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Role Preparartion for HIAs Day 1 - Welcome to UKMi National

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Role Preparartion for HIAs Day 1 - Welcome to UKMi National Powered By Docstoc
					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

				
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