Download Document

Role Preparation for Nurse Advisors
Handling Medicines Calls
Your Name
Your Medicines Information Service
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Learning Outcomes
Handle medicines calls safely and effectively

Gather the necessary background information to
clarify the question and minimise the risks when
advising the caller.

Navigate the key medicines information sources.

Interpret information about medicines and turn it
into appropriate advice.

Know when and how to refer to the MI Service.
Role Preparation For NAs: Handling Medicines Calls
Why are specialist skills in
Medicines Information needed?
Increasing number and
difficulty of medicines
calls
 Therapeutic
explosion
 Information
explosion
Number Of Enquiries
Received By A Regional MI
Service
6000
5000
4000
3000
2000
1000
0
1977
Role Preparation For NAs: Handling Medicines Calls
1995
2000
Structure of MI Services

UKMI - supports MI needs of
NHS health professionals

>½ million enquiries 2005

16 regional & 260 local centres

Specialist services - pregnancy,
breastfeeding, liver disease

Training, websites, QA, drug
reviews
Role Preparation For NAs: Handling Medicines Calls
Your Medicines Information
Service
Your Team Photo
Role Preparation For NAs: Handling Medicines Calls
Trent Medicines Information
Service

Staff




Pharmacists
Pre-registration students
Secretarial support
Service to NHS Direct




Complex medicines calls
MI skills training
Quality Assurance
National work
Role Preparation For NAs: Handling Medicines Calls
Your phone number
and opening hours
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Navigating the eBNF, eMC
netdoctor and NHSD FAQs
Role Preparation For NAs: Handling Medicines Calls
British National Formulary
(BNF)

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 NAs: Handling Medicines Calls
eMC (Electronic medicines
Compendium)

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 members of the public
Role Preparation For NAs: Handling Medicines Calls
NetDoctor

Easy to Search
 Layman’s language
 Good for use, side-effects, drug interactions
 Medicines section written by pharmacists
 Updated daily
Role Preparation For NAs: Handling Medicines Calls
Medicines Chest Online
Book Published annually – Online version
updated daily
 Guide to over the counter medicines
 Particularly useful for checking active
ingredients
 Very little clinical information

Role Preparation For NAs: Handling Medicines Calls
Merits / Disadvantages
Merits
eBNF
eMC
Gold standard
Some opinion
Easy to search
Comprehensive info
Easy to search
Layman’s terms
Use, side effects, drug
interactions
Medicines Good for details on
active ingredients of
Chest
OTC products
Saves time
FAQ
Difficult to find info
NetDoctor
Role Preparation For NAs: Handling Medicines Calls
Disadvantages
Care when searching
Jargon
Technical
Unlicensed / off label
Not all medicines
Pregnancy
Breastfeeding
Very little clinical
information
Limited number
Need prompt updating
Workshop 1 – Navigating eBNF,
eMC, netdoctor and NHSD FAQs
Role Preparation For NAs: Handling Medicines Calls
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Role Preparation For NAs: Handling Medicines Calls
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Handling a Medicines Call
Clarify the question
Record
all
stages
Plan search strategy
& research problem
Evaluate the information
Tailor the answer/advice
Role Preparation For NAs: Handling Medicines Calls
Refer
to MI
The Iceberg Theory
This is what the
caller may ask
?
Role Preparation For NAs: Handling Medicines Calls
This is the rest
of the story!!
Essential questions to ask
Confirm no new or worsening symptoms
THE PERSON
THE MEDICINE

Age?

Name, dose, frequency?

Allergies/disease states?

Who is it for?

Pregnant: no. of weeks,
going well, medicine taken
already?

What prescribed for?

Why asking?

Other medicines? Name,
dose, frequency?

Breastfeeding: baby age,
term/pre-term, well/unwell,
medicine taken already?
Role Preparation For NAs: Handling Medicines Calls
Key Information Sources

BNF / eBNF

Electronic Medicines Compendium (eMC)

NetDoctor

NHSD (Q&As)

Medicines Chest online
Role Preparation For NAs: Handling Medicines Calls
Standard Search Strategies
Encourage best practice and sharing of expertise

Pointers to the best sources available to answer
particular types of medicines call.

Not a definitive list of sources and should check
other sources as appropriate.

No need to check every source in the search
strategy for every call.
Role Preparation For NAs: 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 NAs: Handling Medicines Calls
What should be documented?

Website e.g. eBNF, eMC, NetDoctor

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 NAs: Handling Medicines Calls
Example documentation
Is warfarin safe in 1st trimester of pregnancy?
eBNF: Malformations.
eMC: No monograph.
NetDoctor: Do not use.
Toxbase: Malformations.
Advised to speak to GP by end of day.
Role Preparation For NAs: Handling Medicines Calls
Referral to the MI Service

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.
Role Preparation For NAs: Handling Medicines Calls
Examples of
Complex Medicines Calls
Complex drug history
 Lots of medicines
 Unclear what is taken
 Unlicensed medicines
Pregnant
 Medicines taken but
info sources say to
avoid
Side effects
 Asks if symptoms due
to medicines
Breastfeeding
 Medicines taken but
info sources say to
avoid
 Baby pre-term / unwell
Drug interactions
 Narrow therapeutic
range medicines e.g.
digoxin
Uses / choice
 Contra-indicated
 Doses outside norm
Role Preparation For NAs: Handling Medicines Calls
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Workshop 2 - Medicines Calls
Role Preparation For NAs: Handling Medicines Calls
Morning Timetable
Introduction & learning outcomes
Navigating eBNF, eMC, NetDoctor and
NHSD FAQs
Workshop 1
Tea break
Handling calls about medicines
Medicines Calls
Workshop 2
Lunch
Role Preparation For NAs: Handling Medicines Calls
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Adverse Drug Reactions
Unwanted effect that drug has on a person

Account for 2-6% of hospital admissions

Type A predicted by mode of action
Type B idiosyncratic or unpredictable
Role Preparation For NAs: Handling Medicines Calls
Incidence of Adverse Effects
Very common
>10%
Common
>1%
Risk of dying from cancer if
smoke 20 a day for 30 years
Uncommon
>0.1%
Risk of being injured on the
stairs in next 12 months
Rare
>0.01%
Risk of dying in an accident
at home in next 12 months
Very rare
up to
0.01%
Risk of being killed by
lightening
Role Preparation For NAs: Handling Medicines Calls
Yellow Card Reporting Scheme
NEWER DRUGS
& VACCINES ()
ESTABLISHED DRUGS
& VACCINES
All ADRs even if
All serious ADRs

Not certain that drug
has caused it

Fatal, life threatening
or disabling

Reaction well known


Other drugs at same
time
Prolonged hospital
stay

Even if well known
Role Preparation For NAs: Handling Medicines Calls
Patient reporting to Yellow Card
Scheme

Pilot scheme launched Jan 2005

Patients can report suspected adverse effects


www.yellowcard.gov.uk
Patient report forms from 4000 GPs in pilot or MHRA

Help MHRA understand the patient experience
and perspective of suspected adverse effects

Patients can view anonymous data on website
Role Preparation For NAs: Handling Medicines Calls
MHRA Website
Medicines & Healthcare Products
Regulatory Authority
www.mhra.gov.uk
Role Preparation For NAs: Handling Medicines Calls
Recent Drug Alerts / Scares
Rofecoxib
Withdrawn,  risk MI/stroke
HRT
Avoid longterm,  risk breast cancer
Kava-Kava
Withdrawn, hepatoxicity
Cerivastatin
Withdrawn, rhabdomyolysis
Co-proxamol Risk of death in overdose
Paroxetine
Not if <18 yrs,  risk suicide
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Workshop 3 - Adverse Effects
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Drug Interactions
One drug modifies the effect(s) of a second drug.
More likely if taking several medicines.
 Toxicity
 Efficacy

Warfarin + amiodarone =
greater risk of bleeding

Ciclosporin + Phenytoin =
more ciclosporin needed

Flecainide + Fluoxetine =
greater risk of arrhythmias

Thyroxine + Rifampicin =
more thyroxine needed
Role Preparation For NAs: Handling Medicines Calls
How medicines are handled by
the body
Liver
Gut Blood
wall
ABSORPTION
METABOLISM
DISTRIBUTION
Kidney
ELIMINATION
Role Preparation For NAs: Handling Medicines Calls
One way medicines interact:
Absorption of the drug

Antacids can absorb
other drugs e.g.
Ciprofloxacin

Cholestyramine
(Questran) binds to
many drugs so give 1
hour before or 4-6
hours after
cholestyramine
Role Preparation For NAs: Handling Medicines Calls
More ways medicines interact:
Metabolism of the drug
Metabolic
Enhancers
Smoking
Alcohol
Carbamazepine
Phenytoin
Rifampicin
Role Preparation For NAs: Handling Medicines Calls
DRUG LEVEL
More ways medicines interact:
Metabolism of the drug
Metabolic
Inhibitors
Cimetidine
Ciprofloxacin
Erythromycin
Metronidazole
Role Preparation For NAs: Handling Medicines Calls
DRUG LEVEL
Narrow Therapeutic Range Drugs
CARBAMAZEPINE
CICLOSPORIN
DIGOXIN
LITHIUM
PHENYTOIN
THEOPHYLLINE
WARFARIN
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Workshop 4 - Drug Interactions
Role Preparation For NAs: Handling Medicines Calls
Afternoon Timetable
Adverse drug reactions
Workshop 3
Tea Break
Drug interactions
Where are the risks?
Close
Role Preparation For NAs: Handling Medicines Calls
Workshop 4
Where are the risks when
handling a Medicines Call?
Clarify the question
Record
all
stages
Plan search strategy
& research problem
Evaluate the information
Tailor the answer/advice
Role Preparation For NAs: Handling Medicines Calls
Refer
to MI
Learning Outcomes
Handle medicines calls safely and effectively

Gather the necessary background information to
clarify the question and minimise the risks when
advising the caller.

Navigate the key medicines information sources.

Interpret information about medicines and turn it
into appropriate advice.

Know when and how to refer to the MI Service.
Role Preparation For NAs: Handling Medicines Calls
What next?

Assessment



By practice coaches
2 scenarios similar format to Workshops
Further MI Skills training e.g.





Medicines during in pregnancy and breastfeeding
Immunisation and Vaccination
Complementary and Alternative Medicines
Oral Contraception and EHC
Use of Medicines Complete
Role Preparation For NAs: Handling Medicines Calls