introduction to medicines calls for health advisors name medicines information pharmacist name...

Introduction to Medicines Calls for Health Advisors

NAME

Medicines Information Pharmacist

NAME Medicines Information Service

Introduction to Medicines Calls for Health Advisors (v3.1)

TimetableWelcome & learning outcomes

NHSD policies for medicines calls, access to medicines

Role of UKMI as a support service to NHS Direct

Identification and prioritisation of medicines calls

Workshop 1: Annotating Medicines Calls

Break

The National Poisons Information Service

Substances of low toxicity by ingestion

Workshop 2: Use of the Low Toxicity poster

What is a medicine?

Overview of community pharmacy services

Workshop 3: Medicines Quiz, review of learning outcomes and close


NHS Direct’s Pharmacy and Medicines Services

Why learn about Pharmacy and Medicines?

Research has shown

• More than 40% of all answers to calls include advice about medicines

• More than 6% of all calls to NHSD are for advice about medicines



Types of medicines?Where can medicines be obtained?

Medicines prescribed by the doctor

Homeopathic medicines

Medicines bought at a pharmacy

Food supplements and vitamins

Medicines bought at a general shop

Recreational drugs and drugs of abuse

Herbal medicines Steroids in sport



National Policy for Handling Medicines NP005

Definition of Medicine Calls

Approved Reference Sources

Principles for Handling Medicines calls

Record keeping and Documentation

(Poisons calls) Quality Assurance

Guidance for specific types of calls

Training and Development



Health Advisors P4 “Quick Calls”: Information on access Locations & opening hours of pharmacies, family

planning clinics, walk-in centres. Where can I get EHC? How do I get a repeat prescription? How do I get a new oxygen cylinder?Interim information on Low Toxicity ingestionsInterim care instructions for dental pain

Health Information Advisors

P4 Calls (M1, M2 or M3): Information about medicines No new or worsening symptoms.

Nurse Advisors P1-4 Calls: Advice or information about medicines Symptoms. No new or worsening symptoms.

Dental Nurse Advisors

Information about medicines for dental conditions







Break




What is a medicine?




What is UK Medicines Information?

• UKMI- supports MI needs of NHS health professionals

• ~½ million enquiries per year• 16 regional & 260 local centres• Specialist services -

pregnancy, breastfeeding, liver disease, dental

• Training, websites, QA, drug reviews

www.ukmi.nhs.uk


What is UK Medicines Information?

Staff• Pharmacists• Pre-registration pharmacists• Secretarial support

Services to NHS Direct• Complex medicines calls• MI skills training• Quality Assurance• National work

Mon- Fri 9am - 8.00pmWeekends 9am – 3pmExcept Bank Holidays

Speed Dial 004







Break




What is a medicine?





‘The purpose of CSPT is to get the patient to the right endpoint at the right time and thereby use NHS

resources appropriately’

See Using CSPT Effectively e-learning tool and Using CSPT in the Call Handling Phase of Care Delivery workbook

All calls to NHSD can be categorised as Injury, Illness or Information.



• See Using CSPT Effectively e-learning tool• Questions arranged to rule out the highest

level of care first and lead to lower prioritisation last

• Questions support HA as they explore symptoms in a structured and consistent manner

• Examples – abdominal pain, breathing, fever

Call Streaming and Prioritisation Tool (CSPT)



Call Streaming and Prioritisation Tool (CSPT)

‘Are you calling for Health Information?’ If ‘yes’ leads to drop down menu with five selections

1. Repeat prescriptions

2. Access to services

3. Medicines enquiry

4. Health Information

5. None of the above


All Health Information calls assigned the same priorities nationally:

P4 for Health Information calls


The National Health Information Queue


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



P4QC Quick calls about access to medicines. e.g. “Is there a pharmacy close

to me that is open?”

M1 Assess within

20 mins

Caller extremely anxious or distressed. e.g. Caller crying.

e.g. “I have missed my usual dose of medicine. Should I take 2 now?”

M2 Assess within

1 hr

Urgent medicines call - answer needed before the next dose.

Goes to the First Advice Queue after HI service closes at 8pm.

e.g. “My dentist has given me amoxicillin for a dental abscess. Can I take paracetamol?”

M3 Assess within

4 hrs

All remaining medicines calls.

After HI closed, remains in HI Queue until the next day.

Advise caller that HI is closed so will be answered next day.

e.g. “What vaccinations do I need for a trip to Africa in a few months time?”



Annotating H calls

H1 Assessment within 20 minutes

If extremely anxious or distressed

Eg ‘I have just been diagnosed with breast cancer. I don’t want a mastectomy. Will I die?’

H2 Assessment within 1 hour

Urgent HI call Eg ‘I work in a nursing home. My daughter has chicken pox. Should I go to work today?’

H3 Assessment within 4 hours

Non-urgent HI call

Eg ‘ I want to give up smoking. Can you help please?’



‘ I’ve run out of my blood pressure tablets. How can I get some more?’

‘My Dad’s oxygen cylinder is nearly empty. How do I get another one?’

‘I’m on holiday and have forgotten my inhalers. Can you help?’

‘I need the Morning-After Pill. Where can I get it?’

‘I’ve run out of my contraceptive pill. What should I do?’

‘Are there any late night pharmacies in my area?’

Medicines questions Health Advisors can deal with



Examples

Where to get Rx dispensed - in hours

Buying Over-the Counter medicines

Where to get Rx dispensed – OOH Emergency supplies of medicine

Repeat prescriptions Emergency Hormonal Contraception

How to access oxygen Locations of pharmacies

Pharmacy opening hours Locations of family planning services

Missed contraceptive pills Locations of Walk-in-Centres







Break




What is a medicine?




Workshop 1 Annotating Medicines Calls



Risk Factors for HAs in taking medicines calls

Misunderstanding what the caller said

Using the wrong CSPT protocol

Missed symptoms Working outside level of competency

Incomplete background information

Caller doesn’t understand the answer

Giving incorrect information Incomplete or inaccurate documentation







Break




What is a medicine?




• 24 hour, UK wide clinical toxicology service for healthcare professionals• 5 Poisons Centres: Belfast, Cardiff, Birmingham,

Edinburgh, Newcastle• National Number: 0844 892 0111

• Staffed by poisons information specialists, nurses, pharmacists, physicians

• Information & advice on diagnosis, treatment and management of poisoning




Previously• All potentially toxic ingestion calls were prioritised

P1 and handled by Nurse Advisors

But• Many calls were found to be low toxicity and did

not warrant the high priority eg. Sudocrem®

Now• HAs can handle calls on ingestions of low toxicity

substances



Top 10 hits on TOXBASE by NHS Direct users in 2005

1 Paracetamol 12,848

2 Ibuprofen 8,776

3 Bleach – Liquid 2,720

4 Sodium Hypochlorite Solution 2,605

5 Sudocrem® 2,223

6 Aspirin 2,178

7 Calpol® Infant Suspension 2,153

8 Co-codamol 2,056

9 Ethanol 1,854

10 Olbas Oil® 1,811



Substance ingested? Label information: brand, manufacturer, ingredient(s), symbol any other information which may help assess risk

How much? size of container or packet? any spilt on clothes/carpet?

When? Symptoms? Treatment given? eg. made vomit, given drink, washed area

Age of patient? (for risk assessment)

What to ask







Break




What is a medicine?




Substances of Low Toxicity

Refers to swallowing only – not inhalation, injection or skin contact

See Low Toxicity poster at all workstations at NHS Direct and link on NHSD national

Intranet homepage

Substances of Low Toxicity by Ingestion


• Advise caller to call back if “new or worsening symptoms occur….while waiting for nurse advisor to call”

• Low toxicity poster is based on those substances listed as low toxicity on Toxbase (NPIS database)

• Call placed in queue which is managed by clinical supervisor – will be upgraded if appropriate.

• Caller will get call back from a nurse advisor within P3 timescale in all cases

Use of the Low Toxicity Poster is safe because








Break




What is a medicine?




Workshop 2 – Toxic or not?







Break




What is 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

What is a medicine?


What is a medicine?

Naming medicines

Generic Brand

Amoxicillin Amoxil ®

Salbutamol Ventolin ®

Fluoxetine Prozac ®

Omeprazole Losec ®

Mefloquine Lariam ®


What is a medicine?

Legal classification of medicines

General Sales List GSL

May be sold in general shops e.g. Paracetamol in packs of 16 tablets

Pharmacy OnlyP

May be sold in a pharmacy but not a general shop e.g. Piriton®

Prescription OnlyPOM

May only be supplied on prescription e.g. Amoxicillin


What is a medicine?

Controlled Drugs (CDs)

Class A eg heroin, LSD, ecstasy, morphine, cocaine, crystal meth

Class B eg amphetamines, barbiturates, codeine,

Class C eg anabolic steroids, cannabis,

Misuse of Drugs Act 1971

CDs are POMs with stricter controls on production, supply or possession


What is a medicine?

Simple analgesics (pain killers)

Paracetamol

Ibuprofen

Aspirin

Co-codamol


What is a medicine?

Paracetamol

• Reduces pain and fever

• Used for mild to moderate pain eg toothache,

headache

• Side effects not usually a problem

• Must not exceed recommended dose – dangerous

in overdose 10–15g (20–30 tablets) or 150 mg/kg in 24 hours can cause severe liver / renal damage and death.

• Must not take with other products containing

paracetamol


What is a medicine?

Ibuprofen

• Reduces pain, fever and inflammation

• Used for mild to moderate pain eg toothache, headache, muscle pain, period pain

• Side effects include: Heartburn/indigestion, stomach ulcers, stomach bleeds, allergy – rash, wheezing, breathlessness, worsening of asthma

• Should not be taken if: Allergic to aspirin, stomach ulcer or previous stomach bleed, or on meds to thin the blood

• Use with caution in asthma, high blood pressure


What is a medicine?

Aspirin

• When used as a pain killer has similar effects and precautions as ibuprofen.• Must not be given to children under 16 years.• Also used at low doses to prevent heart attacks and strokes.


What is a medicine?Co-analgesics

Many painkillers contain a combination of more than one drug

Often paracetamol + other(s)Examples: Co-codamol contains paracetamol and codeine

Co-dydramol contains paracetamol and dihydrocodeine

Co-proxamol contains paracetamol and dextropropoxyphene

Co-codaprin contains aspirin and codeine


What is a medicine?

Cough and cold products

Many cough and cold products contain analgesics

Beechams Powders® Aspirin 600mg + caffeine 50mg

Lemsip Max® Paracetamol 500mg + caffeine 25mg

Nurofen Cold and Flu® Ibuprofen 200mg + Pseudoephedrine 30mg







Break




What is a medicine?




• No appointment necessary• 6 million people visit community pharmacies daily. • 94% of population visit at least once per year• Care can be sought on behalf of others• Role of pharmacist is as medicines

expert – advise on the treatment of illness and how to take medicines

Overview of Community Pharmacy Services



What services do community pharmacies offer?Dispensing prescriptions

Emergency supplies of Prescription only Medicines

Health Promotion campaigns

Advising on medicines Sale or supply of the ‘morning after pill’

Needle exchange schemes

Blood pressure monitoring

Pregnancy testing Disposal of unwanted medicines

Selling over-the-counter medicines

Supervised administration of medicines

Advising on minor ailments

Incontinence supplies Stoma care Care Home support

Patient records Smoking cessation Truss fitting


Staff in a community pharmacy

Sales assistants Trained to work in shop but not to sell or advise on medicines

Counter assistants Healthcare assistants

Trained to sell and advise on medicines – supervision by pharmacist

Dispensing technicians Trained to dispense and check prescriptions

Pharmacist Responsible for all sales and Rx of medicines



NHS Prescription Charges

£6.85 for each NHS Prescription from 1st April 2007

• 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



• 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.

Exemptions from prescription charge


.



May be possible when

• Inadvertently run out of medicines at a weekend or surgery closed

• On holiday and forgotten medicines• Not possible to obtain prescription

Pharmacist will check that not run out of through overuse eg inhaler for asthma

There will be a charge to patient

Emergency Supply by a pharmacist



• Pharmacist must interview the person

• Supply up to five days treatment

• Controlled drugs may not be supplied




• Patient must go to pharmacy in person• Take evidence of medicine eg empty

box, repeat slip• Take ID

The pharmacist makes a professional judgement and may decline to supply



Emergency Hormonal Contraception (EHC)

Pharmacists may

•Supply EHC (free to patient) subject to pharmacist training and according to local guidelines (PGD or prescription)

•Sell EHC (cost to patient) subject to certain restrictions e.g.age of patient








Break




What is a medicine?




Workshop 3 – Medicines Quiz

introduction to medicines calls for health advisors name medicines information pharmacist name...

Documents

medicines servicessee

medicines serviceswhy

medicines servicescall

uk medicines information

health advisors v3

interim information

nhs resources appropriatelysee

worsening symptoms