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

Introduction to Medicines Calls for
Health Advisors
NAME
Medicines Information Pharmacist
NAME Medicines Information Service
Timetable
Welcome & 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)
Timetable
Welcome & 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
Herbal medicines
Recreational drugs and
drugs of abuse
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 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
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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
Mon- Fri 9am - 8.00pm
Weekends 9am – 3pm
Except Bank Holidays
Services to NHS Direct
•
•
•
•
Complex medicines calls
MI skills training
Quality Assurance
National work
Speed Dial 004
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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
All calls to NHSD can be categorised as
Injury, Illness or Information.
‘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
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy
and Medicines Services
Call Streaming and Prioritisation Tool (CSPT)
•
•
•
•
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
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)
Identification and prioritisation
of medicines calls
The National Health Information Queue
All Health Information calls assigned the
same priorities nationally:
P4 for Health Information calls
Introduction to Medicines Calls for Health Advisors (v3.1)
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
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?”
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?”
Introduction to Medicines Calls for Health Advisors (v3.1)
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?’
Introduction to Medicines Calls for Health Advisors (v3.1)
NHS Direct’s Pharmacy
and Medicines Services
Medicines questions Health Advisors can deal with
‘ 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?’
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)
Timetable
Welcome & 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
Caller doesn’t understand
the answer
Incomplete background
information
Giving incorrect information
Incomplete or inaccurate
documentation
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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)
Timetable
Welcome & 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)
The National Poisons
Information Service
•
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
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
What to ask

Substance ingested?



How much?






Label information: brand, manufacturer, ingredient(s), symbol
any other information which may help assess risk
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)
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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 by
Ingestion
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
Introduction to Medicines Calls for Health Advisors (v3.1)
The National Poisons
Information Service
Use of the Low Toxicity Poster is safe because
•
•
•
•
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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)
Timetable
Welcome & 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 a medicine?



Active ingredient
Excipients
e.g. bulking agents, tablet
coatings, colours, flavours,
stabilisers, pH adjusters.
Form
e.g. tablet, capsule,
suppository, injection,
cream, patch, eye drops
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Class B
eg heroin, LSD, ecstasy, morphine, cocaine,
crystal meth
eg amphetamines, barbiturates, codeine,
Class C
eg anabolic steroids, cannabis,
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)
Timetable
Welcome & 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)
Overview of Community
Pharmacy Services
•
•
•
•
•
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
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 Supervised
medicines
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)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Overview of Community
Pharmacy Services
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Overview of Community
Pharmacy Services
Exemptions from prescription charge
•
•
•
•
•
•
•
•
•
•
•
•
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.
Introduction to Medicines Calls for Health Advisors (v3.1)
.
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
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
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
Introduction to Medicines Calls for Health Advisors (v3.1)
Timetable
Welcome & 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
Introduction to Medicines Calls for Health Advisors (v3.1)