Docstoc

Guidance to Support National Policy for - UKMI

Document Sample
Guidance to Support National Policy for - UKMI Powered By Docstoc
					  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls




       Guidance to Support National
           Policy for Handling
             Medicine Calls




Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 1 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

  1        Introduction

  1.1      The National Policy for Handling Medicine Calls is intended to support front
           line staff to assess and manage calls about medicines and the therapeutic
           use of medicines for all 0845 4647 and out of hours (OOHs) calls.

  1.2      The introduction of call streaming and Version 10 (V10) management
           system since the policy was introduced April 2005 now demands some new
           guidance for regions to be able to manage medicine calls using the new
           systems available. A condensed version of the National Policy for Handling
           Medicine Calls will follow this document.

  1.3      A medicines and pharmacy microsite is also now available on the NHS
           Direct Microsite: http://nwww.intranet.nhsdirect.nhs.uk/medpharm . The site
           lists:
            Approved resources and search strategies to handle medicine calls
            UKMI Q&As list with links to the National Electronic Library for Medicine
                (NeLM)
            Learning Outcomes for medicine and pharmacy training programmes
            Health Information Advisor Medicine and Pharmacy Protocols

  1.4      Health Information Advisor Medicine and Pharmacy Protocols

           The protocols have been developed as a tool to support medicine
           information calls handled by Health Information Advisors once they have
           undergone specific training in medicine information skills and the use of the
           protocols. The protocols are an interim measure until a revised medicine
           algorithm is released for health information advisors to use in CAS.

  1.5      Medicine Information Calls- P4 Queue management

           When the Health Advisor sends a medicines information call to the P4
           queue, the call reason will be annotated with the prefix MEDS. The queue
           supervisor will then be able to sort the calls to the appropriately
           trained/experienced Health Information Advisor. The nominated clinical
           member of staff who is responsible for the safety of all site based calls
           placed in any of the public or private queues should monitor local calls
           placed in queues regularly for safety. Where a call is deemed to be of a
           clinical risk the clinical shift lead should allocate the call to an individual with
           appropriate skill level to deal with the call. The priority of the call should not
           be changed.

           Health information advisors who are taking medicine information calls from
           the P4 queue must be sure they have had the appropriate training and/or
           experience in medicines information calls before selecting a call. A national
Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 2 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

           training package and competency framework are under development for all
           health information advisors for medicine information calls.

  1.6      General principles for handling medicine calls

               Nurse Advisors and Health Information Advisors must consult the eBNF
                or BNF for Children appropriate to age for all medicine calls, paper
                copies can be used for contingency provided it is latest edition.
               Nurse Advisors and Health Information Advisors should use the
                recommended search strategies for medicine calls.
               Nurse Advisors may use a single source of information if they are
                confident that it is the best source of information available for the
                question.
               Health Information Advisors must confirm the information in a second
                source.
               The eBNF is the prime reference source for all medicine calls, but may
                not always provide the necessary information.
               The NHS Direct Medicines Common Health Questions located on the
                NHS Direct website and the UKMI Q&As may be used as a sole source.
               Nurse Advisors and Health Information Advisors must document all
                information sources that were looked in including those where nil of note
                was found.
               Third party or intermediary calls that involve requests to identify the
                possible uses for specific medicines should be handled with due
                concern for patient confidentiality. Some medicines may be prescribed
                for a variety of conditions, e.g. medicines used to treat cancer, and do
                not indicate a particular condition.
               If Health Information Advisors pick up any calls that subsequently
                require nurse assessment, e.g. symptoms are identified that were not
                described during CSPT, the call is warm transferred to the “warm
                transfer queue”      for nurse assessment with a verbal handover
                describing details of any information provided and subsequent dialogue
                with patient.


  Guidance for Specific Medicine Call Types
  2        Access to Medicines

  2.1      Health Advisors:

           Follow protocol in CSPT:
            Repeat prescription requests
            Emergency supply of medicines enquiries

Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 3 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

           The following enquiries can be dealt with as P4QC:
            Pharmacy opening times
            Where to buy over the counter medicines
            Where to obtain a supply of medicines through a local NHS scheme,
              e.g. minor ailments service.
            Where to have a prescription dispensed
            Requests for access to emergency contraception only.
            Availability of oxygen therapy.

  2.2      Health Information Advisors:

           If the information is not immediately accessible, e.g. no details in Doris LOC
           for any of the above call types the call should be transferred by Health
           Advisor to Health Information Advisor as a P4. Other access to medicines
           P4 enquiries that should be transferred to Health Information Advisor
           include:
            Availability or cost of a medicine including non-UK licensed products
            Availability of travel vaccines
            Availability of a new medicine, unlicensed medicine or trial drug
            Use of Emergency Contraception using the algorithm in CAS version
                14.5
            What to do if missed a dose(s) of the oral contraceptive pill using
                algorithm in CAS version 14.5


  2.3      Nurse Advisors:

           This call type would not normally be completed by a Nurse Advisor. Once a
           symptomatic call has been assessed some calls may require information
           and are then transferred to health information advisor.


  3        Exposure to toxic substance

  3.1      Health Advisor:

           Follow protocol in CSPT: Managing exposure to toxic substance in
           conjunction with additional reference sources for swallowed toxic
           substances in the Low Tox poster and NHS Direct supplementary
           information. Clinical supervisor assesses call reason as soon as possible
           for all P2 end points, in conjunction with Toxbase and assign to nurse for
           urgent call back or return to first advice queue. The priority level must not
           be changed. All exposures including eye contact, skin, inhalation to be
           assigned call reason and assessed appropriate to needs.

Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 4 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

  3.2      Nurse Advisors:

           Advice in Toxbase to be followed for toxic agent or medicine. Additional
           advice can be provided by the National Poisons Information Service (NPIS)
           where the caller is asymptomatic and the information in Toxbase is
           inadequate. UKMI are able to provide advice about adverse effects from
           normal doses of medicines and accidental minor overdoses. Information
           about exposure to toxic substances in pregnancy can be accessed after
           discussion with the NPIS and onward referral to the National Teratology
           Information Service (NTIS). The NTIS is not able to provide a 24 hour
           support. See section 4 for information about medicines in pregnancy.


  4        Side effects of medicines and interactions

  4.1      Health Advisor:

           Caller has no new symptoms or any change or worsening of condition refer
           to Health Information Advisors.

  4.2      Health Information Advisor and Nurse Advisor:

           Some calls about medicines are of a complexity that may require onward
           referral to UKMI. These include:
            Caller/patient is taking 3 or more prescription only medicines. Health
               Information Advisor calls may identify additional prescription medicines
               after taking call from Health Advisor.
            Dose(s) involved are outside normal range
            High risk medicines are involved, e.g. commonly aminophylline,
               carbamazepine, ciclosporin, digoxin, lithium, methotrexate, phenytoin,
               theophylline, warfarin.
            Enquiry involves medicines in pregnancy or breast feeding
            High risk condition, e.g. suppressed immune system
            Medicine is listed in the eBNF with a Black Triangle i.e. newly available
               medicine that requires special monitoring for adverse effects.


  5        Pregnancy and Breast feeding

  5.1      Health Advisor:

           All symptomatic calls are to be transferred to a Nurse Advisor. All callers
           requesting information, who have no symptoms, to be transferred to Health
           Information Advisor. If Health Information Advisor’s P4 queue is very busy
           (e.g. OOHs period when some sites do not have Health Information
Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 5 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

           Advisors available) asymptomatic calls to be assessed as soon as possible
           by clinical supervisor and transferred to Nurse Advisor or put back into
           Health Information Advisor’s queue as appropriate.

  5.2      Health Information Advisor:

           On Monday to Friday between 9am to 5pm, collate relevant information
           from caller and refer to UKMI as per national guidance. At all other times on
           weekdays, weekends and bank holidays discuss timescale for UKMI call
           back with caller and suggest call back NHS Direct at a time when referral to
           UKMI is possible. The complex call queue P5 should not be used to queue
           calls at site to wait for UKMI call back. Advise caller to contact their local
           community pharmacist if request more immediate advice. The UKMI Q&As
           located via hot links from the medicine and pharmacy microsite can be
           used as a sole reference source to support pregnancy and breast feeding
           enquiries.

  5.3      Nurse Advisor:

           Assess symptoms and use medicines algorithm to support assessment for
           medicines used in pregnancy and whilst breast feeding. Refer to UKMI as
           per national guidance if require more detailed advice and to support
           complex enquiries. For calls taken outside working hours for UKMI, refer to
           local community pharmacist.


  6        Therapeutic choice of medicine

  6.1      Health Advisor:

           Use same criteria as side effects and interactions (Section 3). Calls about
           travel requirements, e.g. vaccinations, malaria prophylaxis refer to a Health
           Information Advisor.

  6.2       Health Information Advisor and Nurse Advisor:

           Refer to guidance on side effects and interactions (Section 4). Advice to
           support self care may include advice about the therapeutic use of
           medicines that have not yet been prescribed. Specific prescription only
           medicines should not usually be recommended by name, but a therapeutic
           class of medicines may be suggested. Certain enquiries do require specific
           brand names to be used to ensure the caller is aware of the licensed
           indications for a particular product. E.g. Calpol for Children is licensed for
           particular age groups, only specific brands of a medicine can be purchased
           over the counter (e.g. chloramphenicol eye drops, simvastatin products), or
           only particular brands have a license for use in children or information to
Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 6 of 8
                Review Date: 01/2007      Circulation: Units
  NHS Direct
  Guidance to Support National Policy for Handling Medicine Calls

           support use in pregnant women. When enquiries involve discussions about
           dosage and administration it is important to always check the brand name
           of the medicine used by the caller.

  7        Dental medicine calls

  7.1      Health Advisor:

           Advice in call streaming to be followed as for all dental calls.

  7.2      Dental Nurse Advisors:

           Refer calls to Nurse Advisor that require advice about medicines not
           included in the Dental Practitioners Formulary or the caller wants more
           complex advice, e.g. caller is taking other medicines that may interact with
           their dental treatment, or they are pregnant or breast feeding. Specific
           medicine information training to support dental nurse advisors will support
           practice.


  8        Identification of medicines

  8.1      Health Advisor:

           Caller has no new symptoms or any change or worsening of condition refer
           to Health Information Advisors.

  8.2      Health Information Advisor and Nurse Advisor:

           Calls that involve requests to identify suspected illicit drugs, contraception
           and any other medicine(s) should be advised to speak to a community
           pharmacist once it is established there is no immediate or urgent clinical
           risk to anyone.


  9        Approval




           Helen Young
           Clinical Director

Guidance to Support National Policy for   Version 1                      Author Anne Joshua, National
Handling Medicine Calls                                                  Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06   Implementation Date:08/03/06   Page 7 of 8
                Review Date: 01/2007      Circulation: Units
     NHS Direct
     Guidance to Support National Policy for Handling Medicine Calls

     Annex 1: Flow of Medicine Calls

     0845 4647 and Out of Hours Medicine Call Flow



     P4Quick Call
                                                                            CSPT
     Access to pharmacy services and
     Medicines, e.g. Emergency Hormonal
     Contraception, Repeat medication,
     Oxygen supply, emergency supply of
     medicine




     Priority 4 “MEDS”                                                                Priority 1, 2, 3
     No symptoms, two prescription medicines or                               CAS algorithm for symptoms
     Less, normal dosage range.                                               &
     National pilot Medicine and Pharmacy protocols                           Medicine Algorithm

     -Access as for P4QC                                                      -Wrong dose
     -Identification                                                          -Side effects
     -Travel                                                                  -Interactions
     -Administration & dosage                                                 -Therapeutic dose, e.g.
     -Therapeutic dose, e.g. pregnancy, breast feeding                          pregnancy, breast feeding
     -Interactions                                                            -Administration and dosage
     -Side effects                                                            -Contraception advice, inc.
     - Emergency contraception information                                    emergency contraception
     - Missed doses of contraceptive pills                                    -Travel advice
                                                                              -Identification




                                             Referral                   Local procedure




                                      Medicines Information Service (UKMI)


     Reason for referral:                                     When refer to MI confirm:
             Caller has complicated medicine                     Name of medicine
                 history and/or PMH                               dose frequency,
             Medicine used in pregnancy or when                  duration of treatment
                 breast feeding                                   reason for treatment
             Information cannot be found,                        pregnancy trimester
                 contradictory, unclear or confusing.             age of breast fed baby
             Enquiry is outside professional                     allergies
                 competence                                       any OTC and alternative medicines
             Referral within NHS Direct
                 inappropriate
             Enquiry is unclear or difficult to
                 understand




   Guidance to Support National Policy for     Version 1                               Author Anne Joshua, National
   Handling Medicine Calls                                                             Pharmaceutical Advisor
Status: Final   Creation Date: 21/02/06      Implementation Date:08/03/06            Page 8 of 8
                Review Date: 01/2007         Circulation: Units

				
DOCUMENT INFO