Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors.

Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors

Introduction to Medicines, Poisons and Pharmacy Calls Aim To enable all staff answering Medicines, Poisons and Pharmacy calls to work within role competencies and fulfil them safely, reliably and effectively in this area of care.

Introduction to Medicines, Poisons and Pharmacy Calls Learning Outcomes 1. Have an overview of NHS Direct’s Pharmacy and Medicines Services 2. Have an overview of UK Medicines Information Services, National Poisons Information Services and Community Pharmacy Services 3. Have a baseline knowledge for handling Medicines and Poisons Calls

Introduction to Medicines, Poisons and Pharmacy Calls Session Timetable  NHS Direct’s Pharmacy and Medicines Services  Workshop 1 Ethical Dilemmas  Overview of UK Medicines Information  Overview on National Poisons Information Services  Break  Overview of Community Pharmacy Services  Baseline Knowledge for handling Medicines Calls  Workshop 2 What is a Medicine?  What Next?

Introduction to Medicines, Poisons and Pharmacy Calls Session Timetable  NHS Direct’s Pharmacy and Medicines Services  Workshop 1 Ethical Dilemmas  Overview of UK Medicines Information  Overview on National Poisons Information Services  Break  Overview of Community Pharmacy Services  Baseline Knowledge for handling Medicines Call  Workshop 2 What is a Medicine?  What Next?

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Why learn about Pharmacy and Medicines? Research from 2000 showed 6% of all calls to NHSD are for advice about medicines 40% of calls include advice about medicines

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Medicine Calls may involve Prescription-only Medicines (POM) Homeopathic preparations Pharmacy Medicines (P) Food supplements and vitamins General Sales List Medicines (GSL) Recreational drugs and drugs of abuse Herbal remediesSteroids in sport

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Is there a Policy? Look in NHS Direct National Policy for Handling Medicines Calls NP005 and NP005A

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services 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 NP005 covers

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services NP005 Definition of Medicines Any substance or article which is manufactured, sold, supplied, imported or exported for use wholly or mainly in Treating or preventing disease Diagnosing disease or status of a physiological condition Contraception Inducing anaesthesia Temporarily or permanently affecting a physiological function in any way

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Overview of the roles of different staff in handling medicines calls: role competencies and limitations Call Handlers/Health Advisors Information on access to medicines, repeat prescriptions, P4Q call Health information staffMedicines Information when no new or worsening symptoms Dental Nurse AdvisorsAdvice about medicines on the Dental Practitioners Formulary Nurse AdvisorsMedicines advice when new or worsening symptoms present

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services P4Quick Call P4 Priority Quick Calls on access to pharmacy services and medicines Access to Emergency Hormonal Contraception Information on missed contraceptive pills Repeat medication Access to medicines do not need to be referred to Health Information. Details in the Medicines handling Policy NP005

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Other NHS Direct Policies NP001 - National Guidance for the Management of Frequent Callers NP002 - National Policy for the Referral of Callers with Mental Health Issues to Mental Health Helplines NP006 - Protecting and Using Patient Information NHS Direct Child Protection Policy NP008 - Adverse Incident Management Policy NP022A - Complaints and Feedback Policy NP033 - National procedure for Handling Third Party and Intermediary Calls NP048 - Guidance for Health Information Advisors for Emergency Contraception and Missed Pills

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Compulsory checks for new/active or recurrent symptoms “Are you calling about an injury or a new or worsening health problem?”

Introduction to Medicines, Poisons and Pharmacy Calls NHS Direct’s Pharmacy and Medicines Services Risk Factors in taking medicines calls Misunderstanding what the caller said Omitting relevant information sources Missed symptomsWorking outside level of competency Incomplete background information Caller doesn’t understand the answer Incomplete or inaccurate documentation

Introduction to Medicines, Poisons and Pharmacy Calls 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 or Dentist Wrong information given to caller by HCP Caller taking a higher dose than prescribed Caller prescribed two interacting medicines

Introduction to Medicines, Poisons and Pharmacy Calls Ethical Dilemmas I found a tablet…. My dentist says this…. but I’ve read the other…. Does heroin interact with…..? Could my partner’s tablets cause……?

Introduction to Medicines, Poisons and Pharmacy Calls Ethical Dilemmas – General Guidance 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 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: don’t get caught up in patient conflicts with other professionals. In law no one can give consent on behalf of an adult

Introduction to Medicines, Poisons and Pharmacy Calls Workshop 1 – Ethical Dilemmas A man asks you if he can dissolve or crush temazepam tablets and mix with fruit juice or a fizzy drink? What advice would you give? A women has found some medication in her son’s room. She reads the labels lamivudine, zidovudine & saquinavir. She asks you if these are for the dental treatment he received last week? Can you tell her what they are for? Would your answer be different if the call was from his wife?

Introduction to Medicines, Poisons and Pharmacy Calls Overview of UK Medicines Information UKMi - supports MI needs of NHS health professionals >½ million enquiries 2004 16 regional & 260 local centres Specialist services - pregnancy, breastfeeding, liver disease Training, websites, QA, drug reviews

Introduction to Medicines, Poisons and Pharmacy Calls Overview of UK Medicines Information NAME Medicines Information Service

Introduction to Medicines, Poisons and Pharmacy Calls Overview of UK Medicines Information Staff Pharmacists Pre-registration students Secretarial support Technicians Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work OPENING HOURS TELEPHONE NUMBER

Introduction to Medicines, Poisons and Pharmacy Calls Refer to the UKMi Service if You need interpretation of call You have no information or it is unclear It is a complex call Not within your competency NAME Medicines Information Service OPENING HOURS TEL NUMBER Overview of UK Medicines Information

Introduction to Medicines, Poisons and Pharmacy Calls Caller taking 3 or more prescription medicines Dose(s) outside the normal range Unlicensed use of medicine or use of unlicensed medicine High risk medicines e.g. aminophylline, carbamazepine, digoxin, lithium, methotrexate, phenytoin, theophylline, warfarin Medicines in pregnancy or breastfeeding Complex Calls Overview of UK Medicines Information

Introduction to Medicines, Poisons and Pharmacy Calls 24 hour, UK wide clinical toxicology service for healthcare professionals Staffed by Poisons Information Specialists, Nurses, Pharmacists, Physicians Provide information & advice on diagnosis, treatment and management of poisoning Overview of the Poisons Information Service

Introduction to Medicines, Poisons and Pharmacy Calls Overview of the Poisons Information Service Two poisons services: 24/7 NPIS: Belfast, Cardiff, Birmingham, Edinburgh, Newcastle 0870 600 6266 Guy’s and St Thomas’ 0870 243 2241

Introduction to Medicines, Poisons and Pharmacy Calls Overview of National Poisons Information Service TOXBASE® Primary Clinical Toxicology database of NPIS Available to healthcare professionals only Contains colour-coded NHS Direct advice boxes Updated daily Low Toxicity Poster – substances safe if ingested At NHS Direct used by NAs only

Introduction to Medicines, Poisons and Pharmacy Calls Provides information on toxicity and management of acute poisoning for over 14,000 products – search by brand name or type of product TOXBASE® Overview of National Poisons Information Service PharmaceuticalsHousehold & other Commercial Products Industrial ChemicalsPlants Agricultural ChemicalsSnakes Veterinary ProductsInsect Bites

Introduction to Medicines, Poisons and Pharmacy Calls

Session Timetable  NHS Direct’s Pharmacy and Medicines Services  Workshop 1 Ethical Dilemmas  Overview of UK Medicines Information  Overview on National Poisons Information Services  Break  Overview of Community Pharmacy Services  Baseline Knowledge for handling Medicines Calls  Workshop 2 What is a Medicine?  What Next?

Introduction to Medicines, Poisons and Pharmacy Calls Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls 5 facts about Community Pharmacy 6 million people visit a community pharmacy every day. 94% population use the local pharmacies at least once a year. In 2002, the NHS medicines bill was £8 billion, 250% more than in 1990. In 2002, 712 million prescription items were dispensed, 50% more than 1990. 75% GPs say pharmacists should be able to prescribe certain medicines and offer extended advisory services. Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Started 1 st Apr 2005, Benefits Improve access to community pharmacy Expand range of services provided Make better use of pharmacist skills Help reduce workload pressures on GPs and Dentists 3 levels of service: Essential, Advanced, Enhanced New Contract Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Dispensing Patient records Compliance support Electronic transfer of prescriptions Repeat dispensing Pharmacist managed repeats Disposal of unwanted medicines Health promotion 6 campaigns / year Signposting Support for self care Clinical Governance Essential services Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Optional Accreditation to provide Medicines Use Review Long-term conditions Identified by PCT Report to patient and GP Prescription Intervention Response to specific issue Report to patient and GP Advanced Services Accreditation Pharmacist has passed a competency test Patient and pharmacist can sit down together Talk normally without being overheard Private consultation area Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls PCTs may commission to meet local need May implement recognised services or develop own initiatives Enhanced Services Suggested Enhanced Services Minor Ailments Smoking Cessation Supervised Administration of Medicines Anticoagulant Monitoring Needle Exchange Schemes Care Home Support Emergency Hormonal Contraception Schemes Medicines Review Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Staff in a community pharmacy Sales assistantsTrained to work in shop but not to sell or advise on medicines Counter assistantsTrained to sell and advise on medicines – supervision by pharmacist Dispensing techniciansTrained to dispense Rx – all checked by pharmacist PharmacistResponsible for all sales and Rx of medicines By law a pharmacy is not a pharmacy if pharmacist not present Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Access hours Monday – Saturday standard ‘shop hours’ OOH system to cover evenings and Sunday by local agreement Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Out of Hours (OOH) Provision Check NHS.uk for details of local arrangements for OOH service Look on NHS Direct online under Common Health Problems for Emergency Supply of medicines from a community pharmacy Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Emergency Supply by a pharmacist – £ charge to patient Pharmacist must interview the person Immediate need and impractical to obtain prescription Previously prescribed and dose appropriate Supply up to 5 days except Insulin, ointment, cream, drops, inhaler – smallest pack Oral contraceptive - a full cycle Antibiotic - a full course of treatment Do not supply a Controlled Drug Except phenobarbitone for epilepsy Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls NHS Prescription Charges £6.65 for each NHS Prescription Irrespective of cost to NHS of medicine Irrespective of quantity Same drug and form is one charge Various charges for combination products Prescription Pre-Payment Certificates – online / community pharmacy Overview of Community Pharmacy Services NHS Dental Prescriptions are yellow in colour

Introduction to Medicines, Poisons and Pharmacy Calls 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. Exemptions from prescription charge Overview of Community Pharmacy Services.

Introduction to Medicines, Poisons and Pharmacy Calls Confidentiality Code of Ethics – Pharmacist must treat patients with confidentiality Data Protection Act – Includes paper and computerised patient medication records Caldicott Principles – Good practice for using patient information in the NHS Advanced Services – Private consultation area Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Patient demographics Identity of patients GP Medication dispensed Drug – brand/formulation Strength Quantity Date Directions Special Notes Counselling given No clic-locks Allergies Services offered Patient Medication Records Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls NHS Rxs on PMR Private Rxs - in bound book and on PMR Controlled drugs obtained or supplied - in bound book and / or electronically Record Keeping Checks by RPSGB inspector Superintendent Pharmacists Police Primary Care Trust (PCT) Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls 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 ……..

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Naming medicines GenericBrand AmoxicillinAmoxil ® IbuprofenNurofen ® FluconazoleDiflucan ® AciclovirZovirax ® ClindamycinDalacin C ®

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Naming medicines rINN - Internationally used naming system introduced in June 2004 British Approved Name (BAN) Recommended International Non-proprietary Name (rINN) AmoxycillinAmoxicillin CephalexinCefalexin ChlorpheniramineChlorphenamine LignocaineLidocaine

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Legal classification of medicines General Sales List GSL May be sold in general shops e.g. Paracetamol 16 Tablets Pharmacy Only P May be sold in a pharmacy but not a general shop e.g. Piriton Prescription Only POM May only be supplied on prescription e.g. Amoxicillin

Introduction to Medicines, Poisons and Pharmacy Calls Dental Practitioners Formulary Provides list of items prescribable by dentists on the NHS Private prescriptions may be written for items not on the formulary Formulary found in the BNF and Drug Tariff

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Controlled Drugs (CDs) Class AHeroin, LSD, ecstasy, morphine, remifentanil, cocaine, amphetamines if prepared for injection Class BAmphetamines, barbiturates, codeine, pentazocine, pholcodine, methylphenidate Class CAnabolic steroids, cannabis, growth hormone, clenbuterol, ketamine Misuse of Drugs Act 1971 – Controlled Drugs harmful when misused. Act prohibits production, supply or possession

Introduction to Medicines, Poisons and Pharmacy Calls Controlled Drug Regulations Handwriting requirements removed CD prescriptions valid for 28 days Quantity should not exceed 30 days New private prescription forms for CDs Patients sign on collecting from pharmacy Patients responsibility to return unused CDs to pharmacy Post Shipman Changes

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Marketing Authorisation “Product Licence” www.mhra.gov.uk Issued by Medicines & Healthcare Products Regulatory Agency Product licenses granted if three questions have been fully answered by manufacturer - Safety, Quality, Efficacy

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Key aspects in Summary of Product Characteristics (SPC) and Patient information leaflet (PIL) www.medicines.org.uk Large print and Braille PILs to be available Prescribing within the product licence is the responsibility of the doctor or dentist Patient must give informed consent if medicine is unlicensed or used “off label” Marketing Authorisation “Product Licence”

Introduction to Medicines, Poisons and Pharmacy Calls Workshop 2 What is a Medicine? The brand name of the product The name of the active ingredient The strength of the active ingredient The Product Licence number Look at the sample packs of medicines. Can you find….? The expiry date The name of the manufacturer The legal category The batch number The dosage form

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls 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 Amitriptyline for facial pain Melatonin Most herbal products Unlicensed Medicines

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Newly licensed Monitored intensively by Commission for Human Medicines (CHM) which reports to MHRA Black triangle status usually reviewed after 2 years Black Triangle medicines

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls NEWER DRUGS & VACCINES (  ) All ADRs even if Not certain that drug has caused it Reaction well known Other drugs at same time ESTABLISHED DRUGS & VACCINES All serious ADRs Fatal, life threatening or disabling Prolonged hospital stay Even if well known Yellow Card Reporting Scheme

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Launched Jan 2005 Patients can report suspected adverse effects www.yellowcard.gov.uk Freephone 0808 100 3352 Forms available from pharmacy and GP surgery Help MHRA understand the patient experience and perspective of suspected adverse effects Patients can view anonymous data on website Patient reporting to Yellow Card Scheme

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Known as the ‘Black List’ Pricing Prescription Authority (PPA) will not reimburse dispensing cost. NHS Medicines that may not be prescribed in the NHS Dentists can only prescribe medicines included in the Dental Practitioners’ Formulary on the NHS

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Certain foods considered medicines in specific conditions. Cost of dispensing reimbursed only if GP or Dentist has endorsed script “ACBS” ACBS e.g. artificial saliva products for dry mouth as a result of having or receiving radiotherapy or suffering from sicca syndrome Borderline substances

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Homeopathy Complementary Medicines Herbal Medicine Safe to use with conventional medicines May interact with conventional medicines

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls In the UK, herbal products are either foods or medicines. New legislation from August 2005 placing stricter controls on the levels of vitamins and minerals in food supplements. Food supplements

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls DoctorBNF Dentist Dental Formulary (NHS) District Nurse / Health Visitor qualified as a Nurse Prescriber Nurse Prescribers’ Formulary Nurse / Midwife/Pharmacist qualified as an Independent Prescriber Any Licensed Medicine including some CDs (nurses only) Who can prescribe medicines?

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Voluntary partnership between doctor/dentist and supplementary prescriber to implement a clinical management plan with the patient’s agreement. Pass approved training. Nurses, Midwives, Pharmacists, Chiropodists, Podiatrists, Physiotherapists and Radiographers Nurse, Midwife, PharmacistAllied Health Professional GSL POM CDs GSL POM Supplementary Prescribing

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls New legislation to improve access to medicines No individual prescription but Dr signs instructions for Specific Patient Group Named health professional authorised to: Supply a pre-labelled, fixed quantity medicine or Administer fixed quantity medicine Supply by PGD Casualty Minor Injuries Clinic Walk-In Centre Family Planning Clinic Genito-Urinary Clinic Ante-Natal Clinic Diabetic Clinic and more… Patient Group Direction (PGD)

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Pregnancy Breastfeeding Infants/children Elderly Patients on ‘high risk’ medicines Renal problems Liver problems Adverse Drug Reactions - at risk patient groups

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls More likely if taking several medicines Interactions can occur between conventional medicines and Drug Interactions One drug modifies the effect of a second drug Other conventional medicines Foods Herbal medicinesAlcohol Illicit/street drugsFood supplements

Introduction to Medicines, Poisons and Pharmacy Calls Primary resources for Medicines Calls – not in CAS system Baseline Knowledge for handling Medicines Calls

Introduction to Medicines, Poisons and Pharmacy Calls Other support for medicines calls NHS Direct in-house resources Health Information Specialists Health Information library UK Medicines Information. Your local centre is NAME Medicines Information Service on TELEPHONE NUMBER Baseline Knowledge for handling Medicines Calls

Introduction to Medicines, Poisons and Pharmacy Calls What Next? More practice and hands-on training Dental Nurse Advisors 6 hours – Handling Medicines Calls And MORE….Calculations Medicines in pregnancy and breastfeeding eBNF and eMC – further skills

Introduction to Medicines, Poisons and Pharmacy Calls Learning Outcomes 1. Have an overview of NHS Direct’s Pharmacy and Medicines Services 2. Have an overview of UK Medicines Information Services, National Poisons Information Service and Community Pharmacy Services 3. Have a baseline knowledge for handling Medicines and Poisons Calls

Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors.

Similar presentations

Presentation on theme: "Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors."— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors.

Similar presentations

Presentation on theme: "Introduction to Medicines, Poisons and Pharmacy Calls Name Medicines Information Pharmacist Centre Medicines Information Service For Dental Nurse Advisors."— Presentation transcript:

Similar presentations

About project

Feedback