Role Preparation for Health Information Advisors Handling Medicines

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. n Know what background information is needed to clarify the question and minimise the risks when advising the caller. n Be able to navigate the key medicines information sources and be aware of their merits and disadvantages. n Be able to interpret information about medicines and turn it into appropriate advice. n Know when and how to refer medicines calls to UKMI. n Be able to use the NHS Direct Medicines Algorithm. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

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 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 e. BNF, BNFC e. MC, 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 n 6% calls for information/advice on medicines. n 40% answers included advice about medicines. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

NHSD Policy for Medicines Calls The policy covers n Definition of a medicine call. n Principles for handling medicines calls. n Guidance for specific types of medicines calls. n Approved information sources. n Record keeping and documentation. n Standards and quality assurance. n Training and development. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

What is a Medicines Call? Questions about n Prescribed medicines. n Medicines bought from a pharmacy or shop. But also n Herbal medicines. n Homeopathic medicines. n Food supplements and vitamins. n 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 n 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. n Everyone will be able to get the medicines information they want and need, from whatever source they choose. n 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 choice Avoid naming a specific medicine if referring to another HCP. 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. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Information sources n Consult the e. BNF for all medicines calls. n Use only if an NHS Direct approved information source. n NAs - may use just one information source if confident this is the best source. n 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 P 4 “Quick Calls”: information on access n Locations & opening hours of pharmacies, family planning clinics, walk-in centres. n Where can I get EHC. n How do I get a repeat prescription. n How do I get a new oxygen cylinder. Interim information on Low Toxicity ingestions Interim care instructions for dental pain Health Information Advisors P 4 Calls: Information about medicines n No new or worsening symptoms. Nurse Advisors P 1 -4 Calls: Advice or information about medicines n Symptoms. n No new or worsening symptoms. Dental Nurse Advisors Information about medicines for dental conditions Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Streaming of P 4 medicines calls P 4 QC n M 1 Quick calls about access to medicines. e. g. “Is there a pharmacy close to me that is open? ” n Assess within 20 mins M 2 Assess within 1 hr Caller upset or very anxious. e. g. Caller crying. n Not usually for complaints or angry callers. n Urgent medicines call - answer needed before the next dose. n Goes to the First Advice Queue after HI service closes at 8 pm. e. g. “Can I take paracetamol with amoxicillin? ” All remaining medicines calls. n After HI closed, remains in HI Queue until the next day. n 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? ” n M 3 Assess within 4 hr Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Workshop 1: Ethical Dilemmas 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? 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? 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 e. BNF, BNFC e. MC, netdoctor & NHSD Medicines FAQs 1. 00 Lunch Role Preparation For NHS Direct HIAs: Handling Medicines Calls

What’s in a medicine? n Active ingredient n Excipients e. g. bulking agents, tablet coatings, colours, flavours, stabilisers, p. H adjusters. n 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 acid Antibiotic Co-dydramol Dihydrocodeine & paracetamol Painkiller Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Brand names Many preparations have the same brand attached to slightly different products Paracetamol, Pseudoephedrine & Diphenhydramine Dextromethorphan Guaifenesin Levomenthol Role Preparation For NHS Direct HIAs: Handling Medicines Calls Diphenhydramine Levomenthol

Marketing Authorisation “Product Licence” n Granted by MHRA if Safety, Quality, Efficacy shown. n Key aspects in Summary of Product Characteristics (SPC) found in the electronic Medicines Compendium (e. MC) ww. medicines. org. uk n Prescribing outside the SPC (licence) is the responsibility of the doctor. Role Preparation For NHS Direct HIAs: Handling Medicines Calls Medicines & Healthcare Products Regulatory Authority www. mhra. gov. uk

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 e. g. Thalidomide, most herbal products Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Legal classification of medicines General Sales List GSL Pharmacy Only P May be sold in general shops e. g. Paracetamol (packs of 16) May be sold in a pharmacy but not a general shop e. g. Ranitidine Prescription Only POM 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 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 Omeprazole Sumatriptan Chloramphenicol eye drops Paracetamol suspension Ibuprofen syrup Aciclovir cream 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 n Newly licensed. n Monitored intensively by Committee for Safety of Medicines (CSM) which reports to MHRA. n 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 n Sometimes known as the Black List. n Pricing Prescription Authority (PPA) will not reimburse dispensing cost to pharmacist. Role Preparation For NHS Direct HIAs: Handling Medicines Calls NHS

Medicines that may be prescribed in certain circumstances n Sometimes called the Selected List. n 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 e. BNF, BNFC e. MC, netdoctor & NHSD Medicines FAQs 1. 00 Lunch Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Workshop 2: Navigating e. BNF, e. MC, netdoctor & NHSD Q&As www. medicines. org. uk www. medicinescomplete. com www. netdoctor. co. uk nww. nhsdirect. nhs. uk Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Merits / Disadvantages Merits e. BNFC e. MC netdoctor NHSD Meds Q&A Disadvantages Gold standard Some opinion Care when searching Jargon Easy to search Comprehensive info Technical Unlicensed / off label Not all medicines Easy to search Layman’s terms Use, side effects, drug interactions Pregnancy Breastfeeding Saves time Difficult to find info Limited number Need prompt updating 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 Call record Plan search strategy & research problem Evaluate the information Tailor the answer/advice Role Preparation For NHS Direct HIAs: Handling Medicines Calls Refer to MI

The Iceberg Theory This is what the caller may ask ? Role Preparation For NHS Direct HIAs: Handling Medicines Calls This is the rest of the story!!

Essential questions to ask Confirm no new or worsening symptoms n Allergies? n Conditions or diseases? n Medicines? n n Pregnant? n n Name, dose, frequency of all medicines? What prescribed for? OTC, complementary, oral contraceptive pill? No. of weeks, going well, medicine taken already? Breastfeeding? n Baby’s age, term/pre-term, well/unwell, medicine taken already? Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Key information sources n e. BNF / BNFC n Electronic Medicines Compendium (e. MC) n Netdoctor n NHSD Medicines Q&As n Medicines Chest Online Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Standard Search Strategies Encourage best practice and sharing of expertise n Pointers to the best sources available to answer particular types of medicines call. n Not a definitive list of sources and should check other sources as appropriate. n 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? n Website e. g. e. BNF, e. MC, netdoctor Is warfarin safe in 1 st trimester of pregnancy? n All places looked including those where no information was found. n Web page link / brief detail of the information found. e. BNF: Link. e. MC: No monograph. netdoctor: Link. Toxbase: Link. n Brief detail of what was said to caller. Advised caller that warfarin is known to cause foetal malformations if taken during pregnancy. Speak to GP by end of the day. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Referral to UKMI n Complex medicines call. n 3 or more prescription medicines. n Medicines in pregnancy & breastfeeding unless there is a NHSD Medicines Q&A. n No information can be found. n The information found is unclear or conflicting. n 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 9 am - 8. 00 pm Sat & Sun 9 am - 3 pm 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. n 6 million people visit a pharmacy every day. n NHS could save £ 380 million/year if 1 in 4 people consulted their pharmacist about minor ailments instead of their GP. n Extended hours – 100 hour pharmacies. n Role Preparation For NHS Direct HIAs: Handling Medicines Calls

What services do community pharmacies offer? Standard services Specialist services n Advising on medicines n Medicines use review n Dispensing & repeat prescriptions n Smoking cessation n Needle exchange schemes n Nursing Care Home support n Supervised administration of medicines n Anticoagulant clinics n Selling OTC medicines n Patient records n Sale or supply of EHC n Emergency supply of medicines n Health promotion campaigns n Disposal of medicines Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Staff in a community pharmacy Counter assistants Dispensing technicians Pharmacist must be present for sale/supply of medicines Trained to sell and advise on medicines when supervised by a pharmacist. NVQ training, follow protocols. Trained to dispense prescriptions, checked by pharmacist. NVQ / BTEC training. Pharmacist Responsible for all sales and 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 n Irrespective of cost to NHS of medicine. n Irrespective of the quantity prescribed. n Various charges for combination products. n Pre-payment certificates forms available from the pharmacy or via PPA website. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Prescription charge exemptions n n n n n 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 (HC 2). Free of charge oral contraceptives. Income Support or Income Based Jobseekers Allowance. n NHS Tax Credit exemption certificate. n Partner gets Pension Credit Guarantee. Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Emergency supply of medicines by a pharmacist n Pharmacist must interview the person n Immediate need and impractical to obtain prescription n Previously prescribed for the person n Dose appropriate for the person n Supply up to 5 days except n Insulin, ointment, cream, drops, inhaler – smallest pack n Oral contraceptive - a full cycle n Antibiotic - a full course of treatment n Can not supply a Controlled Drug n Except phenobarbitone for epilepsy n Charge to patient Role Preparation For NHS Direct HIAs: Handling Medicines Calls

Emergency supply of medicines by a pharmacist Advice to the caller n Person requiring the medicine must go to the pharmacy. n Go to your usual pharmacy if possible. n Take evidence of the medicine (e. g. repeat prescription slip, empty box/bottle). n Take personal identification. n There will be a charge. n 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 n Cost to patient. n Subject to national restrictions e. g. patient age. n Supply EHC by local arrangement n Free to patient. n Local funding and guidelines (PGDs). May include under 16 years. n Subject to pharmacist training. n 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. n Know what background information is needed to clarify the question and minimise the risks when advising the caller. n Be able to navigate the key medicines information sources and be aware of their merits and disadvantages. n Be able to interpret information about medicines and turn it into appropriate advice. n Know when and how to refer medicines calls to UKMI. n Be able to use the NHS Direct Medicines Algorithm to support handling of medicines calls. Role Preparation For NHS Direct HIAs: Handling Medicines Calls