Role Preparation for Health Information Advisors Handling Medicines Calls Day 1

1
Role Preparation for Health Information
AdvisorsHandling Medicines CallsDay 1

• Name
• Centre Medicines Information Service

2
Learning Outcomes

• Have an overview of NHS Direct policies for
  medicines calls and roles of staff.
• Have a baseline knowledge about medicines.
• Have an overview of Community Pharmacy services
  and emergency supply of medicines.
• Be able to handle medicines calls safely and
  effectively.

3
Learning Outcomes

• 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.

4
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

5
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

6
Afternoon Timetable

• 1.30 Overview of handling medicines calls
• Workshop 3 Practice medicines calls
• 3.30 Tea Break
• Community Pharmacy
• 4.00 Close

7
Why are Medicines Information Skills needed?

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

8
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.

9
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.

10
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.

11
Guidance for specific types of medicines call
12
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 QA.

13
Roles of NHS Direct staff when handling medicines
calls
14
Streaming of P4 medicines calls
15
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
sons 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?
16
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

17
Whats in a medicine?

• Active ingredient
• Excipients
• e.g. bulking agents, tablet coatings, colours,
  flavours, stabilisers, pH adjusters.
• Form
• e.g. tablet, capsule, suppository, injection,
  cream, patch, eye drops

18
Naming medicines
19
Co- medicines
20
Brand names

• Many preparations have the same brand attached to
  slightly different products

21
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
22
Unlicensed medicines

• Off Label
• UK product licence but being used for an
  indication / at a dose / by a route not in the
  licence.

• No Licence
• No 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
23
Legal classification of medicines
24
Reclassification of medicines
New focus to encourage wider availability of
medicines as soon as adequate evidence of safety

• POM ? P
• Simvastatin
• Omeprazole
• Sumatriptan
• Chloramphenicol eye drops

• P ? GSL
• Paracetamol suspension
• Ibuprofen syrup
• Aciclovir cream
• Clotrimazole pessaries
• Cetirizine liquid
• Chlorpheniramine tablets

25
Misuse of Drugs Act

• Prohibits production, supply or possession of
  certain substances.

26
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.

27
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.

28
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.

• SLS
• e.g. Viagra for erectile dysfunction

29
Tea Break
30
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

31
Workshop 2 Navigating eBNF, eMC, netdoctor
NHSD QAs





32
Merits / Disadvantages
33
Lunch Break
34
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

35
Handling a Medicines Call
Refer to MI
Call record
36
The Iceberg Theory
This is what the caller may ask
This is the rest of the story!!
?
37
Essential questions to ask
Confirm no new or worsening symptoms

• 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?
• Babys age, term/pre-term, well/unwell, medicine
  taken already?

38
Key information sources

• eBNF / BNFC
• Electronic Medicines Compendium (eMC)
• Netdoctor
• NHSD Medicines QAs
• Medicines Chest Online

39
Standard Search Strategies
Encourage best practice and sharing of expertise

• 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.

40
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.

41
Referral to UKMI

• Complex medicines call.
• 3 or more prescription medicines.
• Medicines in pregnancy breastfeeding unless
  there is a NHSD Medicines QA.
• No information can be found.
• The information found is unclear or conflicting.
• Not within your competency.

42
Role of UK Medicines Information Service (UKMI)
Speed Dial 004 Mon- Fri 9am - 8.00pm Sat Sun
9am - 3pm except Bank Holidays
43
Workshop 3 Medicines Calls
44
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

45
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.

46
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

47
Staff in a community pharmacy
Pharmacist must be present for sale/supply of
medicines
48
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.

49
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.

50
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

51
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.

52
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.

53
Learning Outcomes

• Have an overview of NHS Direct policies and roles
  of staff for Medicines Calls.
• Have a baseline knowledge about medicines.
• Have an overview of Community Pharmacy services
  and emergency supply of medicines.
• Be able to handle medicines calls safely and
  effectively.

54
Learning Outcomes

• 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.