Lactulose Sachets: Transforming our care home practice

Constipation is a major issue in care homes and is reported to affect up to 80% of residents (1). Lactulose is commonly prescribed on a daily basis for the condition. Ongoing treatment and medication administration creates a burden on nursing time.

“The administration of standard lactulose is a care home nightmare ? with the issue of messy, sticky bottles! We decided to address this problem by piloting the use of Lactulose Sachets to see if it made a difference to the day-to-day management in our local care homes,” said Lindsay Gracey, a Ballymena pharmacist, who services 11 care homes in the local area.

One local care home, Lindsay Gracey serves, currently has 45 residents, with at least 80% on routine lactulose. The care home manager explained, “The sachets have transformed the way we provide lactulose to our residents. It is so much easier using the simple single dose sachet ? less messy and far less time consuming than measuring out the correct amount from a bottle each time. Lactulose Sachets are very easy to give – just tear open the sachet, empty the contents on to a spoon and give it to the resident.”

The home uses both bottles and sachets and is trialling sachets for ease of storage, administration and auditing purposes.

Currently the home uses two types of trolley; one which allows bottle storage in the doors, and the other where the trolley has a cube for each patient and a neat box of Lactulose Sachets can be stored with their other medications. Alternatively all the residents’ prescribed lactulose can have a box placed in a single cube together, as this is also very tidy and space efficient.

With the old ‘bottle system’, the process of accurately determining the amount left in the bottle is difficult, time consuming and messy. In comparison, the simple process of counting the sachets in the box and confirming this matches the administration record is accurate, clean and convenient.

“As most residents are on multiple medications, a box of sachets can be stored easily with the individual’s other medication. The problem with lactulose bottles is that they are often sticky, causing hygiene and contamination problems with other medications”, the care home manager said. “The staff like using the sachets for ease of administration. The single dose lactulose sachet is the way forward as it is so much easier to administer and more efficient – with the bottles it is so time-consuming continually having to stop to wipe bottles and clean hands.”

Another major advantage of switching to the Lactulose Sachets is for the weekly or monthly audit. “It saves me valuable time because I can easily check off the use on the individual residents’ administration sheet versus what medication has been used from a box of sachets. With the old system I have to reconcile the amount that is left in a bottle versus the administration sheets and this is difficult when lactulose is stored in dark brown bottles. Checking the amount is not very accurate as usually I have to estimate roughly what is left in the bottle – this is a time consuming procedure.”

Lindsay Gracey concludes, “Using the Lactulose Sachets has transformed the daily practice in this busy care home, and we hope more of our care homes will benefit from using the sachets in the future.”

For further information on Lactulose Sachets please visit www.intrapharmlabs.com or contact: Marisa Broadbent at Intrapharm Laboratories – marisam@intrapharmlabs.com – 01628 771800

1. Potter J and Wagg A, ‘Management of bowel problems in older people: an update’, Clin Med, 2005, vol. 5, no. 3, pp. 289-95.