Introduction to Medicines, Poisons and Pharmacy Calls

1. Introduction to Medicines, Poisons and Pharmacy Calls For Health Advisors, Health Information Staff and Nurse Advisors Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service

2. Aim To enable all staff answering Medicines, Poisons and Pharmacy calls to work within role competencies and fulfil them safely, reliably and effectively in this area of care.

3. Learning Outcomes • Have an overview of NHS Direct’s Pharmacy and Medicines Services • Have an overview of UK Medicines Information Services, National Poisons Information Service and Community Pharmacy Services • Have a baseline knowledge for handling Medicines and Poisons Calls

4. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

5. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Call • Workshop 2 What is a Medicine? • What Next?

6. NHS Direct’s Pharmacy and Medicines Services Why learn about Pharmacy and Medicines? Research from 2000 showed • 6% of all calls to NHSD are for advice about medicines • 40% of calls include advice about medicines

7. NHS Direct’s Pharmacy and Medicines Services Medicine Calls may involve

8. NHS Direct’s Pharmacy and Medicines Services Is there a Policy? Look in NHS Direct National Policy for Handling Medicines Calls NP005

9. NHS Direct’s Pharmacy and Medicines Services NP005 covers

10. NHS Direct’s Pharmacy and Medicines Services NP005 Definition of Medicines Any substance or article which is manufactured, sold, supplied, imported or exported for use wholly or mainly in Treating or preventing disease Diagnosing disease or status of a physiological condition Contraception Inducing anaesthesia Temporarily or permanently affecting a physiological function in any way

11. NHS Direct’s Pharmacy and Medicines Services Overview of the roles of different staff in handling medicines calls: role competencies and limitations

12. NHS Direct’s Pharmacy and Medicines Services P4Quick Call P4 Priority Quick Calls on access to pharmacy services and medicines e.g. Emergency Hormonal Contraception Information on missed contraceptive pills Repeat medication Access to medicines do not need to be referred to Health Information. Details in the Medicines handling Policy NP005

13. NHS Direct’s Pharmacy and Medicines Services Other NHS Direct Policies NP001 – National Guidance for the Management of Frequent Callers NP002 – National Policy for the Referral of Callers with Mental Health Issues to Mental Health Helplines NHS Direct FAQs regarding Protecting and Using Patient Information NHS Direct Child Protection Policy NHS Direct Adverse Incident Management Policy NHS Direct Complaints and Feedback Policy NHS Direct Third Party Calls Policy

14. NHS Direct’s Pharmacy and Medicines Services Compulsory checks for new/active or recurrent symptoms “Are you calling about an injury or a new or worsening health problem?” 

15. NHS Direct’s Pharmacy and Medicines Services

16. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

17. Ethical Dilemmas Medicines calls that may lead to ethical dilemmas • Age of caller • Third party calls • Refusal of another HCP to supply a medicine • Caller not wishing to disclose information to Dr • Wrong information given to caller by HCP • Caller taking a higher dose than prescribed • Caller wants information about how to obtain a medicine that is of dubious worth • Caller prescribed two interacting medicines

18. Ethical Dilemmas I found a tablet…. My G.P. says this…. but I’ve read the other…. Does heroin interact with…..? Could my partner’s tablets cause……?

19. Ethical Dilemmas – General Guidance There are often no “right answers” . Give yourself thinking time Second opinion: try to speak to a colleague or to the Medicines Information Centre. Conflicts: try not to get caught up in patient conflicts with other professionals. Allthe published information sources that you use are in the public domain. Instinct: You may have to do what seems right to you. You do not have to answer everything that you are asked! Document carefully everything that you do

20. Workshop 1 – Ethical Dilemmas A woman says she has found some medicines in her son’s room. She reads the labels - lamivudine, zidovudine & saquinavir. 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?

21. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

22. Overview of UK Medicines Information • UKMi - supports MI needs of NHS health professionals • >½ million enquiries 2005 • 16 regional & 260 local centres • Specialist services - pregnancy, breastfeeding, liver disease • Training, websites, QA, drug reviews

23. Overview of UK Medicines Information Your Medicines Information Service Your team photo

24. Staff Pharmacists Pre-registration students Secretarial support Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work 9am - 5.00pm Your MI phone number Overview of UK Medicines Information

25. Overview of UK Medicines Information Refer to the UKMi Service if • You need interpretation of call • You have no information or it is unclear • It is a complex call • Not within your competency Name, hours and contact details of your Regional MI Service

26. Caller taking 3 or more prescription medicines Dose(s) outside the normal range Unlicensed use of medicine or use of unlicensed medicine High risk medicines e.g. aminophylline, carbamazepine, digoxin, lithium, methotrexate, phenytoin, theophylline, warfarin Medicines in pregnancy or breastfeeding Overview of UK Medicines Information Complex Calls

27. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

28. Overview of National Poisons Information Service • 24 hour, UK wide clinical toxicology service for healthcare professionals • Staffed by Poisons Information Specialists, Nurses, Pharmacists, Physicians • Provide information & advice on diagnosis, treatment and management of poisoning

29. Overview of National Poisons Information Service • Five poisons centres Belfast, Cardiff, Birmingham, Edinburgh, Newcastle • One national number 24/7 0870 600 6266

30. Overview of National Poisons Information Service TOXBASE® At NHS Direct used by NAs only Primary Clinical Toxicology database of NPIS Available to healthcare professionals only Contains colour-coded NHS Direct advice boxes Updated daily Low Toxicity Poster – substances safe if ingested

31. Overview of National Poisons Information Service TOXBASE® Provides information on toxicity and management of acute poisoning for over 14,000 products – search by brand name or type of product

32. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

34. Session Timetable • NHS Direct’s Pharmacy and Medicines Services • Workshop 1 Ethical Dilemmas • Overview of UK Medicines Information • Overview on National Poisons Information Service • Break • Overview of Community Pharmacy Services • Baseline Knowledge for handling Medicines Calls • Workshop 2 What is a Medicine? • What Next?

35. Overview of Community Pharmacy Services

36. Overview of Community Pharmacy Services 10 facts about Community Pharmacy

37. Overview of Community Pharmacy Services 10 facts about Community Pharmacy

38. Overview of Community Pharmacy Services New Contract Started 1st Apr 2005, monitoring delayed until Oct • Benefits • Improve access to community pharmacy • Expand range of services provided • Make better use of pharmacist skills • Help reduce workload pressures on GPs • 3 levels of service: Essential, Advanced, Enhanced

39. Dispensing Patient records Compliance support Electronic transfer of prescriptions Repeat dispensing Pharmacist managed repeats Disposal of unwanted medicines Health promotion 6 campaigns / year Signposting Support for self care Clinical Governance Overview of Community Pharmacy Services Essential services

40. Overview of Community Pharmacy Services Advanced Services • Optional • Accreditation to provide • Medicines Use Review • Long-term conditions • Identified by PCT • Report to patient and GP • Prescription Intervention • Response to specific issue • Report to patient and GP

41. Overview of Community Pharmacy Services Enhanced Services PCTs may commission to meet local need May implement recognised services or develop own initiatives

42. Overview of Community Pharmacy Services By law a pharmacy is not a pharmacy if pharmacist not present

43. Overview of Community Pharmacy Services Access hours Monday – Saturday standard ‘shop hours’ OOH system to cover evenings and Sunday by local agreement

44. Overview of Community Pharmacy Services Out of Hours (OOH) Provision Check NHS.uk for details of local arrangements for OOH service Look on NHS Direct online under Common Health Problems for Emergency Supply of medicines from a community pharmacy

45. Overview of Community Pharmacy Services Emergency Supply by a pharmacist – £ charge to patient • Pharmacist must interview the person • Immediate need and impractical to obtain a 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 • Do not supply a Controlled Drug • Except phenobarbitone for epilepsy

46. Overview of Community Pharmacy Services NHS Prescription Charges £6.65 for each NHS Prescription Irrespective of cost to NHS of medicine Irrespective of quantity Same drug and form is one charge Various charges for combination products Pre-payment certificates – forms from community pharmacies

47. Overview of Community Pharmacy Services Exemptions from prescription charge • Aged under 16 • Aged 16, 17 or 18 years in full time education. • Aged 60 or over. • Has a Maternity Exemption certificate. • Has a Medical Exemption certificate. • Has a War Pension exemption certificate. • Has a Prescription Prepayment certificate. • Named on a NHS Charge certificate (HC2). • Prescribed free of charge oral contraceptives. • Gets Income Support or Income Based Jobseekers Allowance. • Entitled to / named on, NHS Tax Credit Exemption certificate. • Partner gets Pension Credit Guarantee Credit. .

48. Overview of Community Pharmacy Services Confidentiality Code of Ethics – Pharmacist must treat patients with confidentiality Data Protection Act – Includes paper and computerised patient medication records Caldicott Principles – Good practice for using patient information in the NHS Advanced Services – Private consultation area

49. Overview of Community Pharmacy Services • Patient demographics • Medication dispensed • Drug – brand/formulation • Strength • Quantity • Date • Special Notes • Counselling given • No clic-locks • Allergies Patient Medication Records

50. Overview of Community Pharmacy Services • NHS Rxs on PMR • Private Rxs - in bound book or on PMR • Controlled drugs obtained or supplied - in bound book Record Keeping Checks by RPSGB inspector Superintendent Pharmacists Police