Creams, bath preparations and ointments
Creams, oils and ointments generally fall into one of 3 categories:
- Those which contain medicines and have to be prescribed.
- Those which are available for purchase but contain medicines that could possibly interact with prescribed medicines.
- Those which can be purchased in a variety of outlets, and are used for moisturising the skin, as a soap substitute or as a barrier to protect the skin.
Staff must only ever support service users with creams and ointments that have been prescribed as in Category 1.
Refer to the Kirklees Good Practice Medication Guidance for Non-prescribed medication for further information relating to category 3.
It is important for providers to be aware that smoking or using a naked flame could cause paraffin-based cream or emollient products covered by dressings or clothing to catch fire. Providers must ensure they carry out checks to identify whether a cream or emollient contains paraffin and if so, it is vital that a fire risk assessment is completed, used and regularly reviewed. Also refer also to Kirklees Good Practice Medication Guidance for risk assessments
Watch the video made by the West Yorkshire Fire and Rescue Service: Fire Hazards - Paraffin-Based Skin Products
A support plan and Medication Administration Record (MAR) must be available in the service users home along with a body chart with clear instructions for staff to follow when applying any cream and ointment in the same way as any other medication they support with. It is important that staff are informed where to apply, how much to apply, for example, thinly or liberally, when to apply and for how long. Sometimes creams and ointments are only prescribed for a limited period.
If instructions on packaging states 'use as directed' further medical advice should be sought from the pharmacist or service users GP to seek clarity.
The administration and support of any creams and ointments by staff must be recorded on the service users Medication Administration Record (MAR) by each staff member following each application.
If a service user is prescribed a bath preparation to be used to wash with and needs support for this from the provider, a record must be made by staff supporting with this in the daily care notes to show it is being used appropriately and as instructed.
Some creams may need to be kept at fridge temperatures. If this is the case, staff need to be advised that it is not good practice to apply creams and ointments to the skin directly from the fridge, due to the cold temperature but that it is good practice to warm the packaging (usually a tube) of cream up in a clean gloved hand for a few moments before applying.
It is important that staff follow good hygiene practices and always wash their hands before and after applying creams or ointments and wear clean disposable gloves. This is particularly important with some creams such as Corticosteroid creams to ensure the active ingredients are not soaked into staff's skin.
Any concerns of possible side effects for a service user using a prescribed cream, bath preparation or ointment must be reported to the pharmacy or service users GP immediately. Side effects of each medication can be found on the leaflet that is supplied with the original packaging. It is always good practice for staff to read side effects of medications they are supporting service users with, so they know what signs to look for.
Further guidance
Managing medicines for adults receiving social care in the community | Guidance | NICE
Paraffin-based skin emollients on dressings or clothing: fire risk | GOV.UK