Cwm Taf Pre-registration MI Training

Cwm Taf Pre-registration MI Training October 21st 2015 Claire Ganderton Helen Morteo

Aims of day • Increase knowledge of reference sources – how to access via sharepoint • Increase awareness of questions to ask enquirer. • Know how to record enquiries on MI Databank. • Develop skills in writing an answer

MI Resources eBNF/eBNFC eMC IV Guide – nursing staff and pharmacists Shared Care Protocols and Guidance Toxbase Travax WMIC site for Drugs in Porphyria NICE Evidence Cwm Taf UHB Primary Care Portal C&V Good Prescribing Guide Neonatal Drug Withdrawal Handbook TDM bulletin Reference Sources- Sharepoint

Sharepoint • Formulary • Antimicrobial Guidelines • There are also lots of external links on the Medicines Management Page incl: • NICE Guidance • National Patient Safety Agency • AWMSG • Micromedex • Drug Safety Update (MHRA) • HOWIS • General Medical Council • Yellow Card Online

Reference sources Medicines Complete • AHFS, Stockley, Herbal Medicines, Dietary Supplements, Handbook on Injectable Drugs HOWIS • Directory • E-journals/ books • Travax Micromedex • Martindale, Drugdex, AltMedDex, Reprorisk • Drug interactions tool, IV compatibility database

Reference sources • Websites • UKMI www.ukmi.nhs.uk • NICE Evidence www.evidence.nhs.uk • WMIC www.wmic.wales.nhs.uk

Reference sources • NEWT www.newtguidelines.com Log-in details are site specific

Beware of the internet! • Some websites may contain information which is poorly evaluated, inaccurate and/or biased • Always consider: • Who are the authors? • Are key statements referenced? • Are the references reputable? • Is the information current? • Who owns or sponsors the site? • Is the site referred to by another authoritative site? • Always try and check an answer in another resource

The internet may be good for... • Branded or foreign products • Identification of drugs and herbal products • Hospital guidelines or formulary evaluations • News regarding ‘unusual’ treatments • Street drugs and substance misuse

The Internet is not good for... • Drug interactions • ADRs • Formulation and compatibility queries • Pharmacoeconomics

Question Time • Have go questions

Enquiry Answering • Documentation – MiDatabank • Background information • Research • Answering the enquiry

Documentation of enquiries • Why should MI enquiries be documented?

What MI work should be documented? • UKMi Clinical Governance Working Group document • Would you record… • Is hydrochlorothiazide on the formulary and is it stocked in pharmacy? • Is there a PIL available for Hydroxycarbamide capsules? • Can glycopyrronium be used for hypersalivation?

How and what to document • UKMi standards • Clear explanation of the question • Resources: • Books/Journals: specify edition/ date & page numbers. • Databases: specify dates searched/accessed/state search terms used. • People: include full name & title of people you speak to e.g. company MI Departments/ specialist doctors/ pharmacists. • Other electronic resources e.g. websites: specify name and/or full address of website(s) used/date accessed/search terms used. NB. Full address is not necessary for those websites used regularly or those listed in the minimum resources list (e.g. eMC etc.). “Bewareof the ‘cut & paste’ technique” • Be specific – if nothing found say so • Summary of answer given (include any subsequent points discussed).

Mi Databank 4 virtual “trays” • In tray • In progress • Awaiting authorisation • Reply authorised

Input – Background detail For all enquiries: • Who is calling? • Name, designation, contact details etc. • Patient specific or general? • Patient name, DoB, Hospital number • Question • Prospective or retrospective? • Negotiate when you will provide an answer. Also: • Enquiry category • Keywords

Research • Add the most appropriate resources in a logical order eg Past enquiries Medicines Q&A BNF SPC Micromedex Resources specific to enquiry type Literature search • Standard search patterns and UKMi Enquiry Answering Guidelines can help

Answer • Gather data, evaluate it and present in a clinically useful manner • Advice vs information • Be aware and openly acknowledge limitations to answer given • Tailor answer to enquirers needs • Meet deadline or communicate that answer delayed • Document attempts at contacting enquirer • Anticipate further questions

Verbal communication • When is verbal answer appropriate? • Prepare answer prior to speaking to enquirer • Introduce yourself • Present information in logical manner • Ensure answer is understood • Consider offering written reply

Writing skills • When is written reply appropriate? • Letter vs e-mail • Ensure confidentiality • Open with summary of question • Present information in logical order • Write clearly and concisely • Summarise at end • References?

Communication skills • When writing (or speaking), consider using phrases such as: • “As you will know,...” • “As you will be aware,...” • Avoid using phrases such as: • “There are no reports of ...” • Instead, use phrases like: • “Following a detailed literature search, I have been unable to locate any reports of...”

Completion • Stats • Time taken • On time • Complexity level • Keywords • Origin • Follow up

Enquiry 1 - administration • A staff nurse on the acute medical unit rings MI to ask how to administer phenytoin 1.4g IV • What further information do you need?

Enquiry 1 • Enquirers name and contact details • SN John Jones, ext 3506 • Patient: William Williams, DOB 1/1/40 Hosp no: M1234567 • Prescribed on stat side of drug chart, no diluent, no volume, no rate of administration

Enquiry 1 continued • Prospective – needs to administer asap • Indication: status epilepticus • Urgency – ASAP (next half an hour) • Enquirer has checked leaflet in product box but no information • Manufacturer: Mercury Pharma 50mg/ml injection

Search strategy • Past enquiries • BNF • SPC • IV guide Prepare your answer for verbal communication

Cwm Taf Pre-registration MI Training