Role Preparation for Nurse Advisors Handling Medicines Calls Day 1
description
Transcript of Role Preparation for Nurse Advisors Handling Medicines Calls Day 1
Role Preparation for Nurse AdvisorsHandling Medicines Calls
Day 1
NAME
Medicines Information Pharmacist
NAME Medicines Information Service
Role Preparation for Nurse Advisors - Day 1
Medicines Training for NursesTraining Duration Trainer
Week 4 Using Toxbase® to support poisons calls ½ day NHSD
Week 5/6 Handling Calls about medicines and the Medicines Algorithm
Trainer evaluation
Further medicines case scenarios
1 ½ days
½ day
UKMI
UKMI + NHSD
Self directed
Week 10 Handling calls about Hormonal Contraception and Emergency Contraception
EC algorithm – further scenarios
½ day UKMI
Self directed
3-6 months Medicines calculations for NAs
e-Toxbase®
One-to-one medicines training on request
Self directed
Self directed
UKMI
6 months Handling calls about medicines during pregnancy and breastfeeding
½ day UKMI
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 2 Morning
9.30 Welcome & re-cap
9.45 Handling calls about Adverse Effects & Drug Interactions
Workshop 4: Case scenarios on Adverse Effects and
Drug Interactions
11.15 Break
11.30 Handling calls about analgesia
Workshop 5: Case scenarios on analgesia
1.00 Lunch
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 2 Afternoon
Medicines Algorithm
Workshop 6: Case scenarios using the medicines algorithm
Break
Where are the risks when handling medicines calls?
Examples of common mistakes
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
NHS Direct’s Pharmacy and Medicines Services
Why learn about Pharmacy and Medicines?
Research has shown
More than 6% of all calls to NHSD are for advice about medicines
More than 40% of all answers to calls include advice about
medicines
Role Preparation for Nurse Advisors - Day 1
NHS Direct’s Pharmacy and Medicines Services
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
Role Preparation for Nurse Advisors - Day 1
NHS Direct’s Pharmacy and Medicines Services
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
Role Preparation for Nurse Advisors - Day 1
• Based on a set of shared beliefs between NHS Direct and the users of the service:
• Everyone is entitled to be involved in decisions about medicines and choose a different option if they prefer
• Everyone will be able to get medicines information they want and need
NHS Direct’s Pharmacy and Medicines Services
Principles for Handling Medicine Calls
Role Preparation for Nurse Advisors - Day 1
• Complex calls• Advice to support a therapeutic choice• Advice and information about EC and
unprotected sex• Dental medicines calls• Third party and intermediary calls• Requests for repeat medication
NHS Direct’s Pharmacy and Medicines Services
Guidance for specific types of calls
Role Preparation for Nurse Advisors - Day 1
NHS Direct’s Pharmacy and Medicines Services
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 ingestionsInterim 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. No new or worsening symptoms.
Dental Nurse Advisors
Information about medicines for dental conditions
Role Preparation for Nurse Advisors - Day 1
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
Identification and prioritisation of medicines calls
Annotating calls
Role Preparation for Nurse Advisors - Day 1
Identification and prioritisation of medicines calls
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
4 hrs
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?”
Role Preparation for Nurse Advisors - Day 1
Identification and prioritisation of medicines calls
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 4 hours
Non-urgent HI call
Eg ‘ I want to give up smoking. Can you help please?’
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines Information?
• UKMI- supports MI needs of NHS health professionals
• >½ million enquiries 2006• 16 regional & 260 local centres• Specialist services -
pregnancy, breastfeeding, liver disease, dental
• Training, websites, QA, drug reviews
www.ukmi.nhs.uk
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines Information?
Alana Adams Wales
Alison Alvey Bristol
Kelly Broad Leicester
Ruth Cheema Leicester
Jane Farris Birmingham
Matt Haggerty Leeds
Wynn Pevreal London
Caroline Riddle Bristol
Paula Russell Newcastle
Jill Rutter Liverpool
Davina Wraight London
Role Preparation for Nurse Advisors - Day 1
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 - 8.00pmWeekends 9am – 3pmExcept Bank Holidays
Speed Dial 004
Role Preparation for Nurse Advisors - Day 1
What is UK Medicines Information?
• Complex medicines call.
• Difficult to interpret what is being asked.
• No information or it is unclear or conflicting.
• Not within your competency or a second opinion needed.
• When Medicines Algorithm advises referral
Referral to UKMI
Role Preparation for Nurse Advisors - Day 1
Examples of Complex Medicines Calls
Complex drug history • Lots of medicines• Unclear what is taken• Unlicensed medicines
Side effects• Not clear if symptoms due
to medicines
Drug interactions• Narrow therapeutic range
medicines e.g. digoxin
Pregnant• No UKMI Q&A
Breastfeeding • No UKMI Q&A• Baby pre-term / unwell
Uses / choice• Contra-indicated• Doses outside norm
What is UK Medicines Information?
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
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
Role Preparation for Nurse Advisors - Day 1
Ethical Dilemmas
• I found a tablet….• My G.P. says this…. but I’ve read
something different• Does heroin interact with…..?• Could my partner’s tablets cause……?• What are my friend’s tablets for….?
Role Preparation for Nurse Advisors - Day 1
General Guidance• 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.• 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.
Ethical Dilemmas
Role Preparation for Nurse Advisors - Day 1
Workshop 1 – Ethical Dilemmas
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?
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?
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
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 ……..
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Naming medicines
Generic Brand
Amoxicillin Amoxil ®
Salbutamol Ventolin ®
Fluoxetine Prozac ®
Omeprazole Losec ®
Mefloquine Lariam ®
Role Preparation for Nurse Advisors - Day 1
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 OnlyP
May be sold in a pharmacy but not a general shop e.g. Piriton®
Prescription OnlyPOM
May only be supplied on prescription e.g. Amoxicillin
Role Preparation for Nurse Advisors - Day 1
What is a medicine?
Controlled Drugs (CDs)
Class A eg heroin, LSD, ecstasy, morphine,
Class B eg amphetamines, barbiturates, codeine,
Class C eg anabolic steroids, cannabis,
Misuse of Drugs Act 1971
CDs are POMs with stricter controls on production, supply or possession
Role Preparation for Nurse Advisors - Day 1
Off LabelUK product licence but
being used for an indication/at a dose/by a route not in the licence
No LicenceNo UK product licence
•Methotrexate for asthma and lupus
•Sodium valproate for prevention of migraine
•Thalidomide
•Melatonin
•Most herbal products
Unlicensed Medicines
What is a medicine?
Role Preparation for Nurse Advisors - Day 1
• 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
What is a medicine?
Role Preparation for Nurse Advisors - Day 1
• Known as the ‘Black List’
• Pricing Prescription Authority (PPA) will not reimburse dispensing cost.
NHS
Medicines that may not be prescribed in the NHS
What is a medicine?
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Key Information Sourceson Medicines
Role Preparation for Nurse Advisors - Day 1
• Published every six months
• Information on drugs generally prescribed in UK
• Designed for rapid reference
• Less detail on specialist areas
• Appendices at the back
Key Information Sourceson Medicines
Electronic British National Formulary (eBNF)
Role Preparation for Nurse Advisors - Day 1
• Summary of Product Characteristics (SPC) and Patient Information Leaflets (PILs)
• Updated daily
• Information provided by manufacturers
• SPC - very detailed, written for healthcare professionals
• PIL - written for patients
Key Information Sourceson Medicines
Electronic Medicines Compendium (eMC)
Role Preparation for Nurse Advisors - Day 1
• Easy to Search
• Layman’s language
• Good for use, side-effects, drug interactions
• Medicines section written by pharmacists
• Updated daily
Key Information Sourceson Medicines
NetDoctor
Role Preparation for Nurse Advisors - Day 1
Key Information Sourceson Medicines
• Online version updated daily – book published annually
• Guide to over the counter medicines• Particularly useful for checking active
ingredients• Very little clinical information
MedicinesChestOnline
Role Preparation for Nurse Advisors - Day 1
Key Information Sourceson Medicines
• A series of questions and answers written by UKMI for NHS Direct
• May be used a single reference source• Topics cover areas commonly asked by
callers• Ongoing project – Q&As added regularly
NHS Direct Medicines Q&As
Role Preparation for Nurse Advisors - Day 1
Key Information Sourceson Medicines
• MedicinesComplete provides online access to twelve medicines and healthcare resources – published by the Pharmaceutical Press
• NHS Direct have a quick link to MedicinesComplete. No password now needed
MedicinesComplete
Role Preparation for Nurse Advisors - Day 1
When to use each Source
eBNF For all calls unless Q&A available or inappropriate eg OTC medicine
eMC PIL and SPC – manufacturers information
NetDoctor For patient friendly information. Can be read aloud
Medicines Chest
For Over-the-Counter medicines to establish ingredients, licensed dose and licensed maximum daily dose
Q&As Single reference source. Question asked must exactly match Q&A
Key Information Sourceson Medicines
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Workshop 2 – Navigating Key Resources
Role Preparation for Nurse Advisors - Day 1
Merits Disadvantages
eBNF Gold standard Some opinion
Care when searchingJargon
eMC Easy to searchComprehensive info
TechnicalUnlicensed / off label Not all medicines
NetDoctor Easy to searchLayman’s termsUse, side effects, drug interactions
PregnancyBreastfeeding
Medicines Chest
Good for details on active ingredients of OTC products
Very little clinical information
Q&As Saves timeDifficult to find info
Limited numberNeed prompt updating
Key Information Sourceson Medicines
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 MorningWelcome & learning outcomes
NHSD policies for medicines calls,
Role of UKMI as a support service to NHS Direct
Workshop 1: Ethical Dilemmas
Baseline knowledge for handling medicines calls
Break
Key information sources on medicines
Workshop 2: Navigating the eBNF, eMC, NetDoctor,
MedicinesChest, Medicines Q&As and Medicines Complete
Lunch
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
Contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in Pregnancy and during Breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Baseline knowledge for handling medicines calls
Clarify the question
Plan search strategy& research problem
Evaluate the information
Tailor the answer/advice
Refer to MI
Using Speed
Dial 004
Recordall
stages
Role Preparation for Nurse Advisors - Day 1
THE PERSON
• Age?
• Allergies/disease states?
• Pregnant: no. of weeks, going well, medicine taken already?
• Breastfeeding: baby age, term/pre-term, well/unwell, medicine taken already?
THE MEDICINE
• Name, dose, frequency?
• Who is it for?
• What prescribed for?
• Why asking?
• Other medicines? Name, dose, frequency?
Confirm no new or worsening symptoms
Baseline knowledge for handling medicines calls
Role Preparation for Nurse Advisors - Day 1
Standard Search Strategies
• Encourage best practice and sharing of expertise
• Are pointers to the best sources available to answer particular types of medicines call.
• Not a definitive list of sources. You should check other sources as appropriate.
• No need to check every source in the search strategy for every call.
Baseline knowledge for handling medicines calls
Role Preparation for Nurse Advisors - Day 1
Reasons for Documentation
• Patient record in case of ongoing enquiry.
• Risk management.• In case of query in the future.• Record/evidence of how you arrived at the
answer.
• Training.
Baseline knowledge for handling medicines calls
Role Preparation for Nurse Advisors - Day 1
What should be documented?• Website e.g. eBNF, eMC, NetDoctor
including URL
• All places looked including those where no information was found.
• Brief detail of information found.
• Brief detail of what was said to caller.
Baseline knowledge for handling medicines calls
Role Preparation for Nurse Advisors - Day 1
Example documentation
Is warfarin safe in the 1st trimester of pregnancy?
eBNF: Malformations. eMC: No monograph.NetDoctor: Do not use in pregnancyToxbase: Malformations.
Advised to speak to GP by end of day.
Baseline knowledge for handling medicines calls
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Handling medicines calls
• How do I take?• When do I take?• What condition (indication) is this
medicine used to treat?• When should I not take this medicine?
Role Preparation for Nurse Advisors - Day 1
Handling medicines calls
• Is it OK to crush these tablets as I have difficulty swallowing?
• I missed my tablet this morning. Should I double-up tomorrow?
• My Dr has given me new tablets. Will they work like the old ones?
• The leaflet says not to take if you have asthma. Why is this?
• I’m going to Barbados. At what time of days should I take my contraceptive pill?
Examples
Role Preparation for Nurse Advisors - Day 1
Medicines in Pregnancy • 35% of women will take medicines at least
once during pregnancy• All medicines should be avoided in pregnancy
unless they are essentialMedicines whilst Breastfeeding• Unnecessary drug use should be avoided• Assess benefit/risk ratio for both mother and
infant
Handling medicines calls
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Workshop 3 – Case Scenarios
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
Overview of Community Pharmacy Services
Review and close
Role Preparation for Nurse Advisors - Day 1
• 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
Overview of Community Pharmacy Services
Role Preparation for Nurse Advisors - Day 1
Overview of Community Pharmacy Services
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
Role Preparation for Nurse Advisors - Day 1
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
Overview of Community Pharmacy Services
Role Preparation for Nurse Advisors - Day 1
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 or buy online
Overview of Community Pharmacy Services
Role Preparation for Nurse Advisors - Day 1
• 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
.
Role Preparation for Nurse Advisors - Day 1
Overview of Community Pharmacy Services
May be possible when
• Inadvertently run out of medicines at a weekend or surgery closed
• On holiday and forgotten medicines
Pharmacist will check that not run out of through overuse eg inhaler for asthma
There will be a charge to patient as not an NHS service
Emergency Supply by a pharmacist
Role Preparation for Nurse Advisors - Day 1
Emergency Supply by a pharmacist
• Pharmacist must interview the person
• Supply up to five days treatment
• Controlled drugs may not be supplied
•Not an NHS Service so will be a charge
Overview of Community Pharmacy Services
Role Preparation for Nurse Advisors - Day 1
Overview of Community Pharmacy Services
• 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
Emergency Supply by a pharmacist
Role Preparation for Nurse Advisors - Day 1
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
Overview of Community Pharmacy Services
Role Preparation for Nurse Advisors - Day 1
Timetable - Day 1 AfternoonOverview of steps when handling medicines calls
Handling calls about Administration, Dose, Indications
contra-Indications
Workshop 3: Case scenarios on Administration, Dose,
Indications, Contra-Indications, Missed and Double Doses,
Medicines in pregnancy and during breastfeeding
Break
What is a Medicine? revision
Overview of Community Pharmacy Services
Review and close