Drops, ointments, sprays and gels

This information is intended as general guidance only and should not be regarded as authoritative or a complete set of instructions or statement of any regulations. Kirklees Council, NHS North Kirklees and Greater Huddersfield Clinical Commissioning Groups and their employees accept no liability whatsoever in connection with or arising from this guidance.

Providers need to seek independent advice specific to the individual needs of service users as appropriate and undertake their own risk assessments in relation to service delivery, including those associated with administration and support with medications.

Providers need to ensure any employees who support service users with their medications have access to and understand the provider's policies and procedures relevant to their role and responsibilities. The provider must ensure that all employees supporting service users with their medications have successfully completed medication training and be able to evidence the employee has been assessed as competent prior to supporting service users with their medications.

Administration of nasal sprays, application of eye ointments or gels and the instillation of ear, eye and nose drops.

Prior to support, administration, instillation or application

Gather together and ensure instructions and equipment are available, for example, the Medication Administration Record (MAR) chart, Care Plan, prescribed medication with dispensed label, patient information leaflet (PIL), tissues, gloves.

General guidance for all drops, ointments and sprays

Identify the correct service user, confirm selected medicine is dispensed for that service user and consult their MAR chart and the PIL to determine:

• Name of the prescribed medication
• Route and method of administration
• Number of drops (if eye, ear or nasal drops) to be instilled
• Sequence to follow if several different drops to be administered (which drops go in first and how long should the gap be in between, check with pharmacist or GP if unsure)
• How often the selected medicine should be administered
• When was the last dose administered and when is the next dose due (ensuring that it has not already been administered - check verbally and check documentation)
• Discontinuation date if appropriate
• Expiry date and date bottle opened (if opening a new bottle write the date on the side of the bottle. Eye, ear, nasal drops and eye ointments can only be used for 28 days after opening but always check the PIL as some may be less, for example, preservative free.
• Storage requirements. Most drops, ointments, gels and sprays should be stored at room temperature and away from heat, moisture, and direct light. Some may require storage in the fridge.
• Any other specific instructions from the PIL.
• Information on the MAR chart and dispensed label must match.

Explain procedure to service user and gain consent.

• Wash hands with soap and dry thoroughly before and after procedure. Alcohol hand gel should be used if the home does not have suitable hand washing facilities
• Put on disposable (single use) gloves
• Refer to the specific guidance below for the different preparations
• Complete the MAR chart immediately after administration.
• Report any concerns, errors, queries or changes to your manager immediately to seek further advice. Your manager may also need to seek further medical advice in the interests of the service user's safety.

Nose drops:

• Ask the service user to gently blow their nose
• Check the dropper tip to make sure that it is not chipped or cracked. Do not use if it is damaged, contact pharmacist for a replacement
• Avoid touching the dropper tip against the nose or anything else - the dropper must be kept clean, avoiding germs
• Ask the service user to tilt their head as far back as comfortably possible, but ideally lie down on their back on a flat surface and hang their head over the edge
• Shake the bottle
• Place the correct number of drops into the service user's nostril and repeat in the other nostril if required
• The service users head should be tilted well back, allowing the correct number of drops to flow down into the nose. The service user's head should be kept tilted for a few minutes to allow the drops to be absorbed
• Wipe away any excess drops or ointment from the service user's face, ensuring you use a clean, soft tissue
• With another clean tissue, wipe the tip of the tube or dropper clean. Do not rinse the dropper
• Place the dropper back in the bottle and tighten the cap immediately.

Nasal sprays:

• Ask the service user to gently blow their nose
• Shake the bottle/canister and remove the cap. The first time you use the spray each day you may need to 'prime' it by squirting a few times into the air until a fine mist appears
• Gently insert the bottle tip into one nostril. The service user or staff member should press on the other side of the service user's nose with one finger to close off the other nostril
• The service user should keep their head upright to prevent the medicine from running down the throat.
• The service user should breathe in slowly while they or the staff member squeezes the bottle then breathe out gently through their mouth after each spray
• Repeat in the other nostril if required
• The service user should not blow their nose right after using the spray

Ear drops:

• Do not use ear drops if they change color or turn cloudy or if they have small bits floating in them
• Check the tube or dropper tip and make sure it is not chipped or cracked - Do not use if it is damaged, contact pharmacist for a replacement
• Gently wipe the ear with a clean damp facecloth and then dry the ear
• Warm the bottle in your hands for a few minutes
• Gently shake the bottle well for 10 seconds
• Ask the service user to tilt their head, or lie on their side, so the affected ear is facing up.
• Gently pull the ear lobe down to open the ear canal
• Avoid touching the dropper tip against the ear or anything else - the dropper should be kept clean, avoiding germs
• Gently squeeze the bottle to drop the correct number of drops into the ear and then gently press on the small skin flap over the ear to help the drops to run into the ear canal
• Ask the service user to keep their head tilted for several minutes to give the medicine time to coat their ear
• Wipe away any excess drops or ointment from the service user's face, ensuring you use a clean, soft tissue
• With another clean tissue, wipe the tip of the tube or dropper clean. Do not rinse the dropper
• Place the dropper back in the bottle and tighten the cap immediately.

Further information

The GP should be informed if the service user has any side effects including:

• Changes in their hearing, such as ringing in the ears
• Their ear itches, stings, or burns
• They develop a rash in or around their ear
• They are dizzy
• They have questions or concerns about their condition or care

Eye drops, gels and ointments:

• Do not use the drops if they change color or turn cloudy or if they have small bits floating in them
• When drops/ointments/gels are prescribed to be put into both eyes, it is good practice to have separate containers/bottles and to mark them left (L) and right (R) on the containers to reduce the possibility of cross contamination. If drops and ointments are prescribed always use the drops first
• Gently shake if the container is a bottle
• Check the tube or dropper tip and make sure it is not chipped or cracked. Do not use if it is damaged, contact pharmacist for a replacement
• If the eye is sticky seek medical advice before administering
• Do not touch the tip of the bottle. Germs from your eye can spread to the medicine bottle
• The service users head should be tilted back slightly
• While the head is tilted back gently pull down the lower lid of the eye with your index finger to form a pocket.
• Gently squeeze the dropper to drop the correct number of drops into the eye, wait at least 5 minutes between each drop or squeeze ¼ to ½ inch (0.6- to 1.25-centimeter) ribbon of ointment or gel, into the pocket made by the lower eyelid
• Remove your index finger from the lower eyelid
• Ask the service user to blink and then close their eyes and press their finger against the inside corner of the eye next to the nose for 1 minute and then blink and not to rub their eyes
• With another clean tissue, wipe the tip of the tube or dropper clean. Do not rinse the dropper
• Wipe any excess drops or ointment from the eyelids and lashes, ensuring you use a clean, soft tissue
• With another clean tissue, wipe the tip of the tube or dropper clean. Do not rinse the dropper
• Place the dropper back in the bottle (if using one for eye drops) and tighten the cap immediately.

Further information

• The service user's vision may be blurry for a short amount of time after using the eye ointment. The service user should wait until they can see normally before they do any activities that require good vision.
• The service users GP should be informed if the service user has any side effects, including:
• Eye pain or watering
• Changes in their vision
• Eyes are red, swollen, or draining pus
• They develop a rash or hives
• They have questions or concerns about their condition or care