Topical Application Audit - Care Homes

Q1 | Unanswered

Is there a current Medicines Management policy that includes topical medicines (creams, ointments, gels, lotions, patches) and is it reviewed at least annually?

Q2 | Unanswered

Is there a clear local procedure for ordering, receiving, storing, administering, recording, and disposing of topical medicines?

Q3 | Unanswered

Is there a named lead responsible for topical medicines oversight (e.g., clinical lead) and audit follow-up?

Q4 | Unanswered

Are topical application audits completed at a defined frequency and documented (findings, actions, owners, deadlines)?

Q5 | Unanswered

Are learning themes from topical errors/skin-related incidents reviewed in governance meetings and shared with staff?

Q6 | Unanswered

Are CQC notifications and safeguarding referrals considered where topical medicine issues contribute to serious harm?

Q7 | Unanswered

Are all topical medicines applied under a valid prescription or written direction (including dose, site, frequency, duration)?

Q8 | Unanswered

Where PRN topical products are used, is there a clear protocol (when to apply, maximum frequency, review date)?

Q9 | Unanswered

For OTC / ‘homely remedy’ topical products (if used), is authorisation in place in line with policy and GP/pharmacist guidance where required?

Q10 | Unanswered

Are allergies, sensitivities, and contraindications clearly recorded and checked prior to application?

Q11 | Unanswered

Do directions specify exact anatomical sites (e.g., ‘left lower leg only’) and avoid ambiguous instructions (e.g., ‘apply thinly’ without site detail)?

Q12 | Unanswered

Is there a review process for ongoing topical prescriptions (e.g., emollients, steroid creams) to avoid long-term inappropriate use?

Q13 | Unanswered

Are transdermal patches prescribed with clear timing, rotation schedule, and safe disposal instructions?

Q14 | Unanswered

Is there a current skin assessment for each resident receiving topical treatments (including integrity, risks, and history)?

Q15 | Unanswered

Is the topical application care plan person-centred and aligned with the prescription (what, where, when, how, and why)?

Q16 | Unanswered

Are risks assessed for residents who may remove creams/patches, ingest products, or resist application?

Q17 | Unanswered

Is capacity and consent assessed for topical treatments, with best-interests decisions recorded where required?

Q18 | Unanswered

Are preferences recorded (timing, preferred staff gender if relevant, comfort considerations, privacy needs)?

Q19 | Unanswered

For residents with pressure area risk, is topical treatment aligned with tissue viability guidance and repositioning plans?

Q20 | Unanswered

For residents with diabetes/vascular issues, is additional monitoring in place for skin healing and infection risk?

Q21 | Unanswered

Are nurses/qualified staff applying prescribed creams competent and trained in topical medicine administration and documentation?

Q22 | Unanswered

Where application is delegated to carers (if applicable), is delegation appropriate, documented, and competency-assessed?

Q23 | Unanswered

Do staff understand the difference between medicinal creams (prescribed) and general toiletries (non-medicinal)?

Q24 | Unanswered

Are staff aware of high-risk topical medicines (e.g., potent steroids) and safe use requirements?

Q25 | Unanswered

Do staff understand safe handling of cytotoxic/irritant products if any are used (PPE, exposure management)?

Q26 | Unanswered

Are new staff inducted into topical application processes, including use of body maps and MAR/TAR recording?

Q27 | Unanswered

Do staff consistently follow the ‘rights’ of medicines for topicals (right person, right product, right dose/amount, right site, right time, right route)?

Q28 | Unanswered

Is hand hygiene performed before and after each application, and gloves/aprons used appropriately?

Q29 | Unanswered

Are separate, individualised products used where required (e.g., avoiding shared tubs unless policy permits safe single-person use)?

Q30 | Unanswered

Is cross-contamination prevented (e.g., using clean spatulas, no double-dipping fingers into tubs, appropriate pump dispensers)?

Q31 | Unanswered

Are body maps used consistently to indicate application sites and rotation (especially for patches and multi-site treatments)?

Q32 | Unanswered

Are topical quantities applied as directed (e.g., fingertip unit guidance where relevant) and not over/under applied?

Q33 | Unanswered

Are emollients applied safely with consideration for slip risk on floors and resident mobility?

Q34 | Unanswered

Are patches applied to clean, dry, intact skin and rotated appropriately to prevent irritation and dosing issues?

Q35 | Unanswered

Are old patches removed before new patches are applied, and is removal documented?

Q36 | Unanswered

Are residents observed for discomfort, reactions, or adverse effects during and after application?

Q37 | Unanswered

Are topical administrations recorded immediately and accurately on MAR/TAR charts after each application?

Q38 | Unanswered

Do records include the product name, strength, site, time, initials/signature, and any codes for omission/refusal?

Q39 | Unanswered

Are omissions/refusals documented with reasons and appropriate escalation (re-offer plan, nurse/GP/pharmacist contact)?

Q40 | Unanswered

Where skin conditions change (worsening rash, broken skin, infection signs), is this documented and escalated promptly?

Q41 | Unanswered

Are photographs (if used) managed with consent, governance, and secure storage in line with policy?

Q42 | Unanswered

Is there evidence of review notes for effectiveness (e.g., reduction in inflammation, healing progress) and ongoing need?

Q43 | Unanswered

Are topical incident/error reports completed when required (wrong site/product/omission), with learning recorded?

Q44 | Unanswered

Are topical medicines stored securely and appropriately (including temperature requirements and away from food/toiletries)?

Q45 | Unanswered

Are all topical products labelled correctly with resident name (where required), directions, and expiry/opening dates?

Q46 | Unanswered

Are multi-occupancy areas protected from mix-ups (e.g., clearly separated resident baskets, clear labelling on containers)?

Q47 | Unanswered

Is there a process to monitor stock levels to prevent running out or over-ordering topical products?

Q48 | Unanswered

Are products disposed of safely when expired, discontinued, contaminated, or no longer required?

Q49 | Unanswered

Are sharps/clinical waste arrangements appropriate for patch disposal and contaminated materials?

Q50 | Unanswered

Are staff trained to recognise signs of infection or adverse reactions (redness, blistering, spreading rash, swelling, pain, fever)?

Q51 | Unanswered

Is there prompt escalation to GP/tissue viability/dermatology services where deterioration occurs?

Q52 | Unanswered

Are pressure ulcers, skin tears, or dermatitis incidents investigated for contributory factors, including topical regimen adherence?

Q53 | Unanswered

Where residents have recurrent skin issues, is there evidence of multi-disciplinary input (TVN, OT, dermatology, pharmacy)?

Q54 | Unanswered

Is there an effective handover process for communicating changes in topical regimens and skin observations between shifts?

Q55 | Unanswered

Are safeguarding concerns raised where poor topical care may indicate neglect or repeated missed treatments?

Q56 | Unanswered

Can staff describe a recent topical-related issue (e.g., skin reaction or omission) and how it was managed and learned from?

Q57 | Unanswered

Can a senior staff member provide evidence of topical audit outcomes, action plans, and measurable improvements over time?