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Nurse Advisor and Health Information Advisor
Clinical Update
For the release of
CAS Clinical Version 15
Handling Medicines Enquiries
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Author/s
Version
Date for review
Purpose of circulation
Medicines Enquiry Algorithm Alias
CAS Clinical v15
31 05 06
Janet Haslam/Carys Murray/Anne Joshua/Davina
Wraight/Caron Taylor
1
August 2006
To support clinical version v15 release
Page 1 of 44
Contents
Page
Content
3
Introduction
4
Answering Medicines Enquiries using CAS Clinical v15
7
Documenting Patient Medical History
12
Using the Other Problems Algorithm
32
Where to find information about medicines
43
Learning summary: Portfolio reflection
Document reviews
Date
Reviewed by
Medicines Enquiry Algorithm Alias
CAS Clinical v15
31 05 06
Comment
Page 2 of 44
Introduction and Background to the Development
Other Problems Algorithm-Medicines Enquiries
In CAS clinical release V13 an algorithm was introduced to assist the
documentation process for Nurse Advisors in recording information on
enquiries related to medicines. This was a process used for non-symptomatic
calls only.
Let’s revisit some of the principles behind its development.

Nurse advisors traditionally entered call details for non-symptomatic
patients within the add/view comments function leaving the call
unstructured with little supporting evidence.

For medicines enquiry calls it is important that relevant questions are
asked and that any potential problems can be avoided.

The addition of the Other Problems Algorithm enabled general enquiries
that did not require assessment or health information and those calls
relating to social circumstances to be documented in a consistent
manner, whilst also enabling an audit trail.

A cautionary question was written into the initial assessment question to
inform Nurse Advisors that this algorithm should not be used if any
active symptoms were present, however it may be appropriate to launch
as a secondary algorithm should it become evident that there is a
medicine element to the consultation.
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Section 1:
Answering Medicines Calls using CAS Clinical Version 15
The following section introduces Nurse Advisors and Health Information
Advisors to a development within the Other Problems Algorithm to further
assist non-symptomatic medicines calls. In CAS clinical version 15 using the
Other Problems Algorithm, Medicines Enquiry algorithm alias it is now
possible to address medicines enquiries with a format that offers structure
and enables advisors to collate all the relevant information to understand
what the patient is calling about.
Some calls about medicines do not involve symptoms or changes in conditions
and where there are Health Information staff trained to handle medicines
calls they should continue to do so as indicated within the NHS Direct
National Policy for Handling Medicines Calls (NHS Direct 2005).;
‘Health Information staff must access training to support practice and have
access to a specialist Medicines Information Service. Where this is not the
case, calls should be dealt with by Nurse Advisors’ (NHS Direct 2005).
A number of Health Information staff have undergone specialist training to
handle medicines enquiries using specifically developed protocols that are
currently available on the Medicines and Pharmacy intranet site. The
Medicines Enquiry algorithm in CAS clinical version 15 will now host the
information from the protocols and will be accessible by both Health
Information Advisors and Nurse Advisors.
The NHS Direct policy for managing medicines enquiries gives clear
definitions on what constitutes a medicine, pharmacy or poisons call and
which staff discipline should manage the call process for each call type:
The National Policy for Handling Medicines Calls (NHS Direct 2005)
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For the purpose of this document the list below outlines those calls which
may be managed by Nurse Advisors but not by Health Information Advisors.

The subject of the call is taking 3 or more medicines.

For some enquiries about a high-risk medicine, for example,
warfarin, aminophylline, carbamazepine, ciclosporin, digoxin,
lithium, methotrexate, phenytoin or theophylline

The individual is pregnant (excluding calls where there is a
Medicines Q&A that answers the question e.g. is it safe to take
paracetamol in pregnancy).

The individual is currently breastfeeding

The enquiry relates to a child under the age of 16 years

The medication enquiry is ethically sensitive – ‘Can you tell me what
methadone is, I have just found a bottle of it in my son’s bag?’

The enquiry conflicts or undermines a GP or Consultant
recommendations

The prescribed dose is outside of the usual range

The enquiry relates to an unlicensed medicine (NHS Direct 2005)
It is important to understand when handling medicine calls the conditions
where medicines may present a particular challenge as the response to the
medication may be compromised and those medicines that have a narrow
window between therapeutic effect and toxicity
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
Medicines Information Service
Referral to a Medicines Information service is a valuable resource and the
usual reasons for referral are:

Caller has complicated medicine and/or past medical history

Information is missing, contradictory, unclear or confusing

Enquiry is outside of professional competence

Difficulty in understanding the question or problem
The service is currently only available 9-5 Monday to Friday excluding Bank
Holidays so this has to be considered when handling the call.
Take this opportunity to check your local UK Medicines Information
service number and record below.
Please refer to the following guidance on the Medicines and Pharmacy
intranet site; (http://nww.intranet.nhsdirect.nhs.uk/medpharm/)
NHS Direct Working with UKMi Guidance for sites (NHS Direct 2005)
NHS Direct Guidance for Referral of Complex Medicines Calls to UKMi
(NHS Direct 2005)
NHS Direct Working with UKMi Guidance for sites (NHS Direct 2005)
NHS Direct Guidance for Referral of Complex Medicines Calls to UKMi
(NHS Direct 2005)
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Section 2
Documenting Patient Medical History
What is a Medicine?
A medicine can be any substance used therapeutically that is administered
by systemic, topical, inhalation, rectal, vaginal, intramuscular, subcutaneous
or intravenous route.
Recording Patient Medical History (PMH)
When collecting the relevant patient medical history Advisors should ensure
that the history collected contains any medicines being taken including the
name, dose, frequency and any existing conditions or allergies and record
within the PMH function. This is a mandatory field in this type of call in
order to complete all medicine enquiries.
For this reason all medicines enquiries should be recorded in the name of
the patient who is taking the medicine.
The Patient Medical History screen is accessed using the following process:
Select Patient
Medical History.
Clicking on patient
information on
current tasks will
leave PMH
accessible for the
call duration
Copyright © 2004 CAS Services Ltd. All Rights Reserved
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To launch PMH when required within the episodes of care click on the PMH
within ’MY CURRENT TASKS’.
Key information that needs to be collected in all medicines enquiries
includes:

What is the drug?

What has it been prescribed for?

What is the dose and frequency?

Any other medicines?

Any other disease states?

Who is it for?- it should be for the person who is ringing otherwise
classed as third party

The age of the patient? This will have been collated already and
will be seen on screen
‘In symptomatic calls the PMH collected should be relevant at the time of
the call. Recording of medicines in these circumstances may not require dose
and regime’.
To add to the PMH click on
to ADD PMH on the menu
bar. This will make the
Medicines, Conditions and
Allergies active.
Copyright © 2004 CAS Services Ltd. All Rights Reserved
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Copyright © 2004 CAS Services Ltd. All Rights Reserved
Any active PMH will be displayed in the applet and will appear on the call
report.
Copyright © 2004 CAS Services Ltd. All Rights Reserved
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Editing PMH
Clicking on show all will
show any errors or inactive
PMH entered into the
patient record
Copyright © 2004 CAS Services Ltd. All Rights Reserved
Copyright © 2004 CAS Services Ltd. All Rights Reserved
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If you need to edit any of the information select edit PMH from the menu
bar and using the drop down menu choose the item you wish to edit.
Once you have made changes to the PMH information in the applet will
indicate when the item was modified and by whom.
Other information that is displayed in the applet includes;
 The date any PMH was entered,
 The time it was entered and
 The name of the user who entered it.
Key Board shortcuts
As each item of PMH has to be entered and saved before adding any more
the following key board shortcuts may assist in reducing the number of
mouse actions required to enter the information;
CTRL + S allows you to save any data added
CTRL + Z will cancel any data you do not wish to save while the applet is
active
CTRL + Q will close the applet
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Section 3
Using the Other Problems algorithm to support medicines enquiries
Medicine topics addressed within the Other Problems Algorithm, Medicines
Enquiry algorithm alias incorporates the following single select options;

Adverse effects

Interactions

Therapeutic dose

Travel medicine

Administration and dosage

Identification

Access
In launching the algorithm Advisors should first fully explore what it is the
patient is asking, for example if they want to know if Ciprofloxacin can cause
headaches it is important to ascertain whether the patient is experiencing
them or wondering about the potential for this to happen. If headaches are
occurring then an assessment of the current symptoms should be undertaken
using the appropriate algorithm by a nurse advisor.
If the patient has taken an overdose of a medicine that has not been
ascertained at the call streaming and prioritisation stage of the care
process, the algorithm will transfer out to the ‘ingestion’ algorithm in order
that an appropriate assessment is made or transferred to a nurse advisor
for assessment.
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Using the Medicines Algorithm Alias to answer medicine enquiries
Let’s look at the single select topics addressed within the Medicines Enquiry
algorithm alias relating to medicines individually and highlight any key issues
and the appropriate search strategy.
Adverse Effects
Think about the terminology a patient is using, the Medicines Enquiry
algorithm alias should only be used if the patients concern relates to
potential not actual side effects.
In ascertaining the patient history you would need to find out the following:
 1. Is the medicine they are enquiring about currently being taken or
when do they plan to start?

2. What is it being taken for?

3. What is the specific question or concern regarding the medicine?
Document the patient responses using the ‘add note’ applet within the
algorithm.
Search Strategy

eBNF nww.intranet.nhsdirect.nhs/bnf/ The interactions appendices is
very comprehensive and will usually state if there is an interaction
present or not, but in a lot of cases does not give details on how to
manage the interaction.

eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).

eMC http://emc.medicines.org.uk The company SPC again will state most
of the interactions re[ported for that product, in some cases gives more
detailed and practical details of what to do.
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
detailed and practical details of what to do.

Drug Interactions – Stockley now via Medicines Complete
Comprehensive source that covers interactions in more detail, giving you
an idea of how serious the interaction is, timescale and practical advice
on what the patient should do.

NHS Direct FAQ's Can be used as a sole source to document an enquiry.
This resource can be found on the NHS Direct Online site and at
www.ukmi.nhs.uk

Can be used as a sole source to document an enquiry. This resource can be
found via the NHS Direct Intranet add link

Additionally in support of the system information the following can be
used for complimentary medicines:

Herbal medicines, Pharmaceutical Press

Dietary supplements, Pharmaceutical Press

Herbal Safety News, www.mhra.gov.uk
Top Tips/Referral
If an adverse reaction occurs and a patient has been on a medicine for years
do not assume the medicine is not the cause, some times adverse reactions
can occur after a period of many months.
Interactions
1. What medicines is the caller enquiring about?
2. Why does the caller wish to know this?
3. Which of the medicines is the caller already taking and how long have
they been taking them for?
4. Have the medicines been taken together? (If so how long has the
combination been taken for and have any symptoms been seen)
5. Is the caller taking any other medicines?
6. What are they being taken for?
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7. Who prescribed the medicine or was the medicine bought from a
pharmacy?
Has a potential side effect already been seen, or are they asking just be on
the safe side. Is the caller worried about any side effect in particular, has
the caller read about an interaction somewhere and if so where.
If it is because new symptoms have been noticed the call should be passed
to a nurse advisor.
The algorithm supports the following questions when assessing an enquiry
relating to actual or potential interactions;
You will need to collect details not only of the medicine the patient has
concerns about but also any other medicines being taken.
The caller takes medicine X and wants to take medicine Y.
The caller takes medicines X & Y.
The caller takes medicine X and wants to drink alcohol or eat for Y.
A caller should never be advised to take medicine that has been prescribed
for someone other than themselves.
Check the following reference sources:
--- eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).
--- eMC
--- NetDoctor
--- Patient.co.uk (Drug Information Leaflets section)
--- Medicines Q&As
--- Shockley's Drug Interactions (accessible via Medicines Complete)
In addition, for Complementary Medicines:
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--- Herbal Medicines (Accessible via Medicines Complete)
--- Dietary Supplements (Accessible via Medicines Complete)
--- Herbal Safety News
--- UKMI Factsheets on Complementary Medicines
Top Tips/Referral
If you are unable to find an interaction listed in the eBNF do not assume
that it means there is no interaction, check other sources first.
If you are unable to find any information or don’t understand the
information you have found – contact the Medicines Information Service.
Therapeutic Use
An example of a therapeutic use enquiry could be that of a patient who is
about to take a long haul flight and wishes to take aspirin prophylactic ally
and wants to know if this is OK as they have mild asthma
Again it needs to be confirmed whether the patient is taking any other
medicines or has any other existing medical condition and if they are
pregnant or breast feeding.
Document the nature of the enquiry confirm the name, dose and frequency
of all medicines?
CLINICAL INSIGHT:
CAN I TAKE?
Is
Is
Is
Is
it OK to take medicine X? The caller has condition Y.
it OK to take medicine X? The caller has allergy Y.
it OK to take medicine X? The caller is having test Y.
it OK to take prescribed medicine X for unlicensed indication Y?
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A caller should never be advised to take medicine that has been prescribed
for someone other than themselves.
Consider:
Medicines X may interact with other medicines taken by caller. Medicine X
may be contra-indicated in one of the caller's medical conditions of diseases.
Search Strategy
Depending on the type of enquiry the search strategy and best use of
resources will vary
REFERENCE GUIDELINES:
Check the following reference sources:
--- eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).
--- eMC
--- NetDoctor
--- Patient.co.uk (Drug Information Leaflets section)
--- Medicines Q&As
--- Best Treatments
--- Prodigy
In addition, for Complementary Medicines:
--- Herbal Medicines (Accessible via Medicines Complete)
--- Dietary Supplements (Accessible via Medicines Complete)
--- Herbal Safety News
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--- UKMI Factsheets on Complementary Medicines
HALFLIFE
Time medicine/Drug stays in the body, blood or urine (half life)
How long does medicine X stay in the body?
How long does drug X stay in the blood or urine?
The caller is having a drug screen test.
Consider:
Medicine X may take longer to be removed from the body because of an
interaction with one of the other medicines taken by the caller. Medicine X
may take longer to be removed from the body because of one of the caller's
other medical conditions or diseases.
REFERENCE GUIDELINES:
Check the following reference sources:
--- eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).
--- eMC
--- Martindale - The Complete Drug Reference (Accessible via Medicines
Complete)
--- Medicines Q&As
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Examples of typical therapeutic use enquiries and the appropriate search
strategies are described within the table below;





Is it okay to take this medicine if I
have this existing condition or known
allergy?
Is it okay to take this medicine as
caller is having a test or investigation?
Is it okay to take this medicine for
unlicensed useage?
Is it okay to drive or operate
machinery whilst taking this medicine?
Is it okay to take this medicine whilst
pregnant?

Is it okay to take this medicine whilst
breastfeeding?

How long does this medicine stay in the
body?
How long does this medicine stay in he
blood or urine? The caller is having a
drug screen test or urinalysis

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eBNF (consult for all calls)
eMC
netdoctor (www.netdoctor.co.uk)
Martindale
NHS Direct FAQ (sole source)
In addition for complementary medicines
Herbal Medicines, Pharmaceutical Press, plus
Dietary supplements, Pharnaceutical Press
Herbal safety News (www.mhra.gov.uk) which are not
identified within the CAS system
eBNF (consult for all calls)
eMC
In addition for complimentary medicines
Herbal Medicines, Pharmaceutical Press
Dietary Supplements, Pharmaceutical Press
Further questions to add to the usual list before
researching medicines in pregnancy calls or
referring to medicines information:
 Already taken or considering taking?
 Who has advised the medicine is taken?
 Weeks pregnant/date of last menstrual period?
 Any problems in previous pregnancies?
eBNF (consult for all calls)
eMC
In addition for breastfeeding advice
UKMI Central (www.ukmicentral.nhs.uk)
In addition for complimentary medicines
Herbal Medicines, Pharmaceutical Press
Dietary Supplements, Pharmaceutical Press
Further questions to add to the usual list before
researching medicines in breastfeeding calls or
referring to medicines information:
 Already taken or considering taking?
 Who has advised the medicine is taken?
 Age of baby, for neonates number of weeks at
term?
 Baby well?
 Breastfeeding going well? How often baby
feeding?
eMC
Martindale
NHS Direct FAQ's (sole source)
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Administration and Dosage
Enquiries that relate to administration and or dosage can relate to missed
doses, not taking enough of the medicine, or what to do if a medicine that
has been taken is out of date.
Wherever possible for administration and dosage the patient leaflet should
be referred to.
Where the medicine taken has expired the patient should be referred to a
pharmacist or the nurse advisor should seek guidance from the Medicines
Information Centre.
Where the medicine taken has expired the patient should be referred to a
pharmacist or the nurse advisor should seek guidance from UKMI .
Search Strategy
Reference sources to check:



eBNF via MC The interactions appendices is very comprehensive and will
usually state if there is an interaction present or not, but in a lot of
cases does not give details on how to manage the interaction.
BNF for Children via MC
Emc http://emc.medicines.org.uk The company SPC again will state most
of the interactions reported for that product, in some cases gives more
detailed and practical details of what to do.
Within the algorithm specify the type of administration and dosage enquiry
(Select One):
1. The caller has been prescribed a different dose of the same medicine
2. The caller is enquiring about how to store a medicine
3. The caller is enquiring about out-of-date medicines / safe disposal
4. The caller has difficulty in reading the label /opening the bottle
5. The caller is enquiring about how / when to take a medicine
6. None of the above
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CLINICAL INSIGHT:
DIFFERENT DOSAGES
Enquiries regarding different doses of the same medicine should be dealt
with by a Pharmacist.
STORAGE
Enquiries about storage of medicines use the following reference sources:
--- eBNF or eBNFc (eBNF for children) (Accessible via Medicines Complete
(Use either eBNF or eBNFc for all calls))
--- eMC (Sole Source)
OUT OF DATE/SAFE DISPOSAL
Enquiries regarding safe disposal or out of date medicines should be dealt
with by a pharmacist.
DIFFICULTY READING LABEL/OPENING BOTTLE
Simple information regarding child resistant bottles can be given over the
phone if know.
All other enquiries regarding difficulty reading the label or opening a bottle
should be dealt with by a pharmacist.
HOW/WHEN TO TAKE A MEDICINE
Enquiries about how and when to take a medicine use the following reference
sources:
Check the following reference sources:
--- eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).
--- eMC
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--- Medicines for Children
In addition, for Complementary Medicines:
--- Herbal Medicines (Accessible via Medicines Complete)
--- Dietary Supplements (Accessible via Medicines Complete)
--- Herbal Safety News
--- UKMI Factsheets on Complementary Medicines
Travel
In all travel medicines enquiries it is best practice to find out, who the
medicine is for, why do they need it/or why have they had it, where they are
travelling to and for how long and what sort of holiday they are going on.
When they last had any travel medicine/vaccinations is also important.
You will also need to find out whether the patient is on any medication
and/or has an existing medical condition.
1. Identify who is travelling and whether this includes any children
2. Identify the exact destination(s) to be visited and nature of the travel
(e.g., backpacking)
3. Find out about the type of accommodation to be used (e.g., camping,
hotels)
4. Check the length of stay and proposed travel dates
5. Check if any of the travellers have any pre-existing medical problems
6. Check whether any female travellers are pregnant, breastfeeding or
thinking of trying to conceive
CLINICAL INSIGHT:
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Destinations:
Recommendations vary according to the part of the world and also within a
given country. For example, high mountainous areas are unlikely to have
malaria carrying mosquitoes, but the low lying areas nearby may have.
At Risk:
If a caller is thinking of trying to conceive, they should be referred to their
own GP for discussion.
Information on travel vaccinations can be found on the Travax web site
For all other queries check DORIS for specialist clinics or advise the caller
to contact their own GP.
Where there are a number of people travelling at the same time a record
should be created for each as their age, existing medical history or
medicines being taken could influence the advice given
Search Strategy
For travel enquiries a two-stage approach is required:

eBNF

netdoctor (www.netdoctor.co.uk)

Health Information for Overseas Travellers (yellow book)

Use TRAVAX to identify what should be taken
Top tips
For complicated travel itineries refer to the Medicines Information Service
Use the search strategies for therapeutic use to answer the enquiry 'can I
take', for example for a child or for pregnancy and travel related enquiries.
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Identification
When answering this type of enquiry it is important to collect the following
information: Specify the type of medicine identification enquiry (Select
One):
1. The caller says their medicine has a different name to that usually
prescribed, OR the medicine is the same but has a different name
2. The caller has been prescribed a medicine abroad and wants to know
the UK equivalent
3. The caller is asking what a particular medicine is for
CLINICAL INSIGHT:
DIFFERENT NAME
Check the following reference sources:
--- eBNF or eBNFc (BNF for children). Accessible via Medicines Complete
(Use Medicine Chest Online to confirm the active ingredient in an OTC
Medicine before looking it up with eBNF or eBNFc).
--- eMC
--- NetDoctor
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--- Patient.co.uk (Drug Information Leaflets section)
--- Martindale - The Complete Drug Reference (accessible via Medicines
Complete)
Note: It may be due to brand and generic names.
The caller should be referred to a pharmacist if a different drug.
MEDICINES FROM ABROAD
The caller may have been prescribed a medicine from abroad and wishes to
know the UK equivalent.
SPECIFIC MEDICINE IDENTIFICATION
The caller may have found a medicine or substance and wishes to identify it.
Who is asking for a medicine to be identified?
Is it the caller’s medicine?
If not do they have the owners consent?
Why do they want it identified?
Is it a foreign medicine, if so where from?
The Nurse Advisor is presented with an ethical dilemma when a caller is
requesting the identification of a medicine belonging to a third party.
Think about the issues third party
medicine identification presents
and make notes on what they
might be and how you would
respond to the request.
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An exception to third party identification request is where the caller is
acting as an intermediary or where the caller is the primary carer for the
person for whom the medicine is prescribed.
Search Strategy

Calls requesting an identification of an unknown medicine that is not the
callers property should be referred to a community pharmacist once it is
established there is no immediate or urgent clinical risk. It is not reliable
to identify a medicine from a physical description only without seeing it
first hand.

Depending on the type of enquiry the following reference sources should
be used:
Section A "What it is or is for"

netdoctor (www.netdoctor.co.uk)

Martindale
Section B "Different name"

eBNF (consult for all calls)

netdoctor (www.netdoctor.co.uk)

eBNF (consult for all calls)

eMC

Martindale
In addition information may be sourced from

netdoctor (www.netdoctor.co.uk)
Section B "Different name"

eBNF (consult for all calls)

netdoctor (www.netdoctor.co.uk)
In addition information may be sourced from
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
eMC

Martindale
Section C "Foreign Medicines"

Martindale (sole source)
Top Tips/Referral
UKMI have access to further reference information to assist with
Medicine Information Services have access to further reference
information to assist with identification and could advise on equivalent
preparations.
Access
There are a number of access issues relating to medicines including
administration, where to obtain supplies.
Consideration should be taken if the call is received in the Out of Hours
period as to the urgency and whether it can be managed in the in hours
period the following day.
The enquiry concerns access to oxygen therapy, pharmacy opening times, or
repeat prescriptions?
CLINICAL INSIGHT:
ACCESS TO OXYGEN THERAPY
Home oxygen is now provided directly by four specialist oxygen companies
and NOT pharmacies, although people will still receive their oxygen cylinders
or concentrators as before. The supplier (dependent on where people live),
details are held in DORIS and updated as national records.
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Note: Due to initial difficulties experienced by some patients in accessing
their supplies via the new system, some local pharmacies have agreed to
continue providing oxygen. Where possible, local contacts are listed in
DORIS. The supply situation changes rapidly and patients will need to
confirm with individual pharmacies whether they are able to provide oxygen.
ACCESS TO PHARMACY OPENING TIMES
Check the following reference sources:
LOC - Pharmacy in DORIS (For Bank Holiday and OOH provision), or nhs.uk
ACCESS TO REPEAT PRESCRIPTIONS IN HOURS
A repeat prescription would usually be issued by the initial prescriber (e.g.,
GP).
For callers who are not registered with a local GP, details can be found on
nhs.uk
ACCESS TO REPEAT PRESCRIPTIONS OUT OF HOURS
If out of hours, callers should be advised to contact their own GP unless
there is an immediate need for the medicines.
Details of out of hours providers can be found in DORIS.
REPEAT PRESCRIPTIONS DISPENSED BY PHARMICIST
For UK residents the caller should be advised that some medicines on repeat
prescriptions can be dispensed by pharmacists as an emergency supply. The
pharmacist must interview the person requesting the medicine(s) and ensure
that the following legal requirements are met:
1. There is an immediate need for the medicine(s) and it is impracticable to
obtain a prescription.
2. A doctor has previously prescribed the medicine(s) for the person.
3. The dose is appropriate for the person to take.
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Supply is limited to 5 days treatment, except if the medicine is:
Insulin, an ointment, a cream, eye drops or an inhaler device (whereby the
smallest pack available can be given).
An oral contraceptive (whereby a full cycle can be given).
An antibiotic (whereby a full course of treatment can be given).
The medicine must not be a controlled drug (e.g., Heroin, Morphine,
Amphetamines). An emergency supply of Phenobarbitone is permitted,
provided that it is for the treatment of Epilepsy.
Supply of any medicine(s) is a t the discretion of the pharmacist concerned
and he/she is allowed to charge a private prescription fee (usually 1.5 times
the base cost of the medicine(s)) or a minimum charge of the NHS
prescription fee, even if the patient is exempt. If a prescription is later
issued, it may be possible to re-claim the cost.
Check LOC - Pharmacy in DORIS, or nhs.uk and give details of Pharmacists
open at the time required the caller must be advised that they need to
telephone the pharmacy first to check opening times.
Examples of access issues can include parental nutrition, needle exchanges,
administration of intra-muscular injections (e.g. a carer giving medication to
a relative and the carer has injured their hand – they may require a District
Nurse to administer the IM in the interim), dialysis. The list is not
exhaustive and you have probably a number of other examples.
Search Strategies

Nhs.uk

Indirect
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
DORIS

Drug Tariff
Top Tips
If the call requires another provider e.g. District Nurse using DORIS LOC
to find the relevant service will enable you to tag the referral source to the
call events.
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Section 4
Documenting Medicine Enquiries Advice
Within the clinical algorithm the rationale will advise which resources you
would need to access for the nature of the enquiry.
Within the home care advice topics you will be able to select those
resources you have consulted and this will then automatically enter them into
the patient’s record.
You should also copy the hyperlink of the web page actually used to provide
the information into the advice recommended applet.
Section 5
Resources to Manage Medicines Enquiries
Electronic resources for the management of medicines enquiries should be
accessed via the National NHS Direct intranet.
The NHS Direct Medicines FAQ’s are hosted on the Pharmacy and Medicines
micro-site on the intranet.
 The eBNF should always be consulted as a routine dose check as part
of the call even if the answer to the enquiry is not likely to be found
there.

For all medicine calls information needs to be clear and at least two
sources must be consulted to find the information unless a sole source
is stated within this learning resource.
On launching the home page clicking on the Medicines Complete hyperlink
which can be located on the left hand pane will take you to the log on page.
Log on using the Medicines Complete password
This will then give you access to the electronic resources required to manage
medicines enquiries.
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Where to find information about medicines?
Getting Started
This section looks at the basic electronic information resources that are available at your
NHSD site. It is not meant to be exhaustive but is designed to give you an introduction to
handle medicines related calls. It looks at what each source covers, and some of the
strengths and limitations and gives search tips to find information
eBNF
NHS Direct intranet or www.bnf.org
The eBNF should be your first port of call for every medicines call.
There are 15 main chapters that cover the main areas of therapeutics. This is where the
main monographs for each medicine can be found, and will include uses, side effects, doses,
cautions & contraindication. The 9 appendices cover more specialist areas such as medicines
in pregnancy, breast-feeding, liver/renal disease.
Strengths
Comprehensive & reliable source of
information on medicines.
Updated every 6 months.
Specialist appendices e.g. drug
interactions, medicines in pregnancy
Some information on unlicensed uses of
medicines.
Difficult to navigate – need to practice a
lot.
Scan down the whole page as content may
sometimes be hidden from view.
Fair amount of jargon e.g. quinolones,
sympathomimetics, MAOIs,
No information on complementary
medicines, apart from St. John’s Wort.
Pitfalls
Tips for searching.
Searching for general information
 Click on the words that say “No Frames” at the top left hand corner.
 Type the name of the medicine in the white box at the top right hand of the screen,
then click Search
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
The main information about a medicine can be found by clicking on the name of that
medicine when it is written in CAPITAL letters
eg. FUROSEMIDE / FRUSEMIDE
Searching for Interactions between medicines
Use interactions search to find interactions between pairs of drugs.


Enter the drugs you wish to search for in the white search box at the top left of
the page.
o To search for the interactions of a single drug, enter
 a single word (e.g. aspirin)
 a phrase enclosed in double quotes (e.g. "ace inhibitors")
OR
o To search for interactions between pairs of drugs, enter the drugs
separated by a space (e.g. Furosemide Lithium)
Click on the interactions button.
If an interaction is listed, you will be able to click on the name of these medicines
highlighted in blue & underlined. Note down the classes of drugs that this interaction
refers to, so you can find these on the next page. You MUST look for the name of the other
medicine in this list AND the class of drugs it belongs to.
Information about an interaction is given next to the drug/class of drugs it refers to.
The importance of an interaction relates to the background colour behind the text;
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Yellow Background Red Background –
Tips




Do not usually have serious consequences
Potentially hazardous
Try to use generic names, not brand names.
Other useful information about that medicine can be found by clicking of the words
underlined in blue and will take you to information about that medicine. The
information in black will tell you what kind of information you will find by clicking on
it.
If you go to back to page you were looking at before, just click on the button that
says back in the top left hand corner of the page.
If no interaction is listed, do not assume that none exists. Check other resources
such as the eMC (see later) or Stockleys – Drug Interactions (Text Book).
eMC
www.emc.medicines.org.uk
The eMC holds the Summaries of Product Characteristics (SPCs) and Patient Information
Leaflets (PILs) produced by drug companies. Every drug company must produce an SPC &
PIL for every medicine, but not every one can be found on the eMC.
Can view the Patient Information Leaflet
(PIL) that is given to the patient.
Strengths
Comprehensive source of information on
medicines.
Very easy to search.
Updated when changes made to the
Summary of Product Characteristics
(SPC).
Pitfalls
Information on branded medicines only.
Information on licensed uses only.
Written by the manufacturer of the
medicine so the information can be
circumspect because of medico-legal
concerns.
Tips for searching
Search the eMC using the search bar on the top right hand side of the screen, using the
generic or brand name of the medicine. Make sure the name is spelt correctly.
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The results page is the same layout in each case; a list of the preparations will be seen,
specifying in each case whether it is the SPC (SPC) or the PIL (PIL).
The SPC is a document describing the properties, effects and warnings about the medicine
such as indications, dosage information, adverse effects, interactions, use in
pregnancy/lactation, ingredients etc and is written to guide healthcare professionals use of
the medicine.
The PIL is the leaflet intended to be read by the patient and is included in the medicines
packaging.
Click on the name of the medicine highlighted in blue next to the SPC or PIL box
depending on what you want to look at. Each is set out in exactly the same way, making
navigation straightforward once you are familiar with the format.
www.netdoctor.co.uk
netdoctor
This website is specifically aimed at patients. It aims to provide basic information written in
a patient friendly style. It is edited and updated by a team of health professionals including
doctors and pharmacists. It is found at the following link: http://www.netdoctor.co.uk . It
can be a very useful source of information but does not have the depth found in the eBNF
or eMC.
Medicines content has much input from
pharmacists – it has good focus on the key
Strengths
facts to be aware of.
Good source of general information on
medicines, especially as a starting point
Pitfalls
before looking at a more complicated
Not very helpful for information about
text.
medicines during pregnancy or whilst
Very easy to search.
breastfeeding.
Written for the lay public with limited
Very
little
information
about
amount of jargon. Worded such that it
complementary medicines.
can be read to the caller with little
Does not have the depth of information
adaptation.
found in other sources such as the BNF or
eMC.
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Tips for searching
Click on the Medicines button in centre of the homepage to go to the section about
medicines.
NHS Direct FAQs
NHS Direct intranet or www.ukmi.nhs.uk
There is a set of standard answers to some of the more common medicine related questions. These
have been produced by pharmacists who are specialists in medicines information. The are fully
referenced and may be used as a sole reference source when handling a medicines call. They are
housed on the UKMI website, available via the following link: http://www.ukmi.nhs.uk/
Click on "FAQs" on the Medicines Information section of the home page.
Strengths
Answers to frequently asked questions about medicines.
Topics identified by NHSD Nurse Advisors and Health Information Advisors.
Content developed by UKMI pharmacists and is well researched, peer reviewed and referenced.
Use of the FAQs was fully tested at 2 NHSD sites.
Updated every 15 months but immediately if warranted.
Can be used as sole information source.
Pitfalls
Limited number of FAQs but more planned.
Tips for Searching
The FAQs section of the UKMi site holds FAQs written for NHSD, which are shown in
green, and FAQs written for the wider NHS, shown in blue. Those shown in blue have not
been written with NHSD in mind and are often quite technical, so should not be copied to
patients or used for counseling.
A username and password is required to access the FAQs. It is available in your NHSD site.
The password and login gives you access to a range of other materials on the UKMi site that
you must not copy to patients unless the text explicitly gives you permission.
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Many of the NHSD FAQs are available on the NHS Direct online website in a patientfriendly format. They can be found at
http://www.nhsdirect.nhs.uk/innerpage.asp?Area=60
UKMI Website - Complementary medicines factsheets
www.ukmi.nhs.uk
There is a set of factsheets that gives key information on the use of some of the more
common herbal medicines. These have been produced by pharmacists who specialise in
medicines information and are fully referenced. They are housed on the UKMI website,
available via the following link: http://www.ukmi.nhs.uk/
Click on "Complementary therapies" in the Medicines Information section of the home
page.
Strengths
Well researched, peer reviewed and
referenced.
Pitfalls
Helpful summary of key facts about
common herbal medicines and dietary
supplements.
Limited number of factsheets so far but
more planned.
At present they cover echinacea, garlic, glucosamine, St Johns Wort, Saw Palmetto &
Valerian.
Toxbase – Poisoning in pregnancy monographs
http://www.spib.axl.co.uk
Toxbase contains the specialist database from the National Teratology Information Service
(NTIS). It holds information about the risks associated with exposure to certain medicines
during pregnancy and in some cases lactation. There is also a section that looks at how to
manage certain conditions in pregnancy.
Strengths
Very useful monographs on the use of
individual medicines e.g. amoxicillin but
also groups of medicines e.g. antibiotics
during pregnancy.
Well researched, peer reviewed and
referenced.
Some information on illicit drugs.
Pitfalls
Not all medicines covered.
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Tips for searching
Click on the text that
says “Poisoning in
Pregnancy”
Remember to look for
both the drug name
and the class of drug.
UKMI Central – Medicines in Breastfeeding
www.ukmicentral.nhs.uk
This guide is written by the UK Drugs in Lactation Advisory Service - a joint service
provided by the West Midlands and Trent Medicines Information Services. Whilst this
guide is a simplified summary of possible adverse effects of commonly prescribed drugs in
breast milk, it is your responsibility to familiarise yourself with these effects. It is
intended to be used only to assess risk where the infant is normal, healthy, and born fullterm. Calls about infants born prematurely, or with serious illnesses or more complex
problems should be referred.
Strengths
Useful traffic light coding for safety
medicines use whilst breastfeeding.
Difficult to find this information
elsewhere.
Well researched, peer reviewed and
referenced.
Pitfalls
Written by specialists in breastfeeding,
and
can
sometimes
contradict
manufacturers advice. If in doubt obtain
further advice.
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Tips for searching
Click on the “quick reference guide” under the heading Drugs in Lactation on the home
page.
Scroll down the list to find drugs grouped together in their therapeutic class eg.
antihistamines, antidepressants.
Immunisation Against Infectious Disease (‘Greenbook’)
www.dh.gov.uk
The Green Book is a document, which charts the history of immunisation and
immunisation advice over the years. It was published in 1996 as a book, which has now
been superceded with the on-line version housed on the Department of Health website:
www.dh.gov.uk . To find it search using the exact term “Green Book”, including the
inverted commas.
This is an essential guide for any enquiry regarding vaccination or immunisation. It
should always be used in conjunction with the eBNF/eMC.
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The first 12 chapters provide general information regarding immunisation including
general indications/contraindications, adverse effects, storage conditions and
immunisation schedules.
The following chapters are each dedicated to an individual infection, covering
background to each infection, how vaccines are used to treat it, dosage instructions,
adverse effects and more specific contraindications for that vaccine.
Each chapter is a separate PDF file that can be downloaded. This means that by using
the binoculars function, you can search the document for a particular word/phrase. It
will scan the document and highlight the relevant part of text, a useful way of quickly
finding information in the document.
Produced by
Richard WK Lee & Davina Wraight
Principal Pharmacists and NHS Direct Leads.
London & London and South East Medicines Information Services.
Contact: [email protected] & [email protected]
October 2004.
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Approved Information Sources For Medicines Calls
First line information sources for most medicines calls
eBNF (intranet link)
eMC http://emc.medicines.org.uk/
Netdoctor “Medicines” http://www.netdoctor.co.uk/medicines/
Medicines FAQs (see next page for specific links, also HIA protocols)
Medicine-Chest (for information about OTC medicines) http://www.medicinechestonline.com/
Administration & dose
Medicines for Children (intranet link)
Therapeutic use / contraindications
Prodigy http://www.prodigy.nhs.uk/ClinicalGuidance/ReleasedGuidance/GuidanceList.asp
Best Treatments http://www.besttreatments.co.uk/btuk/home.html
Side effects
MHRA http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=5
Drug interactions
Stockley’s Drug Interactions (in Medicines Complete)
Pregnancy
Toxbase “Go to exposures in pregnancy” http://www.spib.axl.co.uk/
Breastfeeding
UKMICentral “Drugs in lactation” http://www.ukmicentral.nhs.uk/drugpreg/guide.htm
Complementary medicines
UKMI Herbal Factsheets http://www.ukmi.nhs.uk/Med_info/compthera.asp
Herbal Safety News http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=96
Herbal Medicines, J. Barnes, Pharm. Press
Dietary Supplements, P. Mason Pharm. Press
Unlicensed medicines / off label use
Prodigy http://www.prodigy.nhs.uk/ClinicalGuidance/ReleasedGuidance/GuidanceList.asp
Best Treatments http://www.besttreatments.co.uk/btuk/home.html
Martindale (in Medicines Complete)
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Immunisation & travel medicines
Travax http://www.travax.scot.nhs.uk/
Immunisation.nhs.uk www.immunisation.nhs.uk
Department of Health www.dh.gov.uk/PolicyAndGuidance/HealthAdviceforTravellers
Fitfortravel www.fitfortravel.scot.nhs.uk
Access to medicines
NICE http://www.nice.org.uk/
BMA http://www.bma.org.uk/ap.nsf/content/splashpage
Family Planning Association (oral contraception) www.fpa.org.uk
DORIS (on intranet)
Hormonal contraception
Family Planning Association www.fpa.org.uk
Prodigy http://www.prodigy.nhs.uk/ClinicalGuidance/ReleasedGuidance/GuidanceList.asp
Time in the body
Martindale (in Medicines Complete)
Foreign medicines
Martindale (in Medicines Complete)
Patient friendly language
Patient.co.uk “Drug information leaflets” http://www.patient.co.uk/dils.asp
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National Learning & Development
Practice Profile
Having read through this learning resource and completed the learning
activities take time to write a reflective piece to include in your practice
profile:
Consider the following:






How does the information relate to my practice?
Were the intended learning outcomes met?
If so, has my knowledge increased as a result?
Are there any areas that I can apply immediately in my practice at
NHS Direct?
Have any other learning needs been identified as a result of this
learning?
If so, what is my plan of action and do I need to contact anyone
else to assist me in this?
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If you have any feedback on the pack please direct it to your ETD lead
who will correlate the feedback from your site for the authors.
Please complete the following details and forward to the Learning and
Development Lead for inclusion in your training L&D record.
Complete the following details
Name: _________________________________
Post:_____________________
Date Information Pack Completed:
____/____/06
I confirm that I have completed the Information Pack on Medicines Enquiries
______________________________ Signature
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