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Role Preparation for Nurse Advisors Handling Medicines Calls

Role Preparation for Nurse Advisors Handling Medicines Calls. Your Name Your Medicines Information Service. Morning Timetable. Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines

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Role Preparation for Nurse Advisors Handling Medicines Calls

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  1. Role Preparation for Nurse AdvisorsHandling Medicines Calls Your Name Your Medicines Information Service

  2. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  3. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

  4. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  5. Learning Outcomes • Gather the necessary background information to clarify the question and minimise the risks when advising the caller. • Navigate the key medicines information sources. • Interpret information about medicines and turn it into appropriate advice. • Know when and how to refer to the MI Service. Handle medicines calls safely and effectively

  6. Why are specialist skills in Medicines Information needed? Increasing number and difficulty of medicines calls • Therapeutic explosion • Information explosion

  7. Structure of MI Services • 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

  8. Your Medicines Information Service Your Team Photo

  9. Staff Pharmacists Pre-registration students Secretarial support Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work Your phone number and opening hours Trent Medicines Information Service

  10. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  11. Navigating the eBNF, eMC netdoctor and NHSD FAQs

  12. British National Formulary (BNF) • Published every six months • Information on drugs generally prescribed in UK • Designed for rapid reference • Less detail on specialist areas • Appendices at the back

  13. eMC (Electronic medicines Compendium) • Summary of Product Characteristics (SPC) and Patient Information Leaflets (PILs) • Updated daily • Information provided by manufacturers • SPC - very detailed, written for healthcare professionals • PIL - written for members of the public

  14. NetDoctor • Easy to Search • Layman’s language • Good for use, side-effects, drug interactions • Medicines section written by pharmacists • Updated daily

  15. Medicines Chest Online • Book Published annually – Online version updated daily • Guide to over the counter medicines • Particularly useful for checking active ingredients • Very little clinical information

  16. Merits / Disadvantages

  17. Workshop 1 – Navigating eBNF, eMC, netdoctor and NHSD FAQs

  18. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  19. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  20. Handling a Medicines Call Record all stages Clarify the question Refer to MI Plan search strategy & research problem Evaluate the information Tailor the answer/advice

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

  22. THE PERSON Age? Allergies/disease states? Pregnant: no. of weeks, going well, medicine taken already? Breastfeeding: baby age, term/pre-term, well/unwell, medicine taken already? THE MEDICINE Name, dose, frequency? Who is it for? What prescribed for? Why asking? Other medicines? Name, dose, frequency? Essential questions to ask Confirm no new or worsening symptoms

  23. Key Information Sources • BNF / eBNF • Electronic Medicines Compendium (eMC) • NetDoctor • NHSD (Q&As) • Medicines Chest online

  24. 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

  25. Reasons for Documentation • Patient record in case of ongoing enquiry. • Risk management. • In case of query in the future. • Record/evidence of how you arrived at the answer. • Training.

  26. What should be documented? • Website e.g. eBNF, eMC, NetDoctor • All places looked including those where no information was found. • Brief detail of information found. • Brief detail of what was said to caller.

  27. Example documentation Is warfarin safe in 1st trimester of pregnancy? eBNF: Malformations. eMC: No monograph. NetDoctor: Do not use. Toxbase: Malformations. Advised to speak to GP by end of day.

  28. Referral to the MI Service • Complex medicines call. • Difficult to interpret what is being asked. • No information or it is unclear or conflicting. • Not within your competency or a second opinion needed.

  29. Complex drug history Lots of medicines Unclear what is taken Unlicensed medicines Side effects Asks if symptoms due to medicines Drug interactions Narrow therapeutic range medicines e.g. digoxin Pregnant Medicines taken but info sources say to avoid Breastfeeding Medicines taken but info sources say to avoid Baby pre-term / unwell Uses / choice Contra-indicated Doses outside norm Examples of Complex Medicines Calls

  30. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  31. Workshop 2 - Medicines Calls

  32. Morning Timetable Introduction & learning outcomes Navigating eBNF, eMC, NetDoctor and NHSD FAQs Workshop 1 Tea break Handling calls about medicines Medicines Calls Workshop 2 Lunch

  33. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

  34. Adverse Drug Reactions • Account for 2-6% of hospital admissions • Type A predicted by mode of action Type B idiosyncratic or unpredictable Unwanted effect that drug has on a person

  35. Incidence of Adverse Effects

  36. NEWER DRUGS & VACCINES () All ADRs even if Not certain that drug has caused it Reaction well known Other drugs at same time ESTABLISHED DRUGS & VACCINES All serious ADRs Fatal, life threatening or disabling Prolonged hospital stay Even if well known Yellow Card Reporting Scheme

  37. Patient reporting to Yellow Card Scheme • Pilot scheme launched Jan 2005 • Patients can report suspected adverse effects • www.yellowcard.gov.uk • Patient report forms from 4000 GPs in pilot or MHRA • Help MHRA understand the patient experience and perspective of suspected adverse effects • Patients can view anonymous data on website

  38. MHRA Website Medicines & Healthcare Products Regulatory Authority www.mhra.gov.uk

  39. Recent Drug Alerts / Scares

  40. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

  41. Workshop 3 - Adverse Effects

  42. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

  43. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

  44. Drug Interactions One drug modifies the effect(s) of a second drug. More likely if taking several medicines.  Toxicity • Warfarin + amiodarone = greater risk of bleeding • Flecainide + Fluoxetine = greater risk of arrhythmias  Efficacy • Ciclosporin + Phenytoin = more ciclosporin needed • Thyroxine + Rifampicin = more thyroxine needed

  45. How medicines are handled by the body Liver Gut wall Blood METABOLISM Kidney ABSORPTION DISTRIBUTION ELIMINATION

  46. One way medicines interact:Absorption of the drug • Antacids can absorb other drugs e.g. Ciprofloxacin • Cholestyramine (Questran) binds to many drugs so give 1 hour before or 4-6 hours after cholestyramine

  47. DRUG LEVEL Metabolic Enhancers Smoking Alcohol Carbamazepine Phenytoin Rifampicin More ways medicines interact:Metabolism of the drug

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