Role Preparation for Nurse Advisors Handling Medicines Calls Day 1

1. Role Preparation for Nurse AdvisorsHandling Medicines CallsDay 1 NAME Medicines Information Pharmacist NAME Medicines Information Service

2. Medicines Training for Nurses

3. Timetable - Day 1 Morning

4. Timetable - Day 1 Afternoon

5. Timetable - Day 2 Morning

6. Timetable - Day 2 Afternoon

7. Timetable - Day 1 Morning

8. NHS Direct’s Pharmacy and Medicines Services Why learn about Pharmacy and Medicines? Research has shown More than 6% of all calls to NHSD are for advice about medicines More than 40% of all answers to calls include advice about medicines

9. NHS Direct’s Pharmacy and Medicines Services Definition of a medicines call?

10. NHS Direct’s Pharmacy and Medicines Services National Policy for Handling Medicines NP005

11. NHS Direct’s Pharmacy and Medicines Services Principles for Handling Medicine Calls • Based on a set of shared beliefs between NHS Direct and the users of the service: • Everyone is entitled to be involved in decisions about medicines and choose a different option if they prefer • Everyone will be able to get medicines information they want and need

12. NHS Direct’s Pharmacy and Medicines Services Guidance for specific types of calls • Complex calls • Advice to support a therapeutic choice • Advice and information about EC and unprotected sex • Dental medicines calls • Third party and intermediary calls • Requests for repeat medication

13. NHS Direct’s Pharmacy and Medicines Services

14. Identification and prioritisation of medicines calls All P4 calls now subdivided into either Medicines (M) calls or Health Information (H) calls M calls prioritised M1, M2 or M3 H calls prioritised H1, H2 or H3 Annotating calls

15. Identification and prioritisation of medicines calls

16. Identification and prioritisation of medicines calls Annotating H calls

17. Timetable - Day 1 Morning

18. What is UK Medicines Information? • UKMI- supports MI needs of NHS health professionals • >½ million enquiries 2006 • 16 regional & 260 local centres • Specialist services - pregnancy, breastfeeding, liver disease, dental • Training, websites, QA, drug reviews www.ukmi.nhs.uk

19. What is UK Medicines Information?

20. Staff Pharmacists Pre-registration pharmacists Secretarial support Services to NHS Direct Complex medicines calls MI skills training Quality Assurance National work Mon- Fri 9am - 8.00pm Weekends 9am – 3pm Except Bank Holidays Speed Dial 004 What is UK Medicines Information?

21. What is UK Medicines Information? Referral to UKMI • 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. • When Medicines Algorithm advises referral

22. Complex drug history Lots of medicines Unclear what is taken Unlicensed medicines Side effects Not clear if symptoms due to medicines Drug interactions Narrow therapeutic range medicines e.g. digoxin Pregnant No UKMI Q&A Breastfeeding No UKMI Q&A Baby pre-term / unwell Uses / choice Contra-indicated Doses outside norm Examples of Complex Medicines Calls What is UK Medicines Information?

23. Timetable - Day 1 Morning

24. 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

25. Ethical Dilemmas • I found a tablet…. • My G.P. says this…. but I’ve read something different • Does heroin interact with…..? • Could my partner’s tablets cause……? • What are my friend’s tablets for….?

26. 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. • All the 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.

27. 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?

28. Timetable - Day 1 Morning

29. What is a medicine? Active Ingredient or Drug Excipients – vehicle, bulking agent, tablet coating, capsule shell, colours, flavouring, stabiliser, pH adjuster …… Form – tablet, capsule, suppository, eye drops, cream, patch, inhaler, injection ……..

30. What is a medicine? Naming medicines

31. What is a medicine? Legal classification of medicines

32. What is a medicine? Controlled Drugs (CDs) Misuse of Drugs Act 1971 CDs are POMs with stricter controls on production, supply or possession

33. 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 What is a medicine? Unlicensed Medicines • Methotrexate for asthma and lupus • Sodium valproate for prevention of migraine • Thalidomide • Melatonin • Most herbal products

34. What is a medicine? Black Triangle medicines • Newly licensed • Monitored intensively by Commission for Human Medicines (CHM) which reports to MHRA • Black triangle status usually reviewed after 2 years

35. NHS What is a medicine? Medicines that may not be prescribed in the NHS • Known as the ‘Black List’ • Pricing Prescription Authority (PPA) will not reimburse dispensing cost.

36. Timetable - Day 1 Morning

38. Timetable - Day 1 Morning

39. Key Information Sourceson Medicines

40. Key Information Sourceson Medicines Electronic British National Formulary (eBNF) • Published every six months • Information on drugs generally prescribed in UK • Designed for rapid reference • Less detail on specialist areas • Appendices at theback

41. Key Information Sourceson Medicines Electronic Medicines Compendium (eMC) • 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 patients

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

43. Key Information Sourceson Medicines MedicinesChestOnline • Online version updated daily – book published annually • Guide to over the counter medicines • Particularly useful for checking active ingredients • Very little clinical information

44. Key Information Sourceson Medicines NHS Direct Medicines Q&As • A series of questions and answers written by UKMI for NHS Direct • May be used a single reference source • Topics cover areas commonly asked by callers • Ongoing project – Q&As added regularly

45. Key Information Sourceson Medicines MedicinesComplete • MedicinesComplete provides online access to twelve medicines and healthcare resources – published by the Pharmaceutical Press • NHS Direct have a quick link to MedicinesComplete. No password now needed

46. Key Information Sourceson Medicines

47. Timetable - Day 1 Morning

48. Workshop 2 – Navigating Key Resources

49. Key Information Sourceson Medicines

50. Timetable - Day 1 Morning