Role Preparation for Health Information Advisors Handling Medicines Calls Day 1

1. Role Preparation for Health Information AdvisorsHandling Medicines CallsDay 1 Name Centre Medicines Information Service

2. Learning Outcomes • Have an overview of NHS Direct policies for medicines calls and roles of staff. • Have a baseline knowledge about medicines. • Have an overview of Community Pharmacy services and emergency supply of medicines. • Be able to handle medicines calls safely and effectively.

3. Learning Outcomes • 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.

4. 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 Outline of training

5. 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

6. Afternoon Timetable 1.30 Overview of handling medicines calls Workshop 3: Practice medicines calls 3.30Tea Break Community Pharmacy 4.00 Close

7. Why are Medicines Information Skills needed? Therapeutic and information explosion • 6% calls for information/advice on medicines. • 40% answers included advice about medicines.

8. 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.

9. Questions about Prescribed medicines. Medicines bought from a pharmacy or shop. But also Herbal medicines. Homeopathic medicines. Food supplements and vitamins. Recreational drugs and drugs of misuse e.g. cannabis, Ecstacy, steroids in sport. What is a Medicines Call?

10. 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.

11. Guidance for specific types of medicines call

12. 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.

13. Roles of NHS Direct staff when handling medicines calls

14. Streaming of P4 medicines calls

15. 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?

16. 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

17. 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

18. Naming medicines

19. “Co-” medicines

20. Diphenhydramine Levomenthol Paracetamol, Pseudoephedrine & Diphenhydramine Guaifenesin Levomenthol Dextromethorphan Brand names Many preparations have the same brand attached to slightly different products

21. Marketing Authorisation “Product Licence” • Granted by MHRA if Safety, Quality, Efficacyshown. • Key aspects in Summary of Product Characteristics (SPC) found in the electronic Medicines Compendium (eMC) ww.medicines.org.uk • Prescribing outside the SPC (licence) is the responsibility of the doctor. Medicines & Healthcare Products Regulatory Authority www.mhra.gov.uk

22. 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. Unlicensed medicines Patient must give informed consent e.g. Methotrexate for asthma and lupus Patient must give informed consent e.g. Thalidomide, most herbal products

23. Legal classification of medicines

24. POM  P Simvastatin Omeprazole Sumatriptan Chloramphenicol eye drops P  GSL Paracetamol suspension Ibuprofen syrup Aciclovir cream Clotrimazole pessaries Cetirizine liquid Chlorpheniramine tablets Reclassification of medicines New focus to encourage wider availability of medicines as soon as adequate evidence of safety

25. Misuse of Drugs Act Prohibits production, supply or possession of certain substances.

26. 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.

27. Sometimes known as the Black List. Pricing Prescription Authority (PPA) will not reimburse dispensing cost to pharmacist. NHS Medicines that may not be prescribed within NHS

28. Sometimes called the Selected List. Cost of dispensing reimbursed only if GP has endorsed the script “SLS”. SLS e.g. Viagra for erectile dysfunction Medicines that may be prescribed in certain circumstances

29. Tea Break

30. 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

31. www.medicinescomplete.com www.medicines.org.uk www.medicinescomplete.com www.netdoctor.co.uk nww.nhsdirect.nhs.uk Workshop 2: Navigating eBNF, eMC, netdoctor & NHSD Q&As

32. Merits / Disadvantages

33. Lunch Break

34. Afternoon Timetable 1.30 An overview of the process for handling medicines calls Workshop 3: Practice medicines calls 3.30Tea Break Community Pharmacy 4.00 Close

35. Clarify the question Plan search strategy & research problem Evaluate the information Tailor the answer/advice Handling a Medicines Call Call record Refer to MI

36. The Iceberg Theory This is what the caller may ask This is the rest of the story!! ?

37. 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? Essential questions to ask Confirm no new or worsening symptoms

38. eBNF / BNFC Electronic Medicines Compendium (eMC) Netdoctor NHSD Medicines Q&As Medicines Chest Online Key information sources

39. Standard Search Strategies • 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. Encourage best practice and sharing of expertise

40. Website e.g. eBNF, eMC, netdoctor All places looked including those where no information was found. Web page link / brief detail of the information found. Brief detail of what was said to caller. Is warfarin safe in 1st trimester of pregnancy? eBNF: Link. eMC: No monograph. netdoctor: Link. Toxbase: Link. Advised caller that warfarin is known to cause foetal malformations if taken during pregnancy. Speak to GP by end of the day. What should be documented?

41. 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.

42. Role of UK Medicines Information Service (UKMI) Speed Dial 004 Mon- Fri9am - 8.00pm Sat & Sun 9am - 3pm except Bank Holidays

43. Workshop 3: Medicines Calls

44. Afternoon Timetable 1.30 An overview of the process for handling medicines calls Workshop 3: Practice medicines calls 3.30Tea Break Community Pharmacy 4.00 Close

45. 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.

46. Standard services Advising on medicines Dispensing & repeat prescriptions Selling OTC medicines Patient records Sale or supply of EHC Emergency supply of medicines Health promotion campaigns Disposal of medicines Specialist services Medicines use review Smoking cessation Needle exchange schemes Nursing Care Home support Supervised administration of medicines Anticoagulant clinics What services do community pharmacies offer?

47. Staff in a community pharmacy Pharmacist must be present for sale/supply of medicines

48. 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.

49. 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.

50. 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