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Bath & Shower Emollient Deprescribing

Estimated timings:
1-2 weeks to set up & run the project (steps 1-6)
1-2 months if including review (step 7)

This project is best carried out by a GP (qualified or trainee), a nurse or other allied healthcare professional

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Effective (Evidenced-based care)
  • Well-led (Learning, Improvement & Innovation)
  • Well-led (Environmental Sustainability)

On this page

The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Simplified self-care – same emollient for washing & moisturising
  • Improved compliance with treatment
Project benefits for Your Practice

Benefits for Your Practice

  • £2639/year per 100 patients whose bath/shower emollients stopped**
  • Reduced prescribing leading to decreased administration for prescriptions
Project benefits for The Planet

Benefits for The Planet

  • Reduced manufacture and waste from unnecessary medications

** Cost savings calculated based on Epimax original cream 500g and Hydromol Bath & Shower Emollient 500mL price Feb 2025.5  Assumes 28 day repeat prescribing of Epimax 500g and Hydromol 500mL switched to 28 day repeat prescribing of Epimax 1000g.  

Opportunity for improvement

  • Important: This is a quality improvement resource only and not clinical guidance. Users must follow local and national guidelines and review  disclaimers and carbon footprint methodology before starting. Clinical responsibility lies with the user.
  • NICE guidance states, ‘Do not offer emollient bath additives to children with atopic eczema’. Additionally, a recent study in the BMJ called the ‘BATHE study’ showed no evidence of clinical benefit from including emollient bath additives in the standard management eczema in children.  
  • Patients with eczema or other dry and pruritic skin conditions managed in general practice have no clinical need for added shower or bath emollients and should be informed that they can use their regular emollients for washing. NHS England has included bath and shower preparations for dry and pruritic skin conditions in their list of items which should not routinely be prescribed in primary care.
  • Deprescribing shower and bath emollients is included in the NHS England national medicines optimisation opportunity Addressing Low Priority Prescribing
  • This project outlines how to put these recommendations into practice and in so doing, reduce unnecessary prescribing, improve patient care, and reduce our impact on the environment.  You might like to create a SMART goal for this project e.g. to reduce the number of patients with a diagnosed dry or pruritic skin condition who have bath & shower emollient additives on repeat prescription by at least 90% within 1 month. 
  • If you work in England, check out your ICB or GP Practice Open Prescribing section on ‘Items which should not routinely be prescribed’.  This will tell you if this project is a high priority in your area.   

How to carry out this project

  1. Search for all patients with bath & shower emollient additives on repeat prescription

    Search for all patients diagnosed with eczema and bath & shower emollient additives on repeat prescription.

    If you work in a practice that uses SystmOne or EMIS and have access to Ardens, you will find the correct search for this project by searching for:

    SystmOne: Prescribing | Savings OTC – ?Stop bath or shower emollient

    EMIS: 2.25 Prescribing – Other (Ardens v4.9) –> Info – Drugs of low clinical value –> Recommendation 2 -> LCV: Emollient bath Additives

    If your practice doesn’t have Ardens access, our EMIS and SystmOne search guides can help with creating searches.  Practices using Vision may find this page helpful. 

  2. Training

    Educate prescribers on the guidance about using regular emollients as soap substitutes and not to prescribe any bath or shower emollients. This could be via an online training session and email communications.

    You could adapt these slides for the education session.  Many thanks to Isobel O’Neill and Alex Parker who created them.

    Resource: Emollient Prescribing Slideshow

    View

  3. Communicate with your local community pharmacists so they are aware of the change and can support with consistent messaging to patients about how best to use their medications. Your practice pharmacist will likely know how best to get in touch with the community pharmacists.

  4. You could speak to your IT team about adding a ‘pop-up’ if staff try to prescribe bath & shower emollients additives to remind them that patients can use their regular emollients.

  5. Review the notes of all patients found in step 1 and make the following changes:

    A. Any patients who had had their bath/shower emollient started by dermatology, and are still under dermatology care, should have their bath/shower emollient left on their repeats.

    B. Any patients who have a more complex background, or bath/shower emollients started by dermatology but now no longer under their care, were called by a GP or pharmacist for a discussion about stopping the bath/shower emollients.

    C. Any patients who had their bath/shower emollients started in general practice should have them stopped and be sent the following text:

    Resource:

    Please note your / your child’s bath or shower emollient will no longer be prescribed on prescription. Regular emollients e.g. Zerocream, Epimax cream, E45 etc, can be used as soap substitutes as well as a treatment for eczema or dry, itchy skin conditions. Bath & shower emollients are available to buy over the counter, should you wish to continue, but the BATHE study found no evidence of clinical benefit.

  6. Record how many patients had their bath/shower emollient stopped

  7. Study

    Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process. Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track. Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches. 

Top tip

This is an easy project for a student to do.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could upscale this project by working with your local ICB (England), Health Board (Scotland & Wales) or SPPG Pharmacy Advisor (Northern Ireland) to ensure local formularies do not recommend bath & shower emollients.   

You could take it to your Primary Care Network or Cluster to implement across all practices in your area.   

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and benefits. This project may help with CQC evidence submission (see disclaimers). 

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