Topical Application Audit - Care Homes

Evidence to check

• • Current medicines policy is available and reviewed at least annually
• • Policy includes topical medicines, emollients, steroid creams, medicated patches and PRN topical products
• • Policy explains prescribing, application, recording, storage, disposal, consent and escalation
• • Staff can explain how topical medicines should be managed in practice

Evidence to check

• • Local topical medicines procedure or guidance is available
• • Procedure covers MAR/TAR use, body maps, opening dates, expiry dates and stock checks
• • Staff know how to reorder and report missing or discontinued items
• • Observed practice matches the local procedure

Evidence to check

• • Named clinical lead, nurse, senior carer or medicines lead is documented
• • Lead reviews topical audits, incidents, recording gaps and stock concerns
• • Actions from audits are tracked to completion
• • Staff know who to escalate topical medicine concerns to

Evidence to check

• • Topical medicines audit schedule is in place
• • Completed audits include MAR/TAR accuracy, body maps, storage, expiry dates and application practice
• • Actions have named owners and timescales
• • Follow-up confirms whether actions improved practice

Evidence to check

• • Governance minutes include topical medicines or skin care themes where relevant
• • Topical errors, omissions, wrong-site applications and skin reactions are analysed
• • Learning is shared through handovers, meetings, supervision or training
• • Care plans or procedures are updated after learning

Evidence to check

• • Incident reviews consider safeguarding, CQC notification and external reporting requirements
• • Rationale is recorded where referral or notification is or is not made
• • Serious harm linked to missed or incorrect topical treatment is investigated
• • Learning and protective actions are recorded

Evidence to check

• • Prescription or written direction is available for each topical medicine
• • Directions include exact site, frequency, route and duration where applicable
• • Instructions are not vague or unsafe
• • Staff do not apply prescribed topical medicines without clear authorisation

Evidence to check

• • PRN topical protocol is available and resident-specific
• • Protocol states indication, site, frequency, maximum use and when to escalate
• • Records show reason for application and effectiveness review
• • PRN use is reviewed if frequent or ineffective

Evidence to check

• • Homely remedy policy includes topical products where used
• • Authorisation is recorded before use
• • GP, pharmacist or nurse advice is documented where required
• • Use is reviewed and not continued indefinitely without oversight

Evidence to check

• • Allergy and sensitivity information is visible in MAR/TAR and care plan
• • Staff check allergy status before application
• • Known reactions to ingredients, dressings, adhesives or latex are recorded
• • Adverse reactions are escalated and documented

Evidence to check

• • Directions specify site, such as left lower leg, sacrum or under breasts
• • Body maps are used where more detail is needed
• • Ambiguous prescriptions are clarified with prescriber or pharmacist
• • Staff can identify the correct site before application

Evidence to check

• • Regular review dates are recorded for long-term emollients, steroid creams and other topical medicines
• • Potent steroid use is reviewed for duration, site and side effects
• • Prescriber or pharmacist review is sought where topical treatment continues without clear benefit
• • Discontinued or changed treatments are removed from current records

Evidence to check

• • Patch prescription includes strength, frequency and timing
• • Body map or rotation record is used
• • Old patch removal and new patch application are documented
• • Used patches are disposed of safely according to policy

Evidence to check

• • Skin assessment records are current
• • Assessment includes skin integrity, dryness, inflammation, wounds, infection risk and history
• • Assessment is reviewed when skin condition changes
• • Findings are linked to topical treatment plans

Evidence to check

• • Care plan states what is applied, where, when, how and why
• • Care plan reflects resident preferences, privacy and comfort needs
• • Prescription, body map and care plan are consistent
• • Staff can explain the resident's topical care needs

Evidence to check

• • Risk assessment identifies ingestion, patch removal, refusal or skin picking risks
• • Care plan includes monitoring and safe storage measures
• • Mental capacity, consent and least-restrictive approaches are considered
• • Incidents or repeated risks are escalated

Evidence to check

• • Staff seek consent before application
• • Decision-specific capacity assessment is completed where capacity is in doubt
• • Best-interest decision is recorded where the resident lacks capacity
• • Refusal or distress is respected, recorded and escalated where risk remains

Evidence to check

• • Care plan records topical application preferences
• • Staff respect modesty, privacy, gender preference and routine where possible
• • Preferences are reviewed when resident needs change
• • Residents are not exposed or rushed during application

Evidence to check

• • Topical treatment is linked to tissue viability or pressure care plan where relevant
• • Barrier creams, emollients or dressings are used according to guidance
• • Repositioning and pressure-relieving equipment plans are considered
• • Skin deterioration triggers review of both topical treatment and pressure care

Evidence to check

• • Care plan identifies diabetes, vascular disease or poor healing risk
• • Skin checks are completed at agreed frequency
• • Signs of infection, delayed healing or skin breakdown are escalated promptly
• • Professional input is sought where risk increases

Evidence to check

• • Training records include topical medicines where relevant
• • Competency checks cover application technique, MAR/TAR documentation and escalation
• • Staff understand high-risk topical medicines
• • Practice observations confirm safe application

Evidence to check

• • Delegation arrangements are documented
• • Carers have been trained and assessed as competent
• • Delegated tasks match staff role, policy and resident risk
• • Nurse or senior oversight is maintained

Evidence to check

• • Staff can explain which products require MAR/TAR recording
• • Toiletries and prescribed medicines are stored and labelled appropriately
• • Non-medicinal products are not used as substitutes for prescribed treatment
• • Any uncertainty is escalated to nurse, pharmacist or manager

Evidence to check

• • Staff can identify potent steroids, medicated patches or other high-risk topical medicines
• • Instructions for duration, site and amount are followed
• • Side effects such as thinning skin or irritation are monitored
• • High-risk topical medicines are reviewed by prescriber where needed

Evidence to check

• • COSHH or medicine safety guidance is available for hazardous topical products
• • PPE and exposure management instructions are followed
• • Staff know what to do following accidental exposure
• • Hazardous products are stored and disposed of safely

Evidence to check

• • Induction includes topical medicines procedure
• • New staff are shown how to use body maps and MAR/TAR charts
• • Staff are supervised until competent where required
• • Agency and bank staff receive relevant local guidance

Evidence to check

• • Observation or competency checks confirm correct application process
• • Staff check resident identity and product before application
• • Site and time are checked against prescription and body map
• • Wrong-site or wrong-product risks are monitored and acted on

Evidence to check

• • Observation confirms hand hygiene before and after topical application
• • Gloves and aprons are used based on risk and product type
• • PPE is changed between residents and tasks
• • Poor IPC practice is corrected promptly

Evidence to check

• • Topical products are labelled for individual residents where required
• • Shared tubs are not used unless policy allows and safe controls are in place
• • Products are not taken between residents inappropriately
• • Contaminated products are disposed of

Evidence to check

• • Staff avoid double-dipping fingers into tubs
• • Clean spatulas, pumps or single-resident containers are used where appropriate
• • Hands and gloves are changed between sites where needed
• • Application technique protects the resident's skin and product integrity

Evidence to check

• • Body maps are current and resident-specific
• • Patch rotation sites are clearly recorded
• • Multi-site treatments show exact areas to apply or avoid
• • Body maps are updated when treatment changes

Evidence to check

• • Staff understand prescribed amount or fingertip unit guidance where relevant
• • Application records match frequency and directions
• • Skin response is reviewed for effectiveness or irritation
• • Concerns about unclear dose or amount are clarified with prescriber or pharmacist

Evidence to check

• • Emollient use is recorded and applied as directed
• • Floors, bedding and clothing contamination are managed to reduce slip and fire risk
• • Residents and staff are aware of emollient fire safety risks where relevant
• • Excess product is avoided and cleaned where it creates hazards

Evidence to check

• • Patch site is clean, dry and intact before application
• • Patch rotation is documented on body map or patch record
• • Staff avoid irritated, broken or recently used sites where required
• • Skin under and around patch sites is checked

Evidence to check

• • Records show old patch removal and new patch application
• • Staff check resident skin to confirm no old patch remains
• • Patch removal is documented with date, time and staff signature
• • Missed patch removal incidents are reported and investigated

Evidence to check

• • Staff check for redness, burning, itching, blistering, pain or irritation
• • Resident verbal and non-verbal responses are considered
• • Adverse effects are recorded and escalated
• • Treatment is reviewed if discomfort or reaction occurs

Evidence to check

• • MAR/TAR charts are completed at the time of application
• • No unexplained gaps, late entries or pre-signing are present
• • Records are signed or electronically confirmed by the person applying
• • Documentation matches the prescription and care plan

Evidence to check

• • Records clearly identify product and strength
• • Application site is recorded, especially for patches and site-specific creams
• • Omissions, refusals and reasons are coded correctly
• • Records are clear enough for another staff member to understand what happened

Evidence to check

• • Omissions or refusals include reason and action taken
• • Re-offer or re-approach plan is documented where appropriate
• • Nurse, GP, pharmacist or prescriber is contacted where risk is significant
• • Repeated omissions or refusals trigger review

Evidence to check

• • Records describe worsening rash, broken skin, infection signs, pain, swelling or discharge
• • Senior staff or nurse is informed promptly
• • GP, TVN, pharmacist or dermatology referral is made where needed
• • Care plan and topical treatment are reviewed

Evidence to check

• • Consent for photographs is recorded
• • Photographs are dated, labelled and stored securely
• • Images are not stored on personal devices
• • Photography is used to monitor care, not as a substitute for written assessment

Evidence to check

• • Review notes describe whether inflammation, dryness, rash or wound condition is improving
• • Ineffective treatment is escalated for review
• • Long-term topical use has a clear rationale
• • Treatment is stopped when no longer required and records are updated

Evidence to check

• • Incident records include wrong product, wrong site, omission, overdose, patch error or contamination
• • Resident impact is assessed
• • Root causes are reviewed, including staffing, training, recording or unclear directions
• • Learning is shared and monitored

Evidence to check

• • Topical medicines are stored in appropriate medicine storage areas or resident-specific locations
• • Temperature requirements are followed where applicable
• • Medicines are separated from toiletries, food and cleaning products
• • Access is restricted where residents may misuse or ingest products

Evidence to check

• • Labels are clear and match current prescription
• • Opening dates are written on products where required
• • Expiry dates are checked
• • Unlabelled, unclear or expired products are removed and escalated

Evidence to check

• • Resident-specific baskets, cupboards or containers are clearly labelled
• • Products for different residents are not mixed together
• • Shared bathrooms or treatment areas do not create confusion
• • Staff check resident identity and product before use

Evidence to check

• • Stock checks are completed regularly
• • Low stock is reordered in time
• • Excess or duplicate stock is reviewed
• • Discontinued medicines are removed from current use promptly

Evidence to check

• • Disposal records are completed where required
• • Expired or discontinued products are removed from use
• • Contaminated products are disposed of promptly
• • Disposal follows medicines and waste policy

Evidence to check

• • Used patches are folded and disposed of safely according to policy
• • Clinical waste is used where required
• • Contaminated gloves, dressings or applicators are disposed of safely
• • Staff understand disposal risks for medicated patches

Evidence to check

• • Staff can identify redness, blistering, spreading rash, swelling, pain, heat, discharge or fever
• • Training or supervision covers adverse reaction escalation
• • Staff know when to stop and seek clinical advice
• • Concerns are documented and acted on

Evidence to check

• • Referral or contact records show timely escalation
• • Advice from professionals is documented
• • Care plan and MAR/TAR are updated following advice
• • Delayed responses are chased where risk remains

Evidence to check

• • Incident investigations review whether topical treatments were applied as prescribed
• • Repositioning, continence, nutrition, hydration and equipment are considered
• • Missed applications or wrong product use are identified where relevant
• • Learning leads to changes in care plan or staff practice

Evidence to check

• • TVN, OT, dermatology, GP, pharmacist or community nurse input is recorded where needed
• • Recommendations are added to the care plan
• • Staff follow professional guidance in daily practice
• • Recurrent issues are reviewed until improvement is achieved

Evidence to check

• • Handover includes new topical medicines, discontinued items, patch changes and skin deterioration
• • Staff are alerted to new body maps or changed application sites
• • Night and agency staff receive relevant updates
• • Handover information matches current care plan and MAR/TAR

Evidence to check

• • Staff understand repeated missed prescribed treatment may indicate neglect
• • Safeguarding threshold is considered for serious skin deterioration or repeated omissions
• • Rationale is recorded where safeguarding is considered but not referred
• • Immediate protective actions are taken

Evidence to check

• • Staff can give a real example such as skin reaction, omission, wrong site or patch error
• • Example includes escalation, resident support and documentation
• • Learning changed practice or care planning
• • Staff understand the importance of reporting topical issues

Evidence to check

• • Senior staff can show topical audit results and trends
• • Action plans include owners, deadlines and follow-up evidence
• • Improvements are measured through reduced omissions, fewer errors, better records or improved skin outcomes
• • Governance reviews progress and unresolved risks

Evidence to check

• • Audit includes observation of application technique where appropriate
• • Audit checks resident comfort, dignity, consent and skin condition
• • Records are compared with actual products, body maps and care plans
• • Actions lead to safer application and improved skin care outcomes

Evidence to check

• • Clinical reviews link topical treatment to pressure area care, continence, wounds and IPC
• • Topical treatment is considered when skin deteriorates or infection occurs
• • Care plans are joined up and not duplicated or contradictory
• • Professionals are involved where risks overlap