Role Preparation for Health Information Advisors Handling Medicines Calls Day 1

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.


Learning Outcomes


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.


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


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


Afternoon Timetable

1.30 Overview of handling medicines calls Workshop 3: Practice medicines calls

3.30 Tea Break Community Pharmacy

4.00 Close


Why are Medicines Information Skills needed?

Therapeutic and information explosion 6% calls for information/advice on medicines. 40% answers included advice about medicines.


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.


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.


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.


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.


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.


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


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?”


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?


Morning Timetable

10.30 Introduction




11.30 Tea break


1.00 Lunch


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


Naming medicines

Generic Brand

Amoxicillin Amoxil®

Salbutamol Ventolin®

Fluoxetine Prozac®

Omeprazole Losec®

Mefloquine Lariam®


“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


Brand names

Many preparations have the same brand attached to slightly different products

Paracetamol, Pseudoephedrine & Diphenhydramine

Guaifenesin Levomenthol

Diphenhydramine Levomenthol

Dextromethorphan


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


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


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


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


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.


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.


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


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


Tea Break


Morning Timetable

10.30 Introduction




11.30 Tea break


1.00 Lunch


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


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


Lunch Break


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


Handling a Medicines Call

Clarify the question

Plan search strategy& research problem

Evaluate the information

Tailor the answer/advice

Refer to MI

Call record


The Iceberg Theory

This is what the caller may ask

This is the rest of the story!! ?


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


Key information sources

eBNF / BNFC

Electronic Medicines Compendium (eMC)

Netdoctor

NHSD Medicines Q&As

Medicines Chest Online


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


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.


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 of UK Medicines Information Service (UKMI)

Speed Dial 004 Mon- Fri 9am - 8.00pm Sat & Sun 9am - 3pmexcept Bank Holidays


Workshop 3: 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


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.


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


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


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.


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.


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


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.


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.


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.



Learning Outcomes


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.

Documents

Role Preparation for Health Information Advisors Handling Medicines Calls Day 1