Introduction to Medicines Calls for Health Advisors

Introduction to Medicines Calls for Health Advisors
Your name Medicines Information Pharmacist Your 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 Suggested timings 9.30 Welcome & learning outcomes 9.45 NHSD policies for medicines calls, access to medicines. Role of UKMI as a support service to NHS Direct 10.15 Identification and prioritisation of medicines calls Workshop 1: Annotating Medicines Calls 10.45 Break 11.00 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 12.15 Workshop 3: Medicines Quiz, review of learning outcomes 12.30 close

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 Suggested timings 9.30 Welcome & learning outcomes 9.45 NHSD policies for medicines calls, access to medicines. Role of UKMI as a support service to NHS Direct 10.15 Identification and prioritisation of medicines calls Workshop 1: Annotating Medicines Calls 10.45 Break 11.00 What is a medicine? Overview of community pharmacy services 11.45 The National Poisons Information Service. Substances of low toxicity by ingestion Workshop 2: Use of the Low Toxicity poster 12.15 Workshop 3: Medicines Quiz, review of learning outcomes 12.30 close

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

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 Recreational drugs and drugs of abuse Herbal medicines Steroids in sport Get participants to think of the answers before revealing the table. Herbal meds eg St Johns Wort for depression, Echinacea for colds Homeopathic meds eg Thuja for warts, Rhus Tox for joint pain

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 NP005 is NHSD Medicines Policy. All frontline staff should read and understand the policy. It can be found on the NHSD Intranet. Go to Medicines and Pharmacy microsite and click on Policies and Guidance

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 Advisors P4 Calls (M1, M2 or M3): Information about medicines No new or worsening symptoms. Nurse Advisors P1-4 Calls: Advice or information about medicines Symptoms. Dental Nurse Advisors Information about medicines for dental conditions Emphasise the difference between information and advice. Interestingly, NHSD have now got the word Advisor in the job title of some people who are only allowed to provide information. Dental Nurses deal with medicines calls involving simple analgesia for dental pain. Other medicines calls are referred to a NA

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 Liverpool – Dental Newcastle – Pregnancy Leicester and W Mids – Breastfeeding Cardiff – Complimentary meds Renal – Bristol Leeds – Liver HIV/AIDs - London

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 Mon- Fri 9am pm Weekends 9am – 3pm Except Bank Holidays Speed Dial 004 Explain background to SLA – prior to national SLA, here were local SLAs between some regional centres and some NHSD sites. After NHSD became a Special Health Authority National SLA with UKMI was negotiated. First year was 2005. NHSD staff should familiarise themselves with how to make a Speed Dial call Explain four parts to the SLA and the role UKMI plays in supporting NHSD

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 CSPT supports the user (usually a Health Advisor who is not a clinician, but also sometimes a nurse) to identify a limited number of patients who have specific combinations of symptoms which experience shows invariably lead to a recommendation that a face to face consultation is needed. For these patients, so long as they can be reliably identified by the Health Advisor, additional nurse assessment is unlikely to add value and would simply serve to delay referral of the patient to the provider he/she needs to see. Scenarios which would be difficult for a non clinician to explore adequately in order to determine an appropriate endpoint would be referred to a nurse advisor for a more detailed clinical assessment. The CSPT workbook is located on the NHSD Intranet. Go to National Groups, then Learning and Development microsite, then Learning Resources.

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 CSPT supports the user (usually a Health Advisor who is not a clinician, but also sometimes a nurse) to identify a limited number of patients who have specific combinations of symptoms which experience shows invariably lead to a recommendation that a face to face consultation is needed. For these patients, so long as they can be reliably identified by the Health Advisor, additional nurse assessment is unlikely to add value and would simply serve to delay referral of the patient to the provider he/she needs to see. Scenarios which would be difficult for a non clinician to explore adequately in order to determine an appropriate endpoint would be referred to a nurse advisor for a more detailed clinical assessment. The questions support the health advisor as she/he explores symptoms in a structured and consistent manner The questions also support the health advisor in determining the level of care that the patient requires based upon the presenting symptoms at the time of the call The questions are arranged so that they rule out the highest level of care first and lead to lower prioritisation last. The most critical questions appear first in order to rule out symptoms that would need more urgent care The health advisor using the prioritisation tool and critical thinking skills, taking into account the presenting symptoms decides the priority of the call Using CSPT effectively is an e-learning package available on NHSD Intranet

Call Streaming and Prioritisation Tool (CSPT) ‘Are you calling for Health Information?’ If ‘yes’ leads to drop down menu with five selections Repeat prescriptions Access to services Medicines enquiry Health Information None of the above Repeat prescriptions – Does the person have any of their medicine left? Can it wait until surgery is open? Pharmacist may be able to provide an emergency supply (more later!). Does the caller need to be passed to GP services? Access to Services This is a quick call eg patient requires phone number for dental services or phone number/address for EHC Medicines enquiry Includes EC, missed OC pill and all other medicines enquiry Health Information Anyone requiring health information for themselves or their family but not needing nurse assessment

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 Symptomatic calls are prioritised FAQ (first advice queue) P1 P2 P3 P4 calls are-non symptomatic calls and are now further sub-divided into P4Q calls, Medicines (M) and Health Information (H) calls and P4Q 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

P4QC Quick calls about access to medicines. e.g. “Is there a pharmacy close to me that is open?” M1 Assess within 20 mins Caller extremely anxious or distressed. e.g. Caller crying. e.g. “I have missed my usual dose of medicine. Should I take 2 now?” M2 Assess within 1 hr 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?” M3 Assess within 3 hr 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?” Further examples: M1 ‘I’ve just read the patient info leaflet for my new medicine for Rheumatoid Arthritis. It says it’s for cancer. I’m scared I have got cancer and the doctor hasn’t told me’. M2 ‘I had unprotected sex 48 hours ago. Can I have emergency contraception?’ M3 ‘ What is atenolol and can I still drink alcohol with it?’

Annotating H calls H1 Assessment within 20 minutes If extremely anxious or distressed Eg ‘I have just been diagnosed with breast cancer. I don’t want a mastectomy. Will I die?’ H2 Assessment within 1 hour Urgent HI call Eg ‘I work in a nursing home. My daughter has chicken pox. Should I go to work today?’ H3 Assessment within 3 hours Non-urgent HI call Eg ‘ I want to give up smoking. Can you help please?’ Further examples H1 I’ve having a hysterectomy and just found out it means I won’t be able to have children. Is this true?’ H2 I’ve been diagnosed with hepatitis B and am very worried. Can you give me some information? What do I need to do?’ H3 I have lost the whole family's medical cards. How do I get replacements?’

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?’ These are all examples of types of questions HAs can answer. See For a blog written by a HA at NHSD for some insight into what the job of a HA entails.

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 Use White Board/ Flip Chart Get participants to come up with ideas about the kinds of information they are allowed to provide and other calls they would have to refer Eg access to EHC can be dealt with by HAs, but questions about whether EHC is needed needs to referred to NA

Workshop 1 Annotating 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 Incomplete background information Caller doesn’t understand the answer Giving incorrect information Incomplete or inaccurate documentation Get participants to think about the risks before revealing the table. Remember to get caller to spell the name of the medicine they are asking about.

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: Staffed by poisons information specialists, nurses, pharmacists, physicians Information & advice on diagnosis, treatment and management of poisoning UK NATIONAL POISONS INFORMATION SERVICE The National Poisons Information Service (NPIS) comprises five Poisons Centres (Belfast, Birmingham, Cardiff, Edinburgh, and Newcastle) providing a year-round 24-hour a day service, for health care staff, on the diagnosis, treatment and management of patients who may have been poisoned or taken an overdose. Currently the great majority of enquiries are by telephone to the NPIS Centres. Following a fundamental review of the service, new arrangements have been introduced aimed at: Moving away from the telephone as the first point of contact for poisons information to the use of the online TOXBASE database supported by a second tier consultant-led information service for more complex clinical advice; Moving to a "regionally based" service with stronger local links to promote interaction with users of the service - with a single national telephone number system routing calls to the Centre serving the "region" in which a call originated;

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

Top 10 hits on TOXBASE by NHS Direct users in 2005 1 Paracetamol ,848 2 Ibuprofen ,776 3 Bleach – Liquid ,720 4 Sodium Hypochlorite Solution 2,605 5 Sudocrem® ,223 6 Aspirin ,178 7 Calpol® Infant Suspension ,153 8 Co-codamol ,056 9 Ethanol ,854 10 Olbas Oil® ,811 Ask participants what they think this list will contain. NB ethanol could be from alcoholic drinks, mouth wash or perfume

What to ask Substance ingested? Label information: brand, manufacturer, ingredient(s), symbol any other information which may help assess risk How much? 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) It is important to clarify and document the details about poisons calls. It will be very helpful if you are dealing with a potentially toxic ingestion which needs to be passed on to a nurse if you have all of the relevant details to pass on to them so that they know what they are going to be dealing with. It is also very important for queue management – the supervisors will be able to judge which calls are a priority, and also, as a back-up, if you had thought that the substance was of low toxicity and assigned it as a P3 and it isn’t then the queue manager will be able to tell from the record and reassign it as a P1 It may be difficult to obtain all of the information because the caller may well be anxious or upset but try to clarify the following. Firstly - what the patient has been exposed to. Ask the caller to read out the information from the label, record the brand name and ask if there are any ingredients on the pack, or whether there is a hazard symbol (such as a big black cross) as this will help with the assessment of the call. Often the ingredients are very long and complicated but if you can get the first two or three this will be helpful. How much has been ingested – try to find out the size of the container and whether it was full to begin with. Ask if any has been spilled. This will help in determining how toxic the exposure is. Example – a child may have ingested a bottle of perfume – is this a big 75ml bottle or a 5ml sample size. When – this can be important in deciding what treatment the patient can have. If a toxic substance has been ingested and less than an hour has passed then it may be possible for them to go to hospital and receive charcoal. This will greatly reduce the risk of toxicity. Any symptoms –if there are any symptoms the call must be referred to a nurse for symptomatic assessment whether or not the substance appears on the low tox poster. Treatment given. This can be quite crucial. Some people think that if they have ingested something that could be toxic then they should make themselves sick. They may also try to do this with their children. This can sometimes be more harmful than the substance ingested – eg inducing vomiting, adult fingers down a child’s throat can cause physical damage. If the person has ingested a corrosive then it will burn on the way down and again on the way back up as they vomit. Salt solutions used to induce vomiting can also be very dangerous especially if given to children.

Substances of Low Toxicity by Ingestion
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 Oral irritation or gastrointestinal upset may follow ingestion of large quantities, especially in children. If patient is symptomatic then they must be referred for NA assessment even if substance on Low Tox poster. All patients will be referred to NA, but if ingestion is on Low Tox poster then call will be prioritised P3 Should be a link to Low Tox poster on NHSD Intranet national home page

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 NB Paper-based version of Low Tox Poster is not now the same as that on Toxbase. The paper-based poster has fewer entries.

Workshop 2 – Toxic or not?

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 Get participants to think about all the things that a medicine might contain – not just the drug or active ingredient. Important because some patients may not be able to tolerate certain ingredients eg colours. Others might not be able to take certain ingredients eg gelatin for vegetarians.

What is a medicine? Naming medicines Generic Brand Amoxicillin
Amoxil ® Salbutamol Ventolin ® Fluoxetine Prozac ® Omeprazole Losec ® Mefloquine Lariam ®

Legal classification of medicines
What is a medicine? Legal classification of medicines General Sales List GSL May be sold in general shops e.g. Paracetamol in packs of 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 The Medicines Act (1968), defines three legal categories of medicines. Under the Medicines Act (1968), most medicines can only be sold, or supplied at a pharmacy, under the supervision of a pharmacist. However, certain medicines (classified as general sale) can be sold at other premises such as supermarkets, provided that they are pre-packed and that the premises can be closed to exclude the public. So selling medicines from a market stall, or from a vehicle, such as at a car boot sale is illegal. GSL Medicines from newsagents, supermarkets, petrol stations. Small pack size eg 16 paracetamol. Low strength eg 200mg ibuprofen not 400mg P medicines only sold from a pharmacy. Pharmacist must supervise the sale. May ask about other medical conditions and other medicines. Eg may be asked about high blood pressure if wanting to buy certain nasal decongestants as some of these can rais blood pressure. POM medicines need Rx from GP or dentist, or in some cases a nurse, pharmacist or other HC professional. Some medicines may be reclassified from POM to P to GSL. Happens after several years when it is known that medicine is safe for most people to use. Eg aciclovir cream for cold sores POM to P to GSL. Explain some of the differences between pack sizes and legal classification: Paracetamol up to 16 tablets = GSL, up to 32 tablets = P, more than 32 = POM. But, Paracetamol soluble up to 100 = P as no recorded cases of suicide with soluble paracetamol.

Controlled Drugs (CDs)
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, cocaine, crystal meth Class B eg amphetamines, barbiturates, codeine, Class C eg anabolic steroids, cannabis, Some prescription only medicines are further classified as controlled drugs. In some cases these medicines may be misused or sold illegally so there are stricter legal controls on their supply. Controls on Who may prescribe CDs How the Rx is written How much may be prescribed How the medicines are stored CD register - Pharmacist must make a record of the medicine when it is received into the pharmacy from the wholesaler and when a prescription is dispensed Illegal to possess, supply or manufacture without proper authority (eg Rx written by a registered medical practitioner or dispensed by a registered pharmacist) Get participants to guess what the penalties could be for: Possession of cannabis - two years + a fine Supply of Heroin - Life + a fine Post Shipman - CD regulations strengthened eg returning CDs. Link to DOH website for post-Shipman Guidance: Think about who is allowed to possess and supply for professional purposes

Simple analgesics (pain killers)
What is a medicine? Simple analgesics (pain killers) Paracetamol Ibuprofen Aspirin Co-codamol Get HAs to suggest which are the simple analgesics

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 Maximum daily dose 2 x 500mg qds.

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

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. Reye's syndrome is an acute disorder which affects children when they seem to be recovering from a viral illness like 'flu', chicken-pox or diarrhoea. The child has a change in his/her personality or becomes drowsy or unconscious and develops frequent or persistent vomiting. Unless diagnosed and treated successfully, death or severe disability may result. Abnormal accumulations of fat develop in the liver and some other organs of the body. There is swelling of the brain which can cause it injury. The disease affects children from infancy onwards. Although it does occur in teenagers and adults, it is rarely recognised after 19 years of age. Children of both sexes and all races can be affected. The cause is unknown; but a number of studies suggest a link between the development of Reye's syndrome and the use of aspirin to treat the viral illness which precedes it. These studies do not prove that aspirin causes Reye's syndrome but may aggravate it. Other chemical substances including insecticides and emulsifiers have also been implicated but the evidence that these are involved is controversial. Because there are alternatives, there is no need to use aspirin for feverish illnesses in childhood. Since 1986, aspirin preparations have been labelled with differing warnings. The latest advice from the Medicines and Healthcare Products Regulatory Agency which came into force on 1st October 2003, requires all aspirin products to carry a warning that children under 16 should not take aspirin unless on the advice of a doctor.

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 Co-codamol available as 8/500 P and POM depending on pack size, 15/500 POM, 30/500 POM Co-dydramol 10/500 POM /500 P (Paramol) Co-codaprin – dispersible tablets codeine 8mg + aspirin 400mg Co-proxamol 32.5/325 POM – Patients should not be initiated on this treatment. CSM has advised that Co-proxamol should no longer be prescribed. May be available on a named patient basis. Co-proxamol is implicated in deaths from overdose a year. There is growing concern prompted by UK research which shows that co-proxamol is implicated in almost one fifth of drug related suicides; second only to tricyclic antidepressants as an agent of fatal overdose. MHRA/Committee on Safety of Medicines (CSM) conducted a review of the risks and benefits of co-proxamol. The CSM considered all the available data for co-proxamol and in January 2005 advised that it should be withdrawn from the market on the grounds that the benefits of taking co-proxamol are not considered to outweigh the risks: Decided to withdraw co-proxamol over an extended period of time in order to allow long term users to move to suitable alternatives. Withdrawal phased over a period of up to 36 months. Some manufacturers have already withdrawn co-proxamol and a few will phase the withdrawal until the end of For some patients who are likely to find it very difficult to change continued provision of co-proxamol through normal prescribing may continue until the cancellation of the licences at the end of After this time there is a provision for the supply of unlicensed co-proxamol, on the responsibility of the prescriber.

Cough and cold products
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 mg Nurofen Cold and Flu® Ibuprofen 200mg Pseudoephedrine 30mg Many cough and cold products contain several ingredients. It is important to check the full name of the medicine as many OTC medicines have similar sounding names eg Sudafed congestion and flu Sudafed decongestant elixir Sudafed decongestant nasal spray Sudafed decongestant tablets Sudafed dual relief Sudafed dual relief max

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 Pharmacists must be registered with the Royal Pharmaceutical Society of Great Britain Pharmacists can help people decide whether they need to see a doctor. Can talk to a pharmacist in confidence – even about the most personal symptoms and don’t need an appointment. 80% of the public regard the community pharmacy as the most convenient place to get healthcare advice and OTC medicines Pharmacists complete a 4-year degree course, followed by a year of pre-registration training (where they work under the supervision of a pharmacist) and an examination before becoming a registered pharmacist.

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 medicines Supervised administration of medicines Advising on minor ailments Incontinence supplies Stoma care Care Home support Patient records Smoking cessation Truss fitting Get participants to come up with ideas Table not in any order of priority. Not all pharmacies will offer all of these services. NB Disposal of unwanted medicines is a Core Service which all pharmacies must provide

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 Rx: A medical prescription. The symbol "Rx" is usually said to stand for the Latin word "recipe" meaning "to take." Another explanation for the origin of Rx is that it was derived from the astrological sign for Jupiter which was once placed on prescriptions to invoke that god's blessing on the drug to help the patient recover. If referring a patient to a community pharmacy, it is important that they talk to the right person. They need to ask for the pharmacist or may only speak to the counter assistant.

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 In 2006 the Government announced a review of prescription charges which will report by July Around four out of five prescriptions are exempt . Prescription charges are expected to raise some £425 million for the NHS in Prescription prepayment certificates (PPC), a type of season ticket, are available for those who do not qualify for charge remission but who need a lot of medication. From April 2007 they will be £35.85 for 4 months and £98.70 for 12 months. They offer a saving to anyone who needs more than 5 items in 4 months or more than 14 items in 12 months. From 1 July 2007, Prescription prepayment certificates covering 3 months at a cost of £26.85 will replace 4 month PPCs. FP10 Rx is green, can be taken to any community pharmacy FP10D – yellow dental, written by dentist. Combination products eg HRT may attract two prescription charges eg if have two strengths of tablet within the pack.

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. . Medical exemptions include eg colostomy, diabetes, thyroid disease, epilepsy. Does not include asthma, psoriasis. Explain the purpose of the CD signature box and need for ID Point of Dispensing checks were introduced in pharmacies in April 1999 and involve asking patients claiming free prescriptions to provide evidence to support their claim to exemption and noting on the prescription in the 'Evidence not seen' box if none is available. In August 2001, penalty charges were introduced. By the end of 2002, nearly 75,000 penalty charges have been issued to people who have wrongly claimed exemption from prescription charges and over £1m recovered. The Pharmacy Reward Scheme (PRS) through which pharmacists throughout England and Wales are able to claim a £70 reward for identifying a fraudulent prescription or providing information that leads to an investigation into pharmaceutical patient fraud is one of a series of measures, which have collectively contributed to an estimated reduction in pharmaceutical patient fraud by 41% from £117m to £69 million. For medical exemptions get form FP92A from doctor's surgery

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 In an emergency a patient who does not have access to their regular medicines may be able to obtain a limited supply from any community pharmacist: Emergency Supplies There are provisions within the Prescription Only Medicines (Human Use) Order 1997, as amended, for a pharmacist within a registered retail pharmacy premises to make supplies of Prescription Only Medicines without a legally valid prescription in an emergency. Requests for emergency supplies can be made by either a patient or a prescriber. When a request for an emergency supply is received, pharmacists should consider the individual circumstances of the request and use their professional judgment to determine which course of action they believe to be in the patient’s best interests. Pharmacists should not be pressurised into making an emergency supply by their employer, colleagues or patients, but should act in accordance with there own assessment of the situation. Consideration must be given to making an emergency supply whenever a patient has an urgent need for a medicine and the medical consequences, if any, of not making the supply must be taken into account. Pharmacists must be satisfied that their decision will not lead to patient care being compromised and should be able to justify their reasons for making or, indeed, refusing to make an emergency supply. Where an emergency supply is made, the appropriate records must be maintained. An emergency supply is a private transaction which pharmacists may charge for. The amount charged is at the pharmacist’s discretion. Legislation does not prevent a pharmacist from making an emergency supply when a doctor’s surgery is open. As with any request for an emergency supply, pharmacists must consider the best interests of the patient. Where a pharmacist believes that it would be impracticable in the circumstances for a patient to obtain a prescription without undue delay they may decide that an emergency supply is necessary. Automatically referring patients who are away from home and have forgotten or run out of their medication to the nearest local surgery to register as a temporary resident may not always be the most appropriate course of action.

Emergency Supply by a pharmacist Pharmacist must interview the person Supply up to five days treatment Controlled drugs may not be supplied Pharmacist must establish that there is an immediate need and impractical to obtain a prescription. Previously prescribed for the person Dose appropriate for the person Five days supply except Insulin, ointment, cream, drops, inhaler – smallest pack Oral contraceptive - a full cycle Antibiotic - a full course of treatment No CDs except Phenobarbitone for epilepsy

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 The individual requiring the medicine must go to the pharmacy (unless a child or physically incapable of attending) If possible go to usual pharmacy, although any pharmacist can make the supply Take evidence of medication, including dose e.g. repeat prescription slip, empty box/bottle Take personal identification (esp. if not going to usual pharmacy) In each case the pharmacist makes a professional judgement and may refuse a supply These are points the HA may want to make to the patient who needs an Emergency Supply Suggest phoning pharmacy to check medicine is in stock and what the cost will be to the patient

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 Pharmacists who choose not to supply EHC on the grounds of religious or moral beliefs should treat the matter sensitively and advise women on an appropriate local source of supply available within the timeframe for EHC to be effective (ie within 72 hours of unprotected sex) Suggest ring pharmacy before going, to check if the pharmacist on duty has done the appropriate training Patient must ask to speak to the pharmacist. They will be assessed by the pharmacist to see if EHC is appropriate

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Introduction to Medicines Calls for Health Advisors

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Introduction to Medicines Calls for Health Advisors

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Presentation on theme: "Introduction to Medicines Calls for Health Advisors"— Presentation transcript:

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About project

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