Role Preparation for Dental Nurse Advisors Handling Medicines Calls

1. Role Preparation for Dental Nurse AdvisorsHandling Medicines Calls NAME Medicines Information Pharmacist NAMEMedicines Information Service

2. Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine 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 key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

5. Aim To enable Dental Nurse Advisors to be able to handle medicines related calls safely and effectively within their area of competence and to know when and how to refer calls.

6. 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. • Be able to advise safely on the use of analgesics • Know when and how to refer to the MI Service. Handle medicines calls safely and effectively

7. Structure of MI Services • UKMI - supports MI needs of NHS health professionals • >½ million enquiries 2004 • 16 regional & 260 local centres • Specialist services - pregnancy, breastfeeding, dentistry • Training, websites, QA, drug reviews

8. Name Medicines Information Service

9. Staff Pharmacists Pre-registration students Secretarial support Technicians Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work 9am - 5.00pm TEL NUMBER NAME Medicines Information Service

10. Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

11. Navigating the eBNF, eMC netdoctor and NHSD FAQs

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

13. Dental Practitioner’s Formulary • Provides list of items prescribable by dentists on the NHS • Private prescriptions may be written for items not on the formulary • Also available in the Drug tariff: http://www.ppa.org.uk/ppa/edt_intro.htm

14. 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

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

16. 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

17. Medicines Complete

18. Medicines FAQs Located on the Medicines & Pharmacy Microsite: http://nww.intranet.nhsdirect.nhs.uk/medpharm/ • Can a person on warfarin take paracetamol? • Does paracetamol interact with antibiotics? • Can paracetamol be taken during pregnancy? • Can breastfeeding mothers take ibuprofen? • Can ibuprofen be taken during pregnancy? • What to do if you have missed a dose of antibiotics • When can patients start drinking alcohol after finishing metronidazole? • Which over-the-counter analgesics interact with alcohol? • Which oral antibiotics interact with alcohol? • Can breastfeeding mothers take over-the-counter analgesics? • Is it necessary to stop clopidogrel, dipyridamole or low dose aspirin prior to minor surgery? Single Source

19. Quiz – Navigating Medicine Sources

20. Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

22. Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

23. 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

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

25. 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

26. Key Information Sources • BNF / eBNF • Electronic Medicines Compendium (eMC) • Netdoctor • NHSD Frequently Asked Questions (FAQ) • Medicines Chest online • Medicines Complete

27. 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

28. 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.

29. 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.

30. Example documentation Is ibuprofen safe in 3rd trimester of pregnancy? eBNF: Malformations. eMC: No monograph. netdoctor: Do not use. Toxbase: Malformations. Advised to speak to GP / Dentist by end of day.

31. 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.

32. Complex drug history Lots of medicines Unclear what is taken Unlicensed medicines Not on formulary Side effects Symptoms due to medicines Drug interactions Narrow therapeutic range medicines e.g. digoxin, warfarin Pregnant Medicines taken but info sources say avoid is 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

33. Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

34. Analgesia A state of insensitivity to pain stimuli • derives from Greek • an-, "without", and -algia, "pain"

35. Analgesics - Paracetamol • Adult dosage: 0.5–1 g every 4–6 hours to a max. of 4 g daily; • Childs dosage: Dependent on age of child • Strength of paracetamol product • Form of paracetamol • Multi-constituent preparations

36. Analgesics - NSAIDs Non-Steroidal Anti-Inflammatory Drugs Ibuprofen • Adult dosage: • 400mg three times daily • Higher doses on prescription • Children from 3 months: • Dependent on age

37. Contraindications & Cautions to NSAIDs • Allergy to any NSAID or Aspirin • Asthma • Stomach ulcer or bleed • Kidney, liver or heart conditions • Blood clotting defects • Hypertension • Pregnancy or Breast feeding

38. Adverse effects of NSAIDs • Gastrointestinal effects: • Nausea, diarrhoea, discomfort, bleeding • Allergy: • rashes, breathing difficulties • Fluid Retention TAKE WITH OR AFTER FOOD

39. Analgesics - Aspirin • Adult Dosage: • 300 - 900mg every 4-6 hours • Maximum 4g daily • Analgesic and antiplatelet dosages • OTC products will recommend lower doses • Child Dosage: • Not to be given to children under 16 years old • Reyes Syndrome • Adverse effects and cautions similar to NSAIDs

40. Analgesics – Combination products BEWARE Not only painkillers contain analgesics

41. Workshop 2 - Medicines Calls

42. Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

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

45. Type A – predicted by mode of action, dose-related, common but not severe e.g. Diarrhoea with antibiotics Type B – unpredictable, not dose-related, can be severe/fatal e.g. Anaphylaxis with penicillins Adverse Drug Reactions Unwanted effect that drug has on a person

46. Incidence of Adverse Effects

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

48. Workshop 3 - Adverse Effects

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