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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? • • • • • 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 • • • • • • • 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 • • • • • 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) • • • • 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 • • • • • 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 • • • • • 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 • • • • • 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 • • • • • • • • • • • • 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