education
Supporting Training Initiatives
the otc
treatment clinic
Common conditions and their treatment options
This module has been endorsed with the NPA’s Training Seal as suitable for use by medicines counter assistants
as part of their ongoing learning. Complete the questions at the end to include in your self-development portfolio
module 189
Welcome to TM’s OTC
Treatment Clinic series. This
handy, four-page section is
specially designed so that
you can detach it from the
magazine and keep it for
future reference.
Each month, TM covers a
different OTC treatment area
to help you keep up-to-date
with the latest product
developments. In this issue,
we focus on nasal health
and hygiene. At the end of
the module there are
multiple choice questions
for you to complete, so your
progress can be monitored
by your pharmacist.
You can find out more in
the Counter Intelligence Plus
training guide.
The last six topics we have
covered are:
l Coughs
l Oral care
l Pregnancy-related skin
conditions
l Sore throats
l Headlice
l Irritable bowel syndrome
You can download previous
modules from
www.tm-modules.co.uk
Nasal health and hygiene
author: Jane Feely, PhD
for this module
OBJECTIVES: After studying this module, assistants will:
• Be familiar with the basic structure and function of the nose and sinuses
• Be familiar with common conditions that can affect the nose
• Know which OTC products can be recommended for common nasal conditions
• Know which customers should be referred to the pharmacist
• Be able to advise on lifestyle tips to help maintain good nasal hygiene.
Whether you’re in the habit of keeping it to the
grindstone, turning it up at things or even cutting
it off to spite your face, there’s no denying that the
subject of this month’s OTC Treatment Clinic is as
plain as the nose on your face! But joking aside,
how often do we actually stop and think about our
nose and all the things it goes through – especially
during the cold and flu season?
We may not give our noses a second thought
most of the time, but if we’re feeling stuffy and
congested, or if our nose just won’t stop running,
it certainly makes us feel under the weather. And
have you noticed that if you can’t smell properly,
your sense of taste is off too?
This month we’ll cover conditions like rhinitis,
nasal congestion, sinusitis and post-nasal drip – all
of which are likely to be affecting a fair number of
your customers this winter.
What does the nose do?
Well, the most obvious thing is our sense of smell.
When we smell something – good or bad –
molecules in the air we breathe stimulate special
nerve cells in the nose. These olfactory cells are
found in a small area high up in the nose and they
connect directly to the brain.
Many things can affect our sense of smell,
including a cold, smoking, some medicines, nasal
polyps or prolonged exposure to certain chemicals.
The nose also acts as a vital processing system,
treating the air before it enters the lungs.
The nose is able to achieve all of these actions
because of its specific structure.
The nasal structure
The nose is made up of a combination of bone
and cartilage. At the top, around the bridge, the
structure is bone. Towards the front, the nose is
mostly cartilage and this continues inside, where
a cartilage called the nasal septum divides the
nose into two halves. Air enters into each of these
halves through the nostrils. However, the nose
TM JANUARY 2013
PULL OUT AND KEEP
the otc treatment clinic
sinus cavities become blocked, bacteria in the
mucus may grow, leading to a sinus infection.
reflective exercise
Barry, 45, frequently travels by plane for
work, but suffers from congestion during the
flights. His partner read about something for
dry nose and Barry asks if you know what
this is. He does not take any medication and
does not suffer from any other conditions.
What would you recommend?
A nasal solution or spray based on saline or
seawater would be suitable. Such a product
can provide natural relief from nasal
congestion and would be useful for Barry as
he spends a significant amount of time in a
plane, which is a dry environment that could
be the cause of his stuffy nose.
What if:
Barry asks for a product for his six-month-old
son who, he says, has a slightly stuffy nose.
He has no other symptoms.
A saline or seawater preparation would be
suitable. Such products are generally suitable
for the whole family (but always check labels
first). Stérimar Baby has a specific nozzle with
a protective flange that prevents the spray
being inserted too far into the nose. This
helps to avoid the risk of injury in a baby or
child up to the age of three.
What if:
Barry asks for a decongestant tablet for a
blocked nose. He is taking lisinopril for high
blood pressure.
Decongestant tablets contain ingredients
such as phenylephrine and pseudoephedrine,
which are not recommended for people who
doesn’t stay divided. Towards the back of the
nose, the two nasal cavities join together
around the area called the nasopharynx. In this
area you’ll also find the adenoid tissue and the
Eustachian tubes, which link to the middle ear.
(We detailed this area in September’s issue of
TM, when we covered sore throats.) This is
also where the tear ducts drain, explaining
why your nose runs when you cry!
The side walls inside the nose include three
structures called turbinates. These are fingerlike projections of bone that divide the nasal
cavity into three, groove-like passages. These
increase the surface area inside the nose and
regulate the flow of air through the cavity.
The entire nasal cavity is lined with a
membrane that produces a thin film of clear
mucus. This helps humidify the air we breathe
PULL OUT AND KEEP
TM JANUARY 2013
have high blood pressure. Such a
product would not be suitable for Barry.
Refer him to the pharmacist who might
recommend either steam inhalation
(although care should be taken to avoid
scalding with hot water) or an OTC
product. Putting an inhalant on the
pillow at night can also provide relief.
What if:
Barry describes symptoms of pain
travelling from his nose to under his eyes.
He says that the discharge from his nose
is green.
This sounds like a case of sinusitis, with
possible infection. Sinusitis occurs when
the sinuses become blocked and is often
associated with a cold. Mucus produced
in the sinuses normally drains into the
nose. When mucus cannot drain from the
sinuses, bacteria in the mucus may grow,
leading to a sinus infection. Barry has
green nasal discharge, which suggests an
infection. He may require antibiotics and
should be referred to a GP.
What if:
The customer is a 25-year-old woman
who is suffering from a runny nose and
a headache.
A product containing an antihistamine
and an analgesic would help to dry up
the runny nose and treat the headache.
If the product you recommend contains
paracetamol, warn this customer not to
take any other product containing
paracetamol or at least to avoid doubling
up on the paracetamol dose.
in and traps particles like allergens, bacteria
and viruses. If the inside of the nose is too dry,
its various functions will be impaired.
The nasal cavity is also lined with millions
of tiny hairs called cilia. These hairs move in a
rhythmic fashion and work together to propel
particles and excess mucus out of the nose.
The sinuses
The sinuses are four pairs of air-filled cavities
found in the bones of the face, around the
nose and eyes.
The same mucus membrane that lines the
nasal cavity also coats the inside of the sinuses.
Mucus produced here drains into the nose.
Anything that blocks this drainage can lead to
a build up of pressure in the sinuses and this
can be felt as sinus pain or a headache. If the
Rhinitis (runny nose)
Rhinitis is the medical term for inflammation
and swelling of the mucus membrane inside
the nose. This inflammation increases the
amount of mucus produced and, as a result,
customers may complain of a runny nose.
Rhinitis can be defined by the duration
of symptoms:
l Acute rhinitis
This is a short-lived condition, often triggered
by a viral infection or an allergy.
Viral rhinitis is usually linked to the
common cold. Other possible viral culprits
include the flu virus, and illnesses like
bronchiolitis, chickenpox, rubella and measles.
In addition to a runny nose, sufferers may
complain of sneezing, nasal congestion,
post-nasal drip, cough and fever.
Allergic rhinitis is triggered by an allergic
reaction. The symptoms may be seasonal,
such as with hayfever, or year-round if the
allergen is pet dander or house dust mites.
Symptoms also include sneezing, itchy nose,
itchy or watery eyes and nasal congestion.
Some people suffer from what is termed
vasomotor rhinitis, where the blood vessels
in the nose are overly sensitive to things like
bright lights, cold temperatures, paint fumes,
spicy foods, stress, alcohol or tobacco smoke.
l Chronic rhinitis
This is a longer-lasting condition that may be
caused by any of the following:
• Atrophic rhinitis – the mucus membrane
inside the nose thins and hardens, causing the
nasal passages to dry out. This is more likely to
occur in the elderly and may be accompanied
by the formation of crusts inside the nose and
an offensive odour. Sufferers may also report
recurring nosebleeds and loss of smell
• Hormonal imbalance – e.g. during
pregnancy, puberty or when taking oral
contraceptives or hormone replacement
therapy. An underactive thyroid gland is
another possible cause
• Rhinitis medicamentosa – this is caused by
the overuse of nasal decongestants. You may
have heard it referred to as rebound
congestion. Nasal decongestants work by
reducing the swelling of the nasal mucosa, but
if they are used for too long they may cause
the lining or the nose to swell again, triggering
a re-emergence of symptoms.
Overlapping conditions
Many of the conditions discussed in this
module tend to have some degree of overlap.
In other words, it’s possible for someone with
rhinitis to also report nasal congestion or
someone with a stuffy nose to also suffer from
sinus pain.
the otc treatment clinic
Nasal congestion
Nasal congestion is another common
symptom of infections such as colds and flu.
It can also occur with allergies, hormone
changes during pregnancy and exposure to
irritants like tobacco smoke, etc.
However, nasal congestion can also be
linked to structural abnormalities, e.g. if the
nasal septum is deviated or bent or if there
has been an injury to the nose. In children,
enlarged adenoids are a common cause of
nasal congestion. The parent may report that
the child breathes through their mouth and
snores while asleep.
With young children, there‘s also the
possibility that they may have inserted a
foreign object into their nostril. Consider this
if the parent reports a foul-smelling discharge
draining from one nostril.
Sinusitis
The term sinusitis simply means that the
sinuses are inflamed and this is usually caused
by an infection or an allergy.
As mentioned, the sinuses are air-filled
spaces in the bones around the eyes and nose.
Normally, mucus drains through small
channels into the nose. However, if these
channels get blocked, the sinuses can become
congested and inflamed. The sinuses behind
the cheekbones are most commonly affected.
Sinusitis can be acute (symptoms last less
than 12 weeks), or chronic (condition persists
for longer). Symptoms may include:
l Pain or tenderness in the forehead, cheeks
or around the eyes
l Headache
l Fever
l A blocked or runny nose
l Cough
l Loss of smell or taste
l Bad breath.
In addition, nasal secretions may be
thick and range in colour from white to
yellow/green or even be tinged with blood.
Yellow or green mucus may be an indication
of a bacterial infection that requires antibiotics.
Post-nasal drip
Normally, all mucus secretions from the nose
drain to the back of the throat and are
swallowed in a process we’re not usually aware
of. However, sometimes a person may feel as
if mucus is accumulating at the back of the
throat. This is termed post-nasal drip.
Post-nasal drip may occur when a person
is suffering from a cold or an allergy. Excess
mucus production may mean they become
more aware of it draining at the back of the
throat. This drainage may also irritate delicate
tissues in the area and trigger coughing. If
the secretions from the nose are thicker than
normal, this may make it feel like it is slow to
drain or difficult to swallow. Thicker mucus
may be linked to a sinus infection, dry air or an
allergy to substances such as dairy products.
Post-nasal drip may also be experienced in
situations where the person has problems with
their throat muscles or are not swallowing
efficiently. Stress can be a factor here, as can
gastro-oesophageal reflux disease (GORD).
When to refer
Symptoms which are severe or last longer
than 10 days
l A fever lasting for more than three days
l Nasal discharge that is yellow/green and
accompanied by sinus pain or pressure
l Blood in the nasal discharge or a persistent
clear discharge after a head injury
l Change in vision or swelling around the
eyes
l Nasal congestion in a baby that causes
difficulty feeding
l A child who may have a foreign object
inside the nose
l Symptoms that initially improve but then
worsen
l Anyone taking prescribed medication for
a chronic medical condition
l Symptoms that persist despite the use of
appropriate OTC medication.
l
OTC treatment options
The OTC product of choice will depend on
the person’s symptoms and the cause of those
symptoms, although this may not always be
obvious. Ask the WWHAM questions and refer
to your pharmacist when necessary.
Also, check all product labels and draw
your customers’ attention to the correct
dosage instructions.
l
Seawater and saline nasal sprays
Nasal sprays based on seawater or saline can
be used to give natural relief from a number of
nasal conditions. For those who suffer from dry
nose, or who spend time in dry environments,
these sprays are also an option.
The Stérimar range offers nasal sprays
based on 100 per cent natural seawater that
are suitable for the whole family, including
babies and pregnant women. The products
can be used alone or with medication.
Stérimar Nasal Hygiene is an isotonic
solution (i.e. the solution has the same salt
concentration as cells in the human body),
which can be used two to six times a day, or
more if needed, for as long as required.
The stronger Stérimar Congestion Relief
is a hypertonic solution (i.e. the solution has
a higher salt concentration than cells in the
human body), which relieves congestion. It
can be used between two and six times a day
for a short period.
Stérimar Baby has a specific nozzle with a
Some topical decongestants can be
effective for up to 12 hours
protective flange that prevents the spray being
inserted too far into the nose. This helps to
avoid the risk of injury in children from birth
to three years of age.
Tixylix Saline Nasal Drops can be used to
relieve a dry, irritated or blocked nose. Vicks
First Defence Micro-Gel is a nasal spray based
on plant extracts that traps germs and helps
the body to remove them naturally.
l Decongestants
A blocked, stuffy nose can be relieved with
OTC decongestants:
• Oral decongestants
These work by constricting the blood vessels
in the lining of the nose. This reduces swelling
and opens up the nasal passages. As a result,
the person feels less congested and breathes
more easily.
Examples of oral decongestants include
phenylephrine (e.g. Non-Drowsy Sudafed
Congestion Relief Capsules, Non-Drowsy
Sudafed Decongestant Elixir) and
pseudoephedrine (e.g. Contac Non Drowsy
12 Hour Relief, Non-Drowsy Sudafed 12 Hour
Relief, Non-Drowsy Sudafed Children’s Syrup).
Both active ingredients are also available in
combination cold remedies or formulated with
an analgesic to relieve pain.
Decongestants are not usually
recommended for children under 12, for
women who are breastfeeding or for people
who have certain health conditions such as
high blood pressure. They should also be
avoided by anyone taking antidepressants
called monoamine oxidase inhibitors.
Concerns have been voiced over the
potential for misuse of products containing
ephedrine and pseudoephedrine. The Royal
Pharmaceutical Society advises that products
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the otc treatment clinic
containing these active ingredients should only
be sold by pharmacists or by suitably trained
pharmacy staff under the supervision of a
pharmacist. There are also limits on the
quantities that can be sold and it is illegal
to sell any pseudoephedrine product at the
same time as an ephedrine product.
• Topical decongestants
These are applied as sprays or nasal drops
and have a local action. Longer-acting topical
decongestants such as xylometazoline (e.g.
Non-Drowsy Sudafed Decongestant Nasal
Spray, Otrivine Nasal Spray range) and
oxymetazoline (e.g. Vicks Sinex Decongestant
Nasal Spray, Vicks Sinex Soother) are effective
for eight to 12 hours. Also available are
shorter-acting ingredients such as ephedrine
and phenylephrine (e.g. Fenox Nasal Drops).
Topical decongestants work quickly but
may cause rebound congestion if they are
used for long periods of time. To prevent this,
topical decongestants should not be used for
more than five to seven days. Check individual
product labels for details.
l Inhalants
A wide range of volatile substances or oils
are available in products that can be inhaled,
either directly or after being dissolved in hot
water, although with the latter method, care
should be taken to avoid scalding with hot
water. Breathing feels cooler, easier and
congestion is relieved after use. Common
examples include menthol, eucalyptus,
peppermint, pine oil and camphor. OTC
brands include Care Menthol & Eucalyptus
Inhalation, Covonia Vapor Drops, Happinose,
Karvol, Mentholatum Vapor Rub, Olbas,
Snufflebabe and Vicks.
l Combination cold remedies
These products combine different active
ingredients to target many cold and flu
symptoms. Products may include an analgesic
for aches, pains and fever, a decongestant for
a stuffy nose and possibly an antihistamine to
dry up nasal secretions or something to tackle
a tickly cough. OTC ranges include Beechams,
Benylin, Day Nurse, Lemsip and Vicks.
Combination products are certainly more
convenient than taking several different
medicines and those that come in hot drink
formulations may also add comfort value.
However, when recommending combination
products, be aware of the following:
• Make sure that the person can safely take
all of the ingredients in the product
• Avoid any unnecessary medication – e.g.
if the person doesn’t have a cough, don’t opt
for a product containing an expectorant or a
cough suppressant
• Avoid doubling up on ingredients – e.g. if the
combination product contains paracetamol,
customers should not take additional
paracetamol tablets for a headache
• ‘Night time’ products may cause drowsiness,
so alert customers not to drive or operate
machinery while taking these products.
l
Hayfever remedies
If the person’s nasal symptoms appear to be
allergy related, an antihistamine may be
recommended. We covered hayfever in detail
in the April 2012 issue of TM.
self-care tips
l Keep nasal passages moist by using
seawater or saline sprays, washes or drops
l Drink plenty of fluids (e.g. water, fruit
juices, fruit or herb teas or clear soups) to
help clear nasal congestion
l Steam inhalations, a hot steamy shower
or a vaporiser may help a stuffy nose
l Do not smoke and avoid smoky
atmospheres
l Be scrupulous about personal hygiene.
Cover the mouth when sneezing; wash
hands regularly; discard used tissues
immediately; don’t share kitchen utensils or
cups, especially when suffering from a cold
l For children, raise the head of the bed a
few inches or use extra pillows to ease any
breathing difficulties
l Use an OTC cold remedy appropriate to
the symptoms.
assessment questions: nasal health and hygiene
For each question, select one correct answer. Discuss your answers with your pharmacist.
1. Which of the following statements
is TRUE?
a) The only function of the human nose
is the sense of smell
n
b) The nose filters, humidifies and warms
the air we breathe
n
c) The human nose is totally made up of
cartilage – there is no bone
n
d) The inside of the nose needs to be kept
dry in order to carry out all of its functions
efficiently
n
2. Which of the following statements
is FALSE?
a) The sinuses are four pairs of air-filled
cavities found in the bones of the face
n
b) If anything blocks the drainage of mucus
from the sinuses, pressure can build up and
infection may result
n
c) Rhinitis is the medical term for
inflammation of the sinus cavities
n
d) Acute rhinitis is most likely linked to
a viral infection such as a cold, or to an
allergy like hayfever
n
3. Which of the following statements
does NOT apply to rhinitis?
a) Vasomotor rhinitis can be triggered
in sensitive individuals by things like
bright lights, cold temperatures
and spicy foods
n
b) Atrophic rhinitis occurs when the
membrane inside the nose thins and
hardens. It is a common concern in
younger children
n
c) Hormonal changes can affect the nose,
causing symptoms of rhinitis or nasal
congestion
n
d) The overuse of nasal decongestants
can cause rebound symptoms of rhinitis
and nasal congestion
n
4. Which of the following are possible
symptoms of acute sinusitis?
a) Pain or tenderness in the forehead,
cheeks or around the eyes
n
b) Fever
n
c) A blocked or runny nose
n
d) All of the above
n
5. Which of the following customers can safely
self-medicate with an appropriate OTC product?
a) A man in his early 40s reporting fever, sinus
pressure and a nasal discharge that is yellow/green
in colour
b) A teenager whose symptoms started to improve
but are now getting worse and have lasted longer
than 10 days
c) A young mother in her early 30s whose mild
seasonal allergies come with occasional nasal
congestion
d) A child whose mother suspects may have poked
a pea up his nose
n
n
n
n
6. Which of the following statements is TRUE?
a) Nasal sprays based on natural seawater can provide
relief from congestion, rhinitis, allergies and sinusitis n
b) There are no limitations on the duration of
treatment with OTC decongestants sprays
n
c) There is no danger of ‘doubling up’ on doses
with combination cold remedies
n
d) Allowing the nasal mucosa to dry out is a
recommended step in maintaining good
nasal hygiene
n
Warning: The content contained in this module is the copyright of Training Matters and cannot be reproduced without permission in the form of a valid written licence granted after July 1, 2011. Unbranded pictures copyright
Photodisc/Digital Stock/iStockphoto. Published under licence by Communications International Group Ltd, 162-168 Regent Street, London W1B 5TB. Tel: 020 7434 1530. Email: [email protected]
OTC treatment in practice
Common conditions and their treatment options
Stérimar
TM
For a cleaner, healthier nose
this winter... naturally
Nasal congestion can really get a person down – in fact, it is reported to be one of the most
bothersome symptoms of a common cold.1 But whatever the cause (a cold, sinusitis, allergic
rhinitis, etc), there is one brand UK doctors recommend to clear and cleanse the nasal
passages of excess mucus and unwanted contaminants – Stérimar.
Objectives
After reading this article, you should
be able to:
• Understand the causes of nasal
congestion
• Offer customers appropriate
treatment advice
• Understand the benefits of using a
natural seawater based nasal spray
• Know where to go to for free CPD
on nasal health.
Who can use Stérimar?
Stérimar is so gentle it can be used by any member
of the family – even newborn babies and pregnant
women.2 There are no known interactions with
medicines, and can be used by those who cannot
take medication.
• Stérimar Congestion Relief – a hypertonic spray
which is also suitable for children as young as
three and has the added benefit of helping to
relieve congestion, sinusitis, rhinitis and
rhinopharyngitis
• Stérimar Baby – a gentle, easy to use spray that
can be used from birth.
Key product features
What causes nasal congestion?
A blocked or stuffy nose can be caused by excess
mucus and our natural immune response to cold
and flu germs and allergens. While anyone can
suffer, children and babies can be particularly
susceptible since their nasal cavities are still
developing and there is less space for air flow in
the first place.
What is Stérimar and how does it work?
Tailoring the treatment
Stérimar is a 100 per cent natural solution of
seawater that comes in an easy to use
microdiffusion spray. Packed with beneficial sea
minerals, it has been clinically proven to cleanse the
nasal passages as well as clearing them of excess
mucus and unwanted contaminants before they
can cause problems.
There are three products in the Stérimar range,
which can help to ease certain nasal conditions and
allergies and keep the nose clean and healthy:
• Stérimar Nasal Hygiene – an isotonic spray which
can be used by adults and children, from the age
of three to provide relief from allergies, sinusitis,
rhinitis and chronic conditions
• Naturally washes away germs,
allergens and excess mucus
• Provides relief from nasal conditions
such as sinusitis and rhinitis
• Keeps the nasal passages in optimum
condition to help reduce the risk of
further infections or allergic reactions
• There is a product within the range
for every member of the family, from
pregnant women to small children
and newborn babies
• All products are 100 per cent natural,
are gentle on the nasal mucosa, and
have no contraindications with
medicines
• All products in the range are
available on prescription and are
recommended by doctors in the UK.
1. “A blocked and stuffy nose is one of the most bothersome symptoms of common cold” says the Common Cold Centre in Cardiff. http://www.cardiff.ac.uk/biosi/subsites/cold/commoncold.html
2. Check product specificities
ADAPTED FROM TRAINING MATTERS JANUARY 2013
promotion
Action points
• Ensure adequate stocks of each variety of
Stérimar, particularly at this time of year when
colds and flu are rife and congestion is often a
troublesome symptom
• Ensure new parents are aware that Stérimar is one
of very few clinically proven medications that can
be given to children and babies right from birth,
to ease congestion.
Scan the QR code to find out
how to use Stérimar.
The Stérimar Academy
The Stérimar Academy is a free
educational resource for healthcare
professionals. It offers a wide range of
business tools and CPD content for the
whole pharmacy team, including CPD
on colds and influenza. To find out
more, visit:
www.sterimaracademy.co.uk
In practice...
Claire Scott is a busy working mum
and has three young children.
She says they seem to catch one cold after another at this
time of year and that they particularly struggle with sleeping
at night. She asks if there is anything you can recommend,
even though her youngest has only recently turned one.
Firstly, you should reassure Claire that children are
more susceptible to colds as their immune resistance
to the cold and flu viruses is still at an early stage of
development. They are also more likely to complain
of congestion because their nasal cavities have yet
to fully develop.
Suggest that using Stérimar two to six times a
day, including before bedtime, could really help
clear their nasal passages – easing congestion so
that they can all get a better night’s sleep. And
because it is 100 per cent natural and based on
seawater, there should be no problems with using
Stérimar along with medication such as infant pain
relief suspensions if they have other cold-related
symptoms that also need addressing.
What product should you recommend?
Claire’s eldest two, being at school and nursery,
could benefit from using Stérimar Congestion Relief
(hypertonic) as it washes away cold and flu germs
before they develop. If they are already complaining
of being ‘bunged up’, it will help relieve congestion.
Meanwhile, Claire’s baby could be given Stérimar
Baby (isotonic) which comes in an easy to use spray
and is gentle enough to be used from birth.
Whichever product you recommend, emphasise
that keeping noses clean and clear with Stérimar
should have the added benefit of helping to reduce
the risk of further infection.
What other advice should you offer?
Key points
• Stérimar is the brand recommended by
UK doctors.
• Stérimar is available on prescription.
To help promote restful sleeping when the children
have colds, suggest they have a warm bath before
bed and are propped up slightly higher than usual
with an extra pillow. You should also let Claire know
that Stérimar is available on prescription, which
could save her some money – especially as she has
three children.
putting the OTC treatment clinic
into practice
Warning: The content of this module is the copyright of Training Matters and cannot be reproduced without permission in the form of a valid written licence granted after July 1, 2011. Unbranded pictures copyright
Photodisc/Digital Stock/iStockphoto. Published under licence by Communications International Group Ltd, 162-168 Regent Street, London W1B 5TB. Tel: 020 7434 1530. Email: [email protected]
THE MAGAZINE FOR PROFESSIONAL ASSISTANTS
ADAPTED FROM TRAINING MATTERS JANUARY 2013