration of medicines & as such and as such will be applied equally and reviewed regularly to ensure it adheres to current best evidence based practice Part 3: Conclusion B – A negative impact in unlikely. The guideline has the clear potential to have a positive impact by reducing and removing barriers and inequalities that currently exist. Part 4: Next Steps Action Plan: To review the operation of the guideline as per SCH protocol to ensure there are no changes in its impact Part 5: For the Record Name and Title of people who carried out the EIA: Sarah Miller, Clinical Effectiveness Manager

Name of Director who signed EIA: Pamela Chappell

Date EIA completed: 17/9/14

Signature of Director:

Date EIA signed: 23/9/14


HOMELY REMEDIES (DISCRETIONARY MEDICINE) POLICY FOR … Remedies... · Last review date . July 2014...

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Transcript of HOMELY REMEDIES (DISCRETIONARY MEDICINE) POLICY FOR … Remedies... · Last review date . July 2014...