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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
‘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.
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
• 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)
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
All Health Information calls assigned the same priorities nationally:
P4 for Health Information calls
Identification and prioritisation of medicines calls
The National Health Information Queue
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Identification and prioritisation of medicines calls
Annotating calls
Introduction to Medicines Calls for Health Advisors (v3.1)
Identification and prioritisation of medicines 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?”
Introduction to Medicines Calls for Health Advisors (v3.1)
Identification and prioritisation of medicines calls
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?’
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
‘ 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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy and Medicines Services
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Workshop 1 Annotating Medicines Calls
Introduction to Medicines Calls for Health Advisors (v3.1)
Identification and prioritisation of 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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
• 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
The National Poisons Information Service
Introduction to Medicines Calls for Health Advisors (v3.1)
The National Poisons Information Service
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
Introduction to Medicines Calls for Health Advisors (v3.1)
The National Poisons Information Service
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
Introduction to Medicines Calls for Health Advisors (v3.1)
The National Poisons Information Service
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
• 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
The National Poisons 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
Introduction to Medicines Calls for Health Advisors (v3.1)
Workshop 2 – Toxic or not?
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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?
Introduction to Medicines Calls for Health Advisors (v3.1)
What is a medicine?
Naming medicines
Generic Brand
Amoxicillin Amoxil ®
Salbutamol Ventolin ®
Fluoxetine Prozac ®
Omeprazole Losec ®
Mefloquine Lariam ®
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
What is a medicine?
Simple analgesics (pain killers)
Paracetamol
Ibuprofen
Aspirin
Co-codamol
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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.
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
• 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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Overview of Community Pharmacy Services
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Overview of Community Pharmacy Services
Introduction to Medicines Calls for Health Advisors (v3.1)
• 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
Overview of Community Pharmacy Services
.
Introduction to Medicines Calls for Health Advisors (v3.1)
Overview of Community Pharmacy Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Emergency Supply by a pharmacist
• Pharmacist must interview the person
• Supply up to five days treatment
• Controlled drugs may not be supplied
Overview of Community Pharmacy Services
Introduction to Medicines Calls for Health Advisors (v3.1)
Overview of Community Pharmacy Services
• 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 Supply by a pharmacist
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Overview of Community Pharmacy Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Workshop 3 – Medicines Quiz