PILLs, BILLs & QuILLs

CHOICE AND MEDICATION

Margaret England

Acting Medication Safety & Audit Pharmacist

North Metropolitan Health Service – Mental Health

STOKES REVIEW 2012

Professor Bryan Stokes delivered a report to the WA

government regarding admission, transfer and

discharge practices in the public mental health services

in WA

Jointly commissioned by Mental Health Commission

and the Department of Health in Nov. 2011 to ensure

that effective services, policies & practices were in

place & implemented

The Stokes Review made 117 recommendations

Recommendations from the Stokes

Review (2012)

Recommendation 2: Patients

2.5 ‘A detailed explanation of the advantages and side effects of psychiatric

drugs is given to patients and the need to maintain medication regimes is

comprehensively discussed.’

Deputy Coroner’s Recommendation 7.10:

7.10.14 ‘Practitioners prescribing medications should ensure they

comprehensively discuss compliance issues and discontinuation issues as

well as any other relevant information associated with the particular

medication prescribed. I would prefer both providers and dispensers of

medication ensured up to date CMIs [consumer medicine information] or

other written information be provided to patients and/or carers as a written

record, approved by TGA [the Therapeutic Goods Administration] of the

advice given.’

Background

The chief psychiatrist was informed about the UK version of

the Choice and Medication website by our previous drug

information pharmacist, and saw the value in simplified CMIs

for patients.

Complies with NSQHS standards: Communicating with

patients and carers Standards 4.13, 4.14 and 4.15

Complies with the Stokes Review 2012 recommendations

The local version has been modified for Australian context

Website is maintained by specialist pharmacists and

endorsed by the UK College of Mental Health Pharmacy

Choice and Medication website

Main author is Professor Stephen Bazire (consultant

pharmacist and also author of Psychotropic Drug Directory)

Run by an independent organisation of qualified

professionals & specialists in mental health & mental health

medicines

No affiliations with any pharmaceutical company

Choice and Medication Group

Have developed a suite of consumer medication information

leaflets (CMIs) for psychotropic medications

Website provides multiple flexible options for a range of

diverse consumer needs

Used in other states of Australia and within WA Child &

Adolescent MHS

Over 300 information sheets – covering psychotropic

medications & related issues

Operational Directive OD 0591/15 (Feb 2015)

Mental Health Consumer Medication

Information

Every patient must be provided with both verbal and written

information regarding each new medication commenced

The mental health consumer when prescribed medication

must give informed consent

The consumer needs to be provided with appropriate

comprehensive, accessible and readable information

Must include what is prescribed, the benefits, the risks of

treatment & non-treatment and other options

Operational Directive OD 0591/15 (Feb 2015) cont.

A brief summary of this conversation, reasons for medication

use & dosage must be documented in the patient’s notes

The Chief Psychiatrist and Office of Mental Health have

recommended the use of Choice and Medication CMIs

Access at www.choiceandmedication.org/wadoh Or via the

Healthy WA public website

Choice and Medication Website

PILLs – standard Patient Information Leaflets

BILLS – Brief or Basic Information Leaflets

QuILLs – Quick Information Leaflets

30 common questions regarding 140 psychotropic

medications

Answers to 14 of the most common questions regarding 21

mental health conditions

‘Handy Charts’ for comparing the main medicine options for

each condition

CMIs in languages other than english

Some BILLs are available in Lithuanian, Mandarin Chinese, Polish,

Portuguese, Punjabi, Romanian, Somali, Spanish and Urdu.

European Medicines Agency (link for some medications) EPAR

Overview for the public, in Bulgarian (BG), Croatian (HR), Czech

(CS), Dutch (NL), Estonian (ET), Finish (FI), French (FR), German

(DE), Greek (EL), Hungarian (HG), Italian (IT), Latvian (LV),

Lithuanian (LT), Maltese (MT), Polish (PL), Portuguese (PT),

Romanian (RO), Slovak (SK), Slovenian (SL), Spanish (ES) and

Swedish (SV).

PILL - standard Product Information Leaflet

BILL – Brief or Basic Information

Leaflet

QuILL - Quick Information Leaflet

Handy Charts Comparison table of all the main medicine options for each condition

Alcohol dependence

Alcohol withdrawal

ADHA

Dementia and Alzheimer’s disease

Anxiety

Acute psychiatric emergency

Bipolar depression

Bipolar mania

Bipolar mood disorder

Depression

Insomnia

OCD

Panic

Psychosis and schizophrenia

PTSD

Seasonal affective disorder

Social anxiety

Handy Chart - shows a comparison of all the main

medicines for each condition

Handy Guides and Fact Sheets

Specific topics where useful information is harder to find

Clozapine and constipation

Generic medicines (information about generics vs brands)

Hyperprolactinaemia (raised prolactin in the body)

Medicines over the internet – some guidance on buying medicines over the

internet

Metabolic syndrome (eg. Weight gain, high cholesterol, diabetes)

QTc prolongation with antipsychotics

Ramadan (taking medicines safely during Ramadan)

Smoking and clozapine e.g. stopping smoking

Smoking and olanzapine e.g. stopping smoking

Weight gain advice

Handy Fact Sheet

‘Learn More About Your Medicines’

Booklet

A eBook for consumers of how psychotropic medicines work

Sections on

How the brain works

How we think medicines work

Tolerance, dependence & addiction

The whole book can be printed or just relevant sections

Example of a page from the eBook

Feedback from Clinical Pharmacists

‘I find the PILLs, BILLs and QuILLs helpful and this is what I give patients now.

Depends on their capacity and mental state as to which one I give. If not high

functioning I will give the QuILL, if they can take in more information I’ll give the PILL or

BILL.’

‘Mainly use the PILLs and BILLs’

‘Have used the Choice Medication website. Have only have used the PILLs as it's

concise and only 2 pages. The side-effects are also not daunting.’

‘I understand the doctors use this website to provide patients with information on any

psych meds they are prescribed, as this is mandatory now.’

‘I have used PILLs and BILLs, particularly useful for HiTH patients.’

References

Choice and Medicines website http://www.choiceandmedication.org/wadoh/

Mental Health Consumer Medication Information Operational Directive OD 0591/15

Stokes Review http://www.mentalhealth.wa.gov.au/Libraries/pdf_docs/Mental_Health_Revi

ew_Report_by_Professor_Bryant_Stokes_AM_1.sflb.ashx

Thanks to the pharmacists at Graylands Hospital for their

input