Homely Remedies Guidelines for Community Hospital Wards
Version: V7
Ratified By: Medicines Governance & Safety Group
Date Ratified: 29.01.2026
Job Title of Author: Director of Quality, Pharmacy and AHP
Reviewed by Sub Group or Expert Group: Medicines Governance & Safety Group
Related Procedural Documents: MMPOL30 Medicines Policy
Review Date: 29.01.2029
It is the responsibility of users to ensure that you are using the most up to date document template – ie obtained via the intranet.
In developing/reviewing these guidelines Provide Community has had regard to the principles of the NHS Constitution.
Version Control Sheet
Version Date Author Status Comment
V1 Aug ‘10 Nisha Desai Approved PCT MMC Dec ‘10 New
V2 June 2012 Nisha Desai Approved Review
V3 May 2014 Jayne Lucas Review
V3.1 November 2014 Jayne Lucas MMC November 2014 Ratified
V4 June 2016 Jayne Lucas Review
V5 June2018 Head of Medicines Management
V6 July2021 Senior Medicines Management Technician/Community Health Specialist Pharmacist Ratified on 14/10/21 at MGSG Review
V7 April2025 January2026 Community Health Pharmacist HeadofPharmacy Community Inpatient Ward ManagersBaymanandHalstead Ward Review
(e.g. Laxido®/ Movicol®)
Senna tablets or syrup
Suppositories BP (adult)
Micolette Micro enemas (sodium citrate)
1. Introduction
Homely remedies are an agreed list of General Sales List (GSL) and Pharmacy Only (P) Medicines, used to treat minor ailments which can be administered to patients by Healthcare Professionals. Healthcare Professionals are advised that the medicines in this guideline are to be used for the specified indications only.
The following guidelines have been produced to aid the administration of Homely Remedies for the treatment of minor ailments for Provide community in-patient wards, as an aid to symptom relief.
No Homely Remedy must be administered for more than 48 hours during the working week or a maximum of 72 hours at the weekend before consulting a doctor, to ensure that symptoms are adequately controlled.
Roles
and Responsibilities
The Ward Manager is responsible for ensuring that:
• all nursing staff are aware of the correct procedure for administration of Homely Remedies
• all nursing staff using the homely remedy guidelines have been signed off as competent to do so. A copy of the competency will be kept in the personnel file and reviewed annually.
• all nursing staff have read and signed all relevant medicines Standard Operating Procedures (SOP’s) that will support the application of this guideline.
• the ability of individual Healthcare Professionals to administer Homely Remedies has been assessed and monitoring for any errors that may occur relating to these guidelines is in place.
The healthcare professional administering the remedy should ensure that:
• patient consent is be obtained before administering a Homely Remedy and the reason for treatment should be explained to the patient.
• the allergy status of the patient must be checked prior to any medication being administered. Known allergies must be clearly recorded in the patient’s administration chart (MAR) and patient notes.
• the patient has no other serious symptoms that need immediate assessment by a clinician before using this protocol, and that there are no swallowing difficulties and that treatment via the homely remedy is in the best interests of the patient.
• that there are no contra-indications, drug interactions or duplicate doses once the decision to administer via the homely remedy guideline is made.
• the administration of the homely remedy is recorded on the MAR in the ‘Homely Remedy’ section and in the patient electronic patient record (EPR) SystmOne, clearly stating drug name, dose, form, amount given, date, time administered and nurses initials for administration of medication The SystmOne entry must also include reason for homely remedy guideline used and indication
• In the signature box a statement stating, “Per Homely Remedy Guide” should be written.
• the ward prescriber/medical team is informed that medicines have been given as a homely remedy as soon as practicable after administration. An entry is made in the prescriber book to review the patient and homely remedy
• medical advice is sought should the patient not respond to the homely remedy treatment, or, requires more than three separate episodes
• In the event that the patient does not respond to treatment and their condition deteriorates, please inform the ward prescriber or medical team and follow the usual escalation procedures (refer to CPOL19 Transfer of Inpatients to Alternative Care Settings Policy)
The ward prescriber, advanced practitioner, or other clinician should review and assess the patient after the maximum time allowed for homely remedy administration, so that a prescription can be written if the medication is to continue.
Record Keeping
Any medication administered must be clearly recorded on the patient’s MAR under the homely remedy section. This must be brought to the attention of the next senior person on duty e.g ward manager/nurse in charge. A record should also be made in the prescriber book to review the patient and homely remedy as well as a record in the patients notes stating:
➢ Medication name
➢ Reason for administration
➢ Date administration
➢ Dose given
➢ Time given
Medicines not suitable as homely remedies
• Medicines that take up to 48 hours to work e.g. lactulose
• Vitamins, herbal or homeopathic supplements
• Medicines being obtained via bulk prescription
• Prescription only medicines
Storage
• Homely remedies should be kept separate to patients’ prescribed medication.
• Access should be restricted to staff with medicines management responsibilities.
• All homely remedies MUST be stored in their original packaging together with any information supplied with the product about the medicine use.
• They should be stored in accordance with the instructions in the patient information leaflet.
• Stocks and expiry dates should be checked monthly in line with MMPOL30 Medicines Management Policy.
• Some liquids and eye drops have a reduced shelf-life once opened therefore the date opened should be recorded on the bottle/label. The manufacturer’s instructions should be checked for this information.
Adverse Reaction
In the rare event of any adverse reactions, the ward prescriber or medical team must be informed immediately and/or ward manager/Nurse in Charge. The yellow card adverse reaction reporting must be completed as this notifies Medicines Health Regulatory Authority (MHRA). A yellow card report can be submitted online using the electronic form at www.mhra.gov.uk/yellowcard Details of the adverse reactions must be recorded in the patient EPR. In the event of serious life-threatening adversereaction follow usualescalation procedures.
2. Medicines for Homely Remedy
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication
1.Compound Alginate
Suspension (e.g. Gaviscon) heartburn associated with gastro-intestinal reflux
2.Loperamide 2mg capsules Acute/chronic diarrhoea as shown by more than 2 unformed stools in 24 hours
• Patients with renal failure
• Patients awaiting a swallow reflux test, who cannot swallow, are NBM, are tube fed or have difficulty swallowing
5 – 10ml after meals and at bedtime
40ml in divided doses
• Foul smelling stools
• Suspected infection
• Condition where inhibition of peristalsis should be avoided
• Active ulcerative colitis
• Antibiotic associated colitis
• IBS
• Bacterial enterocolitis
• Hepatic dysfunction
First dose 2 x 2mg capsules orally, then 2mg after each loose stool
Maximum 16mg in 24 hours
• Shake well before use
• Caution: may impair absorption of some drugs
• Not to be used without prescription in patients with renal failure or with sodium restriction
• Should not be used in patients who are severely debilitated or suffering from kidney failure
• Antacids inhibit absorption of tetracyclines and vitamins and should not be taken at the same time. Leave at least 1-2 hours between doses
• Wait at least 2 hours between taking this medicine and other medicines such as thyroid hormones (e.g. levothyroxine), iron preparations (e.g. ferrous fumarate) and bisphosphonates (e.g. alendronic acid).
• Patients on medicines which may cause dyspepsia or with ALARM signals – refer to Doctor (See NICE Clinical Guideline CG184)
• Refer to Doctor if pain continues
Side effects may include:
• Dizziness
• Flatulence
• Nausea
• Headache
• Abdominal cramps
• Urticaria
• Abdominal bloating
• Exclude possibility of Clostridia before commencing treatment
• Inform Doctor within 24 hours of onset of diarrhoea
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication Exclusions
3.Macrogol 3350 sachets (e.g. Laxido) Altered normal bowel habit indicating constipation
Senna Tablets/Syrup
Tablet: total
Sennosides 7.5mg
Syrup: total
Sennosides
7.5mg/5ml Altered normal bowel habit indicating constipation
• Intestinal obstruction
• Intestinal perforation
• Inflammatory bowel disorders
• Cardiovascular impairment
Dose/Route/Frequency Additional information
1-2 sachets
Mix each sachet in 125mls of water as directed by manufacture
Maximum 3 sachets in 24 hours
• Intestinal obstruction 1-2 tablets or 5-10ml orally
Maximum 2 tablets or 10ml in 24 hours
Usually taken at bedtime
• Nausea
• Vomiting
• Electrolyte imbalance
• Stop if gastrointestinal discomfort
• Reconstituted sachets must be discarded after 6 hours if not taken
• This product should not be used when abdominal pain, intestinal obstruction, nausea or vomiting is present.
• Avoid if significant abdominal cramps
• Initial dose should be low and gradually increase
• May colour urine
• Exclude use if: recent bowel surgery and history of intestinal obstruction
• Action may take 8 to 12 hours
• Ensure adequate fluid intake
Glycerol Suppositories BP (adult) Altered normal bowel habit indicating constipation
Micolette Micro enemas (sodium citrate) Altered normal bowel habit indicating constipation
• Avoid if rectal bleeding 1 or 2 suppositories inserted rectally daily as required
• Rectal Fissure, Inflammatory or ulcerative bowel disease
• Patients with poor fluid intake
Insert 1 enema rectally as required
• May occasionally cause local irritation
• Moisten with water before use
• Ensure patient has adequate fluid intake
• Ensure patients have sufficient fluid intake
• Dietary advice may be necessary if patient is prone to constipation
• Action may take 5 to 15 minutes to work
• Blood or mucus in their stools
• Elderly and debilitated
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication
Phosphate Enemas Altered normal bowel habit indicating constipation
4.Chlorphenamine
Maleate 4mg tablets
Symptomatic relief of allergy, such as:
• Seasonal allergic rhinitis (Hay fever)
• Allergic reaction resulting in rash, inflammation or itchiness
Insect bite or sting
• Patients with congestive heart failure
• May cause faecal impaction
• Patients with electrolyte imbalance
• Use with caution in renal impairment
• Prostatic hypertrophy
• Urinary retention
• Renal impairment
• Known severe liver disease
• Epilepsy
• On tricyclic antidepressants (e.g., Amitriptyline, Lofepramine)
• On MAOI’s or treated with MAOI in the last 14 days
• Glaucoma
• Previous anaphylaxis due to Chlorphenamine – do not give
Dose/Route/Frequency
1 enema rectally as required
• Local irritation may occur
• Ensure patients have an adequate fluid intake
One 4mg tablet orally
Take every 4-6 hours
Maximum 24mg daily
Side effects may include:
• Drowsiness, blurred vision, dry mouth, headache, inability to concentrate
• Gastro-intestinal disturbances
• Confusion may occur with oral use
• Avoid alcohol
• Do not use with other antihistamines
• Elderly more susceptible to side effects (consider a maximum dose of 12mg in 24 hours)
5.Simple Linctus (Sugar Free)
Dry, irritating cough
• Productive cough with purulent sputum
• Patient who appear unwell, with shortness of breath or wheeze, have liver disease/epilepsy/alcoholism
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
6.Cyclizine 50mg tablets
• Anti–emetic Nausea and vomiting
• Epilepsy
• Gastrointestinal obstruction,
• Heart failure
• Glaucoma
• Urinary retention
• Hepatic impairment
• Pheochromocytoma
• Prostatic hypertrophy
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
7.Co-codamol 8/500 (soluble) tablets (Codeine 8mg and Paracetamol 500mg tablets) Analgesia for pain not responding to paracetamol
• Acute respiratory depression
• Severe constipation
• Faecal impaction
• Taking other opiates (including Tramadol)
• Taking MAOI or has taken within previous 2 weeks
• Known liver disease
5ml orally, 3-4 times daily if needed
20ml in divided doses
• Product contains 4g sucrose per dose – take into consideration in diabetic patients
• Avoid if patient has fructose intolerance
50mg up to three times a day.
Max dose 150mg in 24hours
• Can cause agitation
• Drowsiness can affect ability to carry out tasks
• Avoid alcohol
• Hypersensitivity to the active substance or excipients
• Can cause antimuscarinic effects when given with other medications
• Can cause decreased level of consciousness
1 or 2 tablets dissolved in water before administration
Take orally
Repeat every 4-6 hours
Maximum of 4 doses a day
Side effects may include:
• Constipation
• Drowsiness
• Rash (rarely)
• Contains paracetamol – do not give with other paracetamol containing preparations
• Maximum 8 tablets in 24 hours
• May be given in conjunction with non-steroidal anti-inflammatories (NSAIDs)
• Not to be taken for more than 2 days without medical review
Paracetamol 500mg tablets
Paracetamol 500mg soluble tablets
Paracetamol 500mg suppositories
• Remember effervescent tablets contain sodium – avoid in patients with restricted sodium diets
• Avoid alcohol
• Patient with weight less than 50kg consider 1 tablet every 4-6 hours. Maximum of 4 tablets in 24hours
Mild to moderate pain associated with headache, muscle or joints Pyrexia
• Hepatic impairment
• Renal impairment
• Alcohol dependence
• Taking any other analgesia 500mg-1g (1 or 2 tablets) orally or 1-2 suppositories rectally
May be administered every 4 to 6 hours
Not more than a total of 4g paracetamol in any 24-hour period by any route
Based on weight
➢ Under 40kg - 500mg every 4-6 hours. Maximum four times a day and no more than 2g (2000mg) in 24 hours.
➢ 41-49kg -1000mg every 4-6 hours. Maximum three times a day and no more than 3g (3000mg) in 24 hours.
➢ 50kg+ -1000mg every 46 hours. Maximum four times a day and no
• Do not give if patient is prescribed any medication containing paracetamol, remember that paracetamol is an ingredient of medicines such as co-codamol (Solpadol, Zapain) and codydramol
• Not to be used without prescription in patients with liver failure, severe liver disease or alcohol abuse
• Remember effervescent tablets contain sodium
• Avoid soluble tablets in patients with restricted sodium diet and hypertension
• Avoid alcohol
• Avoid the use of soluble tablets due to sodium contents
8.Clotrimazole 1% cream Fungal infection of the skin
more than 4g (4000mg) in 24 hours.
If eGFR less than 30ml/min/1.73m2, the dosing interval must be a minimum of 6 hours.
• Apply 2-3 times daily
HOMELY REMEDIES FOR USE IN COMMUNITY
HOSPITAL WARDS
9. Dextrose
Liquid form (Dextrogel) 25g tube
Emergency treatment of hypoglycaemic attack
15-20g given by mouth
• Occasional skin irritation and may sting in acute fungal infection
• Continue to apply for 14 days after lesions have healed
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
Name Indication
10.Uriflex G/ Suby G Urotrainer
Maintenance of urinary catheter
Debris in urine
Blocked catheter unresponsive to Sodium Chloride 0.9% •
One unit via urinary catheter
As required to maintain the catheter
• Repeat after 10-15 minutes if necessary for a MAXIMUM of 2 doses
• Ensure patient has plenty of fluids and carbohydrates following recovery
• Seek medical advice where necessary
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• Regular use not advised unless there is regular blockage
• Leave in situ for a minimum of 20 minutes
11.Resource
Thicken UpClear
12.Hypromellos
e 0.3% Eye Drops
13 Sodium Bicarbonate 5% ear drops
Difficulty in swallowing normal fluid
Thickening agent
Lubricant for relief of dry eyes
Wax visible in ear canal
Difficulty in hearing
14.Oral Balance Gel Dry mouth (Xerostomia)
• No swallowing reflux present
• Eye infection
• Patients allergic to eye drop preservatives
• Pain and high temperature
• Discharge from ear
To be given orally in all food and drink taken by patient
As directed on the container
Use 1-2 drops up to 4 times daily
3-4 drops twice daily for 5 days
Half an inch as often as necessary, especially at night
• New guidelines for thickening of fluids for patients with swallowing difficulties: International Dysphagia Diet Standardisation Initiative (IDDSI)
• Occasional sensitivity and temporary blurred vision
• Do not apply when wearing soft contact lenses
• Occasional irritation and sensitivity
• Apply after brushing or rinsing mouth
• Lasts for up to 5 hours
• Sugar free
HOMELY REMEDIES FOR USE IN COMMUNITY HOSPITAL WARDS
15.Choline
Salicylate
Dental Gel BP
(Bonjela Sugar Free)
Painful mouth due to mild oral and perioral lesions (mouth ulcers)
• Suspected Candida infection
Half an inch of gel to be applied to the sore area of the mouth and massaged gently.
Do not use more often than once every 3 hours.
• Not to be applied to dentures
• Leave for at least 30 minutes before re-insertion of dentures
• Keep a separate tube per patient
• Not to be used in children under the age of 16 years
• Bronchospasm/asthma in susceptible patients
16.E45 Cream Emollient cream to sooth, smooth and hydrate skin in dry scaling disorders
17 Benzalkoniu
m Chloride 0.1% and Dimethicone 22.0% cream (Conotrane)
Barrier cream to protect skin
Maximum of 6 applications daily
• Suspected infection Apply a sufficient quantity to the skin 3 or 4 times a day, as necessary.
Apply in direction of hair growth to reduce the risk of folliculitis
• Broken areas of skin
• Known hypersensitivity to Benzalkonium chloride
16. Epaderm Cream Both an emollient (moisturiser) and a skin cleanser, working by hydrating skin and restoring its natural protective barrier
• Sensitive or allergic to any of the ingredients
• The skin is broken, infected, or weeping
A sufficient quantity to the sore area of skin several times a day as necessary
• Occasional sensitivity
• May be continued for duration of patient stay
• Keep separate tube per patient
• WARNING: Paraffin based emollient – Fire Hazard
• May cause local skin reactions (e.g., contact dermatitis)
Apply directly onto the skin in the direction of hair growth, this will reduce the risk of blocking hair follicles.
There is no limit to how much Epaderm you can use. The below is a guide and will vary based on body size and dryness of skin. Recommend to start with a smaller amount and build up to what is right for the skin.
• WARNING: Paraffin based emollient – Fire Hazard
• Do not smoke or go near naked flames
• Avoid contact with the eyes
• Epaderm Cream can be applied immediately after washing to counteract the loss of essential oils from the skin
• It should be applied generously and frequently –even when the skin has improved
Face, Ears, Neck 1/2 - 1 measure twice a day
Arms 1 - 2 measure twice a day
Back 1 - 2 measure twice a day
Torso 1 - 2 measure twice a day
Legs 3 - 4 measure twice a day
Hands 1/4 - 1/2 measure twice a day
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3. References
• BNF online
• Summary of Product Characteristics
• Electronic Medicines Compendium
• NICE – Managing medicines in care homes adapted for use in community health services
• MSEICB – Self-Care Toolkit for use in Care Homes