Post on 22-Dec-2015
Role Preparation for Health Information Advisors
Handling Medicines CallsDay 1
NameCentre Medicines Information Service
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Learning Outcomes
1. Have an overview of NHS Direct policies for medicines calls and roles of staff.
2. Have a baseline knowledge about medicines.
3. Have an overview of Community Pharmacy services and emergency supply of medicines.
4. Be able to handle medicines calls safely and effectively.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Learning Outcomes
4. Be able to handle medicines calls safely and effectively.
Know what background information is needed to clarify the question and minimise the risks when advising the caller.
Be able to navigate the key medicines information sources and be aware of their merits and disadvantages.
Be able to interpret information about medicines and turn it into appropriate advice.
Know when and how to refer medicines calls to UKMI.
Be able to use the NHS Direct Medicines Algorithm.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Outline of training
Day 1
NHSD policies for medicines calls and roles of staff
Baseline knowledge about medicines
Navigating key medicines information sources
Practice medicines calls
Overview of community pharmacy
Day 2
Adverse effects
Drug interactions
Medicines in pregnancy
Medicines when breastfeeding
Medicines Algorithm
Areas of risks when handling medicines calls
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Morning Timetable
9.30 Introduction
NHS Direct Policy for medicines calls
Workshop 1: Ethical dilemmas
Baseline knowledge for medicines calls
10.30 Tea break
Workshop 2: Navigating the eBNF, BNFC eMC, netdoctor & NHSD Medicines FAQs
12.45 Lunch
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Afternoon Timetable
1.30 Overview of handling medicines calls Workshop 3: Practice medicines calls
3.30 Tea Break Community Pharmacy
4.00 Close
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Why are Medicines Information Skills needed?
Therapeutic and information explosion 6% calls for information/advice on medicines. 40% answers included advice about medicines.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
NHSD Policy for Medicines Calls
The policy covers Definition of a medicine call. Principles for handling
medicines calls. Guidance for specific types of
medicines calls. Approved information
sources. Record keeping and
documentation. Standards and quality
assurance. Training and development.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
What is a Medicines Call?
Questions about Prescribed medicines. Medicines bought from
a pharmacy or shop.
But also Herbal medicines. Homeopathic
medicines. Food supplements and
vitamins. Recreational drugs and
drugs of misuse e.g. cannabis, Ecstacy, steroids in sport.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Principles for medicines calls
Everyone is entitled to be involved in decisions about whether a medicine is right for them and to choose a different option if they prefer.
Everyone will be able to get the medicines information they want and need, from whatever source they choose.
Doctors, nurses pharmacists and other healthcare professionals will be supported to help patients/carers be involved in decisions about medicines and the effective use of their medicines.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Guidance for specific types of medicines call
Therapeutic choice
Avoid naming a specific medicine if referring to another HCP.
Identification Identification of a “tablet” can not be done over the phone. Refer to pharmacist.
Repeat medication
Make sure there has been no sudden increase in use due to worsening symptoms.
Third-party & intermediary Be careful not to break patient confidentiality.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Information sources
Consult the eBNF for all medicines calls.
Use only if an NHS Direct approved information source.
NAs - may use just one information source if confident this is the best source.
HIAs - confirm in a second information source unless using a designated sole source e.g. NHSD Medicines Q&A.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Roles of NHS Direct staff when handling medicines calls
Health Advisors P4 “Quick Calls”: information on access Locations & opening hours of pharmacies, family
planning clinics, walk-in centres. Where can I get EHC. How do I get a repeat prescription. How do I get a new oxygen cylinder.Interim information on Low Toxicity ingestionsInterim care instructions for dental pain
Health Information Advisors
P4 Calls: Information about medicines No new or worsening symptoms.
Nurse Advisors P1-4 Calls: Advice or information about medicines Symptoms. No new or worsening symptoms.
Dental Nurse Advisors
Information about medicines for dental conditions
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Streaming of P4 medicines calls
P4QC Quick calls about access to
medicines.e.g. “Is there a pharmacy close to me that is open?”
M1 Assess
within 20 mins
Caller upset or very anxious. Not usually for complaints or
angry callers.
e.g. Caller crying.
M2 Assess
within 1 hr
Urgent medicines call - answer needed before the next dose.
Goes to the First Advice Queue after HI service closes at 8pm.
e.g. “Can I take paracetamol with amoxicillin?”
M3 Assess
within 4 hr
All remaining medicines calls. After HI closed, remains in HI
Queue until the next day. Advise caller that HI is closed so
will be answered next day.
e.g. “What vaccinations do I need for a trip to Africa in a few months time?”
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Workshop 1: Ethical Dilemmas
A man asks how long cocaine stays in the body. He used some cocaine at the weekend but is due to have a drug test tomorrow.
What advice would you give?
A woman says she has found some medicines in her son’s room. She reads the labels - lamivudine, zidovudine & lopinavir / ritonavir.
Can you tell her what they are for? Would your answer be different if the call was from his wife?
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Morning Timetable
10.30 Introduction
NHS Direct Policy for medicines calls
Workshop 1: Ethical dilemmas
Baseline knowledge for medicines calls
11.30 Tea break
Workshop 2: Navigating the eBNF, BNFC eMC, netdoctor & NHSD Medicines FAQs
1.00 Lunch
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
What’s in a medicine?
Active ingredient
Excipientse.g. bulking agents, tablet coatings, colours, flavours, stabilisers, pH adjusters.
Form e.g. tablet, capsule,
suppository, injection, cream, patch, eye drops
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Naming medicines
Generic Brand
Amoxicillin Amoxil®
Salbutamol Ventolin®
Fluoxetine Prozac®
Omeprazole Losec®
Mefloquine Lariam®
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
“Co-” medicines
Co-amilofruse Amiloride & furosemide Diuretic
Co-careldopa Carbidopa & levodopa For Parkinson’s Disease
Co-amoxiclav Amoxicillin & clavulanic acid
Antibiotic
Co-dydramol Dihydrocodeine & paracetamol
Painkiller
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Brand names
Many preparations have the same brand attached to slightly different products
Paracetamol, Pseudoephedrine & Diphenhydramine
Guaifenesin Levomenthol
Diphenhydramine Levomenthol
Dextromethorphan
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Marketing Authorisation “Product Licence”
Granted by MHRA if Safety, Quality, Efficacy shown.
Key aspects in Summary of Product Characteristics (SPC) found in the electronic Medicines Compendium (eMC) ww.medicines.org.uk
Prescribing outside the SPC (licence) is the responsibility of the doctor.
Medicines & Healthcare Products Regulatory Authority
www.mhra.gov.uk
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Unlicensed medicines
Off LabelUK product licence but being used for an indication / at a dose / by a route not in the licence.
No LicenceNo UK product licence.
Patient must give informed consent
e.g. Methotrexate for asthma and lupus
Patient must give informed consent
e.g. Thalidomide, most herbal products
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Legal classification of medicines
General Sales List GSL
May be sold in general shops e.g. Paracetamol (packs of 16)
Pharmacy OnlyP
May be sold in a pharmacy but not a general shop e.g. Ranitidine
Prescription OnlyPOM
May only be supplied on prescription e.g. Amoxicillin
Prescription Only Controlled Drug
POM CD
May only be supplied on prescription, harmful / prone to misuse e.g. Morphine
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Reclassification of medicines
POM P
Simvastatin
Omeprazole
Sumatriptan
Chloramphenicol eye drops
P GSL
Paracetamol suspension
Ibuprofen syrup
Aciclovir cream
Clotrimazole pessaries
Cetirizine liquid
Chlorpheniramine tablets
New focus to encourage wider availability of medicines as soon as adequate evidence of safety
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Misuse of Drugs Act
Prohibits production, supply or possession of certain substances.
Class A e.g. heroin, LSD, ecstasy, morphine, remifentanil.
Class B e.g. amphetamines, barbiturates, codeine.
Class C e.g. anabolic steroids, cannabis, growth hormone.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Black Triangle medicines
Newly licensed.
Monitored intensively by Committee for Safety of Medicines (CSM) which reports to MHRA.
Black triangle status usually reviewed after 2 years.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Medicines that may not be prescribed within NHS
Sometimes known as the Black List.
Pricing Prescription Authority (PPA) will not reimburse dispensing cost to pharmacist.
NHS
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Medicines that may be prescribed in certain circumstances
Sometimes called the Selected List.
Cost of dispensing reimbursed only if GP has endorsed the script “SLS”.
SLSe.g. Viagra for erectile
dysfunction
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Morning Timetable
10.30 Introduction
NHS Direct Policy for medicines calls
Workshop 1: Ethical dilemmas
Baseline knowledge for medicines calls
11.30 Tea break
Workshop 2: Navigating the eBNF, BNFC eMC, netdoctor & NHSD Medicines FAQs
1.00 Lunch
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Workshop 2: Navigating eBNF, eMC, netdoctor & NHSD Q&As
www.medicines.org.uk
www.netdoctor.co.uk
nww.nhsdirect.nhs.uk
www.medicinescomplete.com
www.medicinescomplete.com
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Merits / Disadvantages
Merits Disadvantages
eBNF
BNFC
Gold standard Some opinion
Care when searchingJargon
eMC
Easy to searchComprehensive info
TechnicalUnlicensed / off label Not all medicines
netdoctor
Easy to searchLayman’s termsUse, side effects, drug interactions
PregnancyBreastfeeding
NHSD Meds Q&A
Saves timeDifficult to find info
Limited numberNeed prompt updating
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Afternoon Timetable
1.30 An overview of the process for handling medicines calls Workshop 3: Practice medicines calls
3.30 Tea Break
Community Pharmacy
4.00 Close
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Handling a Medicines Call
Clarify the question
Plan search strategy& research problem
Evaluate the information
Tailor the answer/advice
Refer to MI
Call record
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
The Iceberg Theory
This is what the caller may ask
This is the rest of the story!! ?
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Essential questions to ask
Allergies?
Conditions or diseases?
Medicines? Name, dose, frequency of all medicines? What prescribed for? OTC, complementary, oral contraceptive pill?
Pregnant? No. of weeks, going well, medicine taken already?
Breastfeeding? Baby’s age, term/pre-term, well/unwell, medicine taken already?
Confirm no new or worsening symptoms
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Key information sources
eBNF / BNFC
Electronic Medicines Compendium (eMC)
Netdoctor
NHSD Medicines Q&As
Medicines Chest Online
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Standard Search Strategies
Pointers to the best sources available to answer particular types of medicines call.
Not a definitive list of sources and should check other sources as appropriate.
No need to check every source in the search strategy for every call.
Encourage best practice and sharing of expertise
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
What should be documented?
Website e.g. eBNF, eMC, netdoctor
All places looked including those where no information was found.
Web page link / brief detail of the information found.
Brief detail of what was said to caller.
Is warfarin safe in 1st trimester of pregnancy?
eBNF: Link.eMC: No monograph.netdoctor: Link.Toxbase: Link.
Advised caller that warfarin is known to cause foetal malformations if taken during pregnancy. Speak to GP by end of the day.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Referral to UKMI
Complex medicines call.
3 or more prescription medicines.
Medicines in pregnancy & breastfeeding unless there is a NHSD Medicines Q&A.
No information can be found.
The information found is unclear or conflicting.
Not within your competency.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Role of UK Medicines Information Service (UKMI)
Speed Dial 004 Mon- Fri 9am - 8.00pm Sat & Sun 9am - 3pmexcept Bank Holidays
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Afternoon Timetable
1.30 An overview of the process for handling medicines calls Workshop 3: Practice medicines calls
3.30 Tea Break
Community Pharmacy
4.00 Close
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Community Pharmacy Services
Specialist in medicines and no appointment necessary.
6 million people visit a pharmacy every day.
NHS could save £380 million/year if 1 in 4 people consulted their pharmacist about minor ailments instead of their GP.
Extended hours – 100 hour pharmacies.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
What services do community pharmacies offer?
Standard services Advising on medicines Dispensing & repeat
prescriptions Selling OTC medicines Patient records Sale or supply of EHC Emergency supply of
medicines Health promotion campaigns Disposal of medicines
Specialist services Medicines use review Smoking cessation Needle exchange schemes Nursing Care Home support Supervised administration of
medicines Anticoagulant clinics
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Staff in a community pharmacy
Counter assistants
Trained to sell and advise on medicines when supervised by a pharmacist.
NVQ training, follow protocols.
Dispensing technicians
Trained to dispense prescriptions, checked by pharmacist.
NVQ / BTEC training.
Pharmacist Responsible for all sales and supply of medicines.
Degree & pre-registration year/exam.
Pharmacist must be present for sale/supply of medicines
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
NHS prescription charges
£7.10 for each item
Irrespective of cost to NHS of medicine.
Irrespective of the quantity prescribed.
Various charges for combination products.
Pre-payment certificates forms available from the pharmacy or via PPA website.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Prescription charge exemptions Under 16 years. 16, 17 or 18 yr in full time education. 60 or over. Maternity Exemption certificate. Medical Exemption certificate. War Pension exemption certificate. Prescription Prepayment certificate. On a NHS Charge certificate (HC2). Free of charge oral contraceptives. Income Support or Income Based
Jobseekers Allowance. NHS Tax Credit exemption
certificate. Partner gets Pension Credit
Guarantee.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Emergency supply of medicines by a pharmacist
Pharmacist must interview the person Immediate need and impractical to obtain prescription Previously prescribed for the person Dose appropriate for the person
Supply up to 5 days except Insulin, ointment, cream, drops, inhaler – smallest pack Oral contraceptive - a full cycle Antibiotic - a full course of treatment
Can not supply a Controlled Drug Except phenobarbitone for epilepsy
Charge to patient
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Emergency supply of medicines by a pharmacist
Advice to the caller Person requiring the medicine must go to the
pharmacy. Go to your usual pharmacy if possible. Take evidence of the medicine (e.g. repeat
prescription slip, empty box/bottle). Take personal identification. There will be a charge. Pharmacist makes a professional judgement and
may refuse a supply.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Emergency Hormonal Contraception (EHC)
Sell EHC Cost to patient. Subject to national restrictions e.g. patient age.
Supply EHC by local arrangement Free to patient. Local funding and guidelines (PGDs). May
include under 16 years. Subject to pharmacist training.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Learning Outcomes
1. Have an overview of NHS Direct policies and roles of staff for Medicines Calls.
2. Have a baseline knowledge about medicines.
3. Have an overview of Community Pharmacy services and emergency supply of medicines.
4. Be able to handle medicines calls safely and effectively.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Learning Outcomes
4. Be able to handle medicines calls safely and effectively.
Know what background information is needed to clarify the question and minimise the risks when advising the caller.
Be able to navigate the key medicines information sources and be aware of their merits and disadvantages.
Be able to interpret information about medicines and turn it into appropriate advice.
Know when and how to refer medicines calls to UKMI.
Be able to use the NHS Direct Medicines Algorithm to support handling of medicines calls.