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Role Preparation for Health
Information Advisors
Handling Medicines Calls
Day 1
Name
Centre Medicines Information Service
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 Day 2
NHSD policies for medicines Adverse effects
calls and roles of staff
Drug interactions
Baseline knowledge about
medicines Medicines in pregnancy
Navigating key medicines Medicines when breastfeeding
information sources
Medicines Algorithm
Practice medicines calls
Areas of risks when handling
Overview of community medicines calls
pharmacy
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 But also
Prescribed medicines. Herbal medicines.
Medicines bought from Homeopathic
a pharmacy or shop. 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 Avoid naming a specific medicine if referring to
choice another HCP.
Identification of a “tablet” can not be done over
Identification
the phone. Refer to pharmacist.
Repeat Make sure there has been no sudden increase
medication in use due to worsening symptoms.
Third-party &
Be careful not to break patient confidentiality.
intermediary
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 ingestions
Interim care instructions for dental pain
Health Information P4 Calls: Information about medicines
Advisors No new or worsening symptoms.
Nurse Advisors P1-4 Calls: Advice or information about medicines
Symptoms.
No new or worsening symptoms.
Dental Nurse Information about medicines for dental conditions
Advisors
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Streaming of P4 medicines calls
Quick calls about access to e.g. “Is there a pharmacy
P4QC medicines. close to me that is open?”
Caller upset or very anxious. e.g. Caller crying.
M1
Assess Not usually for complaints or
within 20 angry callers.
mins
Urgent medicines call - answer e.g. “Can I take paracetamol
M2 needed before the next dose. with amoxicillin?”
Assess Goes to the First Advice Queue
within 1 hr after HI service closes at 8pm.
All remaining medicines calls. e.g. “What vaccinations do I
After HI closed, remains in HI need for a trip to Africa in a
M3 few months time?”
Queue until the next day.
Assess
within 4 hr Advise caller that HI is closed so
will be answered next day.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Workshop 1: Ethical Dilemmas
A woman says she has found A man asks how long cocaine
some medicines in her son’s stays in the body.
room. She reads the labels - He used some cocaine at the
lamivudine, zidovudine & weekend but is due to have a
lopinavir / ritonavir. drug test tomorrow.
Can you tell her what they What advice would you give?
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
Excipients
e.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 Antibiotic
acid
Co-dydramol Dihydrocodeine & Painkiller
paracetamol
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Brand names
Many preparations have the same brand attached to slightly
different products
Paracetamol,
Pseudoephedrine & Dextromethorphan
Diphenhydramine
Guaifenesin Diphenhydramine
Levomenthol Levomenthol
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
Medicines &
(eMC) ww.medicines.org.uk
Healthcare Products
Prescribing outside the SPC Regulatory Authority
(licence) is the responsibility www.mhra.gov.uk
of the doctor.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Unlicensed medicines
Off Label No Licence
UK product licence but No UK product licence.
being used for an
indication / at a dose / by a
route not in the licence.
Patient must give informed Patient must give informed
consent consent
e.g. Methotrexate for e.g. Thalidomide, most
asthma and lupus herbal products
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Legal classification of medicines
General Sales List May be sold in general shops
GSL e.g. Paracetamol (packs of 16)
Pharmacy Only May be sold in a pharmacy but not
P a general shop e.g. Ranitidine
Prescription Only May only be supplied on
POM prescription e.g. Amoxicillin
Prescription Only May only be supplied on
Controlled Drug prescription, harmful / prone to
POM CD misuse e.g. Morphine
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Reclassification of medicines
New focus to encourage wider availability of medicines
as soon as adequate evidence of safety
POM P P GSL
Simvastatin Paracetamol suspension
Omeprazole Ibuprofen syrup
Sumatriptan Aciclovir cream
Chloramphenicol eye drops Clotrimazole pessaries
Cetirizine liquid
Chlorpheniramine tablets
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 NHS
cost to pharmacist.
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”.
SLS
e.g. Viagra for erectile
dysfunction
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Tea Break
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.medicinescomplete.com
www.medicinescomplete.com
www.netdoctor.co.uk
nww.nhsdirect.nhs.uk
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Merits / Disadvantages
Merits Disadvantages
eBNF Gold standard Care when searching
Some opinion Jargon
BNFC
Easy to search Technical
eMC Comprehensive info Unlicensed / off label
Not all medicines
Easy to search Pregnancy
Layman’s terms Breastfeeding
netdoctor Use, side effects, drug
interactions
Saves time Limited number
NHSD Meds
Difficult to find info Need prompt updating
Q&A
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Lunch Break
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 Refer
& research problem to MI
Call
record
Evaluate the information
Tailor the answer/advice
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
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?
Baby’s age, term/pre-term, well/unwell, medicine taken already?
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
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.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
What should be documented?
Website e.g. eBNF, eMC, Is warfarin safe in 1st
netdoctor trimester of pregnancy?
All places looked including eBNF: Link.
those where no information eMC: No monograph.
was found. netdoctor: Link.
Web page link / brief detail of Toxbase: Link.
the information found. Advised caller that warfarin is
known to cause foetal
Brief detail of what was said malformations if taken during
to caller. 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 - 3pm
except Bank Holidays
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Workshop 3: Medicines Calls
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 Specialist services
Advising on medicines Medicines use review
Dispensing & repeat Smoking cessation
prescriptions
Needle exchange schemes
Selling OTC medicines
Nursing Care Home support
Patient records
Supervised administration of
Sale or supply of EHC medicines
Emergency supply of Anticoagulant clinics
medicines
Health promotion campaigns
Disposal of medicines
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
Staff in a community pharmacy
Counter Trained to sell and
assistants advise on medicines
when supervised by a
pharmacist.
NVQ training, follow
protocols.
Dispensing Trained to dispense
technicians prescriptions, checked
by pharmacist.
NVQ / BTEC training.
Pharmacist Responsible for all sales
Pharmacist must be present for and supply of medicines.
sale/supply of medicines Degree & pre-
registration year/exam.
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.
Role Preparation For NHS Direct HIAs: Handling Medicines Calls
