Introduction to Medicines, Poisons and Pharmacy Calls Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service For Health Advisors,

Introduction to Medicines, Poisons and Pharmacy Calls Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service For Health Advisors, Health Information Staff and 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 Service 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 Service  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 Service  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

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 calls Health information staff Medicines Information when no new or worsening symptoms 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 e.g. 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 NHS Direct FAQs regarding Protecting and Using Patient Information NHS Direct Child Protection Policy NHS Direct Adverse Incident Management Policy NHS Direct Complaints and Feedback Policy NHS Direct Third Party Calls Policy

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 documentationInaccurate 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 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

Introduction to Medicines, Poisons and Pharmacy Calls Ethical Dilemmas I found a tablet…. My G.P. 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: try not to get caught up in patient conflicts with other professionals.

Introduction to Medicines, Poisons and Pharmacy Calls Workshop 1 – Ethical Dilemmas 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. What advice would you give? A woman says she has found some medicines in her son’s room. She reads the labels - lamivudine, zidovudine & saquinavir. 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 2005 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 Your Medicines Information Service Your team photo

Introduction to Medicines, Poisons and Pharmacy Calls Overview of UK Medicines Information Staff Pharmacists Pre-registration students Secretarial support Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work 9am - 5.00pm Your MI phone 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, hours and contact details of your Regional MI Service 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 National Poisons Information Service

Introduction to Medicines, Poisons and Pharmacy Calls Overview of National Poisons Information Service Five poisons centres Belfast, Cardiff, Birmingham, Edinburgh, Newcastle One national number 24/7 0870 600 6266

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 Service  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 10 facts about Community Pharmacy 6 million people visit a community pharmacy every day. 94% population use the local pharmacies at least once a year. Community pharmacy could manage up to 8% of adult attendances to A&E. 80% repeat prescriptions could be handled by community pharmacists, saving 2.7 million hours of GP/practice time. NHS could save £380 million/year if 1 in 4 people consulted their pharmacist about minor ailments instead of the GP. Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls 10 facts about Community Pharmacy 30% PCTs developing schemes to provide patients treatment for minor ailments through pharmacies. 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. In one study, 66% of patients did not require all prescription items to be dispensed. Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Started 1 st Apr 2005, monitoring delayed until Oct Benefits Improve access to community pharmacy Expand range of services provided Make better use of pharmacist skills Help reduce workload pressures on GPs 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 a prescription Previously prescribed for the person Dose appropriate for the person 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 Pre-payment certificates – forms from community pharmacies Overview of Community Pharmacy Services

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 Medication dispensed Drug – brand/formulation Strength Quantity Date Special Notes Counselling given No clic-locks Allergies Patient Medication Records Overview of Community Pharmacy Services

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

Introduction to Medicines, Poisons and Pharmacy Calls Emergency Hormonal Contraception (EHC) Pharmacists may Sell EHC (cost to patient) subject to certain restrictions e.g.age of patient Supply EHC (free to patient) subject to pharmacist training and according to local guidelines (PGDs) Overview of Community Pharmacy Services

Introduction to Medicines, Poisons and Pharmacy Calls Existing arrangements - prescriptions for oxygen dispensed at community pharmacy From 2006 new arrangements in place Patients will receive oxygen directly from supplier Oxygen 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 ® SalbutamolVentolin ® FluoxetineProzac ® OmeprazoleLosec ® MefloquineLariam ®

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 DothiepinDosulepin FrusemideFurosemide 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 Pharmacy Only P May be sold in a pharmacy but not a general shop e.g. Zantac Prescription Only POM May only be supplied on prescription e.g. Amoxicillin

Introduction to Medicines, Poisons and Pharmacy Calls Baseline Knowledge for handling Medicines Calls Controlled Drugs (CDs) Class AHeroin, LSD, ecstasy, morphine, remifentanil, Class B if injections Class BAmphetamines, barbiturates, codeine, pentazocine, pholcodine Class CAnabolic steroids, cannabis, growth hormone, clenbuterol Misuse of Drugs Act 1971 – Controlled Drugs harmful when misused. Act prohibits production, supply or possession Post Shipman - CD regulations strengthened eg returning CDs

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 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 Methotrexate for asthma and lupus Sodium valproate for prevention of migraine Thalidomide 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 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 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

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 has endorsed script “ACBS ACBS e.g.Wysoy for milk protein sensitivity 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 District Nurse / Health Visitor qualified as a Nurse Prescriber Nurse Prescribers’ Formulary Nurse / Midwife qualified as an Extended Formulary Nurse Prescriber Nurse Prescribers’ Extended Formulary 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. Prescribe all GSL, POM and CDs within the clinical management plan. Pass approved training. Currently AuthorisedProposed Nurse Midwife Pharmacist Physiotherapists Radiographers Chiropodists, Optometrists 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… Phone number…. Baseline Knowledge for handling Medicines Calls

Introduction to Medicines, Poisons and Pharmacy Calls What Next? More practice and hands-on training All Nurse Advisors6 hours – Handling Medicines Calls All Health Information staff 6 Hours – Handling Medicines Calls 3 Hours – Oral contraception

Introduction to Medicines, Poisons and Pharmacy Calls What Next? …..and More Further skills sessions for HIAs and NAs Medicines in Pregnancy and Breastfeeding Oral Contraception and EHC Travel Medicines Complementary and Alternative Medicines eBNF and eMC – further skills Immunisation

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 Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service For Health Advisors,

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Introduction to Medicines, Poisons and Pharmacy Calls Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service For Health Advisors,

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Presentation on theme: "Introduction to Medicines, Poisons and Pharmacy Calls Ruth Cheema Medicines Information Pharmacist Trent Medicines Information Service For Health Advisors,"— Presentation transcript:

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