Download Trent Medicines Information Service

Role Preparation for Nurse Advisors
Handling Medicines Calls
Day 1
NAME
Medicines Information Pharmacist
NAME Medicines Information Service
Medicines Training for Nurses
Training
Duration
Trainer
Week 4
Using Toxbase® to support poisons calls
½ day
NHSD
Week 5/6
Handling Calls about medicines and the
Medicines Algorithm
Trainer evaluation
Further medicines case scenarios
1 ½ days
½ day
UKMI
UKMI + NHSD
Handling calls about Hormonal Contraception
and Emergency Contraception
EC algorithm – further scenarios
½ day
Week 10
3-6 months
Medicines calculations for NAs
e-Toxbase®
One-to-one medicines training on request
6 months
Handling calls about medicines during
pregnancy and breastfeeding
Role Preparation for Nurse Advisors - Day 1
Self directed
UKMI
Self directed
Self directed
Self directed
UKMI
½ day
UKMI
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 2 Morning
9.30
Welcome & re-cap
9.45
Handling calls about Adverse Effects & Drug Interactions
Workshop 4: Case scenarios on Adverse Effects and
Drug Interactions
11.15
Break
11.30
Handling calls about analgesia
Workshop 5: Case scenarios on analgesia
1.00
Lunch
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 2 Afternoon
Medicines Algorithm
Workshop 6: Case scenarios using the medicines algorithm
Break
Where are the risks when handling medicines calls?
Examples of common mistakes
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
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
Role Preparation for Nurse Advisors - Day 1
NHS Direct’s Pharmacy
and Medicines Services
Definition of a medicines call?
Medicines prescribed by
the doctor
Homeopathic medicines
Medicines bought at a
pharmacy
Food supplements and
vitamins
Medicines bought at a
general shop
Herbal medicines
Recreational drugs and
drugs of abuse
Steroids in sport
Role Preparation for Nurse Advisors - Day 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
Role Preparation for Nurse Advisors - Day 1
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
Role Preparation for Nurse Advisors - Day 1
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
Role Preparation for Nurse Advisors - Day 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 ingestions
Interim care instructions for dental pain
Health Information P4 Calls (M1, M2 or M3): Information about medicines
Advisors
 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
Role Preparation for Nurse Advisors - Day 1
Identification and prioritisation
of medicines calls
Annotating 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
Role Preparation for Nurse Advisors - Day 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?”
Caller extremely anxious or distressed. e.g. Caller crying.
M1
Assess within
20 mins
M2
Assess within
1 hr
M3
Assess within
4 hrs
e.g. “I have missed my usual
dose of medicine. Should I
take 2 now?”
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?”
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?”
Role Preparation for Nurse Advisors - Day 1
Identification and prioritisation
of medicines calls
Annotating H calls
H1
Assessment If extremely
within 20
anxious or
minutes
distressed
Eg ‘I have just been diagnosed
with breast cancer. I don’t want
a mastectomy. Will I die?’
H2
Assessment Urgent HI call
within 1
hour
Eg ‘I work in a nursing home.
My daughter has chicken pox.
Should I go to work today?’
H3
Assessment Non-urgent HI
within 4
call
hours
Eg ‘ I want to give up smoking.
Can you help please?’
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines
Information?
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•
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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
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines
Information?
Alana Adams
Wales
Alison Alvey
Bristol
Kelly Broad
Leicester
Ruth Cheema
Leicester
Jane Farris
Birmingham
Matt Haggerty
Leeds
Wynn Pevreal
London
Caroline Riddle
Bristol
Paula Russell
Newcastle
Jill Rutter
Liverpool
Davina Wraight
London
Role Preparation for Nurse Advisors - Day 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
Role Preparation for Nurse Advisors - Day 1
Mon- Fri 9am - 8.00pm
Weekends 9am – 3pm
Except Bank Holidays
Speed Dial 004
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
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines
Information?
Examples of Complex Medicines Calls
Complex drug history
• Lots of medicines
• Unclear what is taken
• Unlicensed medicines
Pregnant
• No UKMI Q&A
Breastfeeding
• No UKMI Q&A
• Baby pre-term / unwell
Side effects
• Not clear if symptoms due
Uses / choice
to medicines
• Contra-indicated
Drug interactions
• Doses outside norm
• Narrow therapeutic range
medicines e.g. digoxin
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Ethical Dilemmas
Medicines calls that may lead to ethical dilemmas
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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
Role Preparation for Nurse Advisors - Day 1
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….?
Role Preparation for Nurse Advisors - Day 1
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
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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.
Role Preparation for Nurse Advisors - Day 1
Workshop 1 – Ethical Dilemmas
A woman says she has
found some medicines in
her son’s room. She reads
the labels - lamivudine,
zidovudine & saquinavir.
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.
Can you tell her what
they are for? Would your
answer be different if the
call was from his wife?
What advice would you
give?
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
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 ……..
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Naming medicines
Generic
Brand
Amoxicillin
Amoxil ®
Salbutamol
Ventolin ®
Fluoxetine
Prozac ®
Omeprazole
Losec ®
Mefloquine
Lariam ®
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Legal classification of medicines
May be sold in general shops
e.g. Paracetamol in packs of
16 tablets
Pharmacy Only May be sold in a pharmacy
but not a general shop e.g.
P
Piriton®
Prescription Only May only be supplied on
prescription e.g. Amoxicillin
POM
General Sales
List GSL
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Controlled Drugs (CDs)
Misuse of Drugs Act 1971
CDs are POMs with stricter controls on production, supply or possession
Class A
eg heroin, LSD, ecstasy, morphine,
Class B
eg amphetamines, barbiturates, codeine,
Class C
eg anabolic steroids, cannabis,
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Unlicensed Medicines
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
•Methotrexate for
•Thalidomide
asthma and lupus
•Melatonin
•Sodium valproate for
prevention of migraine
Role Preparation for Nurse Advisors - Day 1
•Most herbal products
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
Role Preparation for Nurse Advisors - Day 1
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.
Role Preparation for Nurse Advisors - Day 1
NHS
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on Medicines
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on 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 the back
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on Medicines
Electronic Medicines Compendium (eMC)
• Summary of Product Characteristics (SPC)
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•
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and Patient Information Leaflets (PILs)
Updated daily
Information provided by manufacturers
SPC - very detailed, written for healthcare
professionals
PIL - written for patients
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on Medicines
NetDoctor
• Easy to Search
• Layman’s language
• Good for use, side-effects, drug
interactions
• Medicines section written by
pharmacists
• Updated daily
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on 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
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on 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
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on 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
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on Medicines
When to use each Source
eMC
For all calls unless Q&A available or inappropriate eg
OTC medicine
PIL and SPC – manufacturers information
NetDoctor
For patient friendly information. Can be read aloud
Medicines
Chest
For Over-the-Counter medicines to establish ingredients,
licensed dose and licensed maximum daily dose
Q&As
Single reference source. Question asked must exactly
match Q&A
eBNF
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Workshop 2 – Navigating Key
Resources
Role Preparation for Nurse Advisors - Day 1
Key Information Sources
on Medicines
Merits
eBNF
eMC
NetDoctor
Medicines
Chest
Q&As
Gold standard
Some opinion
Easy to search
Comprehensive info
Easy to search
Layman’s terms
Use, side effects, drug
interactions
Good for details on active
ingredients of OTC
products
Saves time
Difficult to find info
Role Preparation for Nurse Advisors - Day 1
Disadvantages
Care when searching
Jargon
Technical
Unlicensed / off label
Not all medicines
Pregnancy
Breastfeeding
Very little clinical
information
Limited number
Need prompt updating
Timetable - Day 1 Morning
Welcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
Contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in Pregnancy and during Breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Baseline knowledge for
handling medicines calls
Clarify the question
Record
all
stages
Plan search strategy
& research problem
Evaluate the information
Tailor the answer/advice
Role Preparation for Nurse Advisors - Day 1
Refer to
MI
Using
Speed
Dial 004
Baseline knowledge for
handling medicines calls
Confirm no new or worsening symptoms
THE MEDICINE
THE PERSON
• Name, dose, frequency?
• Age?
• Who is it for?
• Allergies/disease states?
• What prescribed for?
• Pregnant: no. of weeks,
• Why asking?
• Other medicines? Name,
dose, frequency?
Role Preparation for Nurse Advisors - Day 1
going well, medicine taken
already?
• Breastfeeding: baby age,
term/pre-term, well/unwell,
medicine taken already?
Baseline knowledge for
handling medicines calls
Standard Search Strategies
• Encourage best practice and sharing of expertise
• Are pointers to the best sources available to answer
particular types of medicines call.
• Not a definitive list of sources. You should check
other sources as appropriate.
• No need to check every source in the search
strategy for every call.
Role Preparation for Nurse Advisors - Day 1
Baseline knowledge for
handling medicines calls
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.
Role Preparation for Nurse Advisors - Day 1
Baseline knowledge for
handling medicines calls
What should be documented?
• Website e.g. eBNF, eMC, NetDoctor
including URL
• All places looked including those where
no information was found.
• Brief detail of information found.
• Brief detail of what was said to caller.
Role Preparation for Nurse Advisors - Day 1
Baseline knowledge for
handling medicines calls
Example documentation
Is warfarin safe in the 1st trimester of pregnancy?
eBNF: Malformations.
eMC: No monograph.
NetDoctor: Do not use in pregnancy
Toxbase: Malformations.
Advised to speak to GP by end of day.
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Handling medicines calls
• How do I take?
• When do I take?
• What condition (indication) is this
medicine used to treat?
• When should I not take this medicine?
Role Preparation for Nurse Advisors - Day 1
Handling medicines calls
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Examples
Is it OK to crush these tablets as I have difficulty
swallowing?
I missed my tablet this morning. Should I doubleup tomorrow?
My Dr has given me new tablets. Will they work
like the old ones?
The leaflet says not to take if you have asthma.
Why is this?
I’m going to Barbados. At what time of days should
I take my contraceptive pill?
Role Preparation for Nurse Advisors - Day 1
Handling medicines calls
Medicines in Pregnancy
• 35% of women will take medicines at least
once during pregnancy
• All medicines should be avoided in pregnancy
unless they are essential
Medicines whilst Breastfeeding
• Unnecessary drug use should be avoided
• Assess benefit/risk ratio for both mother and
infant
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Workshop 3 – Case Scenarios
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
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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
Role Preparation for Nurse Advisors - Day 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 Supervised
medicines
administration of
medicines
Advising on minor
ailments
Incontinence supplies
Stoma care
Care Home support
Patient records
Smoking cessation
Truss fitting
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
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
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
NHS Prescription Charges
£6.85 for each NHS Prescription
from 1st April 2007
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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 or buy online
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
Exemptions from prescription charge
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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.
Role Preparation for Nurse Advisors - Day 1
.
Overview of Community
Pharmacy Services
Emergency Supply by a pharmacist
May be possible when
• Inadvertently run out of medicines at a weekend or
•
surgery closed
On holiday and forgotten medicines
Pharmacist will check that not run out of through
overuse eg inhaler for asthma
There will be a charge to patient as not an NHS service
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
Emergency Supply by a pharmacist
• Pharmacist must interview the person
• Supply up to five days treatment
• Controlled drugs may not be supplied
•Not an NHS Service so will be a charge
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
Emergency Supply by a pharmacist
• 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
Role Preparation for Nurse Advisors - Day 1
Overview of Community
Pharmacy Services
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
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 Afternoon
Overview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
What is a Medicine? revision
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1