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Role Preparation for Dental Nurse Advisors Handling Medicines Calls. NAME Medicines Information Pharmacist NAME Medicines Information Service. Morning Timetable. Introduction & learning outcomes Navigating key information sources Quiz Tea break

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Role preparation for dental nurse advisors handling medicines calls

Role Preparation for Dental Nurse AdvisorsHandling Medicines Calls

NAME

Medicines Information Pharmacist

NAMEMedicines Information Service


Morning timetable
Morning Timetable

Introduction & learning outcomes

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Afternoon timetable
Afternoon Timetable

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Morning timetable1
Morning Timetable

Introduction & learning outcomes

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Aim

To enable Dental Nurse Advisors to be able to handle medicines related calls safely and effectively within their area of competence and to know when and how to refer calls.


Learning outcomes
Learning Outcomes

  • Gather the necessary background information to clarify the question and minimise the risks when advising the caller.

  • Navigate the key medicines information sources.

  • Interpret information about medicines and turn it into appropriate advice.

  • Be able to advise safely on the use of analgesics

  • Know when and how to refer to the MI Service.

Handle medicines calls safely and effectively


Structure of mi services
Structure of MI Services

  • UKMI - supports MI needs of NHS health professionals

  • >½ million enquiries 2004

  • 16 regional & 260 local centres

  • Specialist services - pregnancy, breastfeeding, dentistry

  • Training, websites, QA, drug reviews


Name medicines information service
Name Medicines Information Service


Name medicines information service1

Staff

Pharmacists

Pre-registration students

Secretarial support

Technicians

Service to NHS Direct

Complex medicines calls

MI skills training

Quality Assurance

National work

9am - 5.00pm

TEL NUMBER

NAME Medicines Information Service


Morning timetable2
Morning Timetable

Introduction & learning outcomes

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch



British national formulary bnf
British National Formulary (BNF)

  • Updated every six months

  • Information on drugs generally prescribed in UK

  • Designed for rapid reference

  • Less detail on specialist areas

  • Appendices at the back

  • Dental Practitioners’ Formulary


Dental practitioner s formulary
Dental Practitioner’s Formulary

  • Provides list of items prescribable by dentists on the NHS

  • Private prescriptions may be written for items not on the formulary

  • Also available in the Drug tariff:

http://www.ppa.org.uk/ppa/edt_intro.htm


Emc electronic medicines compendium
eMC (Electronic medicines Compendium)

  • 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 members of the public


Netdoctor
NetDoctor

  • Easy to Search

  • Layman’s language

  • Good for use, side-effects, drug interactions

  • Medicines section written by pharmacists

  • Updated daily


Medicines chest online
Medicines Chest Online

  • Book Published annually – Online version updated daily

  • Guide to over the counter medicines

  • Particularly useful for checking active ingredients

  • Very little clinical information



Medicines faqs
Medicines FAQs

Located on the Medicines & Pharmacy Microsite:

http://nww.intranet.nhsdirect.nhs.uk/medpharm/

  • Can a person on warfarin take paracetamol?

  • Does paracetamol interact with antibiotics?

  • Can paracetamol be taken during pregnancy?

  • Can breastfeeding mothers take ibuprofen?

  • Can ibuprofen be taken during pregnancy?

  • What to do if you have missed a dose of antibiotics

  • When can patients start drinking alcohol after finishing metronidazole?

  • Which over-the-counter analgesics interact with alcohol?

  • Which oral antibiotics interact with alcohol?

  • Can breastfeeding mothers take over-the-counter analgesics?

  • Is it necessary to stop clopidogrel, dipyridamole or low dose aspirin prior to minor surgery?

Single Source



Morning timetable3
Morning Timetable

Introduction & learning outcomes

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Morning timetable4
Morning Timetable

Introduction & learning outcomes

What is a medicine

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Handling a medicines call
Handling a Medicines Call

Record

all stages

Clarify the question

Refer to MI

Plan search strategy

& research problem

Evaluate the information

Tailor the answer/advice


The iceberg theory
The Iceberg Theory

This is what the caller may ask

This is the rest

of the story!!

?


Essential questions to ask

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?

Essential questions to ask


Key information sources
Key Information Sources

  • BNF / eBNF

  • Electronic Medicines Compendium (eMC)

  • Netdoctor

  • NHSD Frequently Asked Questions (FAQ)

  • Medicines Chest online

  • Medicines Complete


Standard search strategies
Standard Search Strategies

  • Pointers to the best sources available to answer particular types of medicines call.

  • Not a definitive list of sources and should check other sources as appropriate.

  • No need to check every source in the search strategy for every call.

Encourage best practice and sharing of expertise


Reasons for documentation
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.


What should be documented
What should be documented?

  • Website e.g. eBNF, eMC, netdoctor

  • All places looked including those where no information was found.

  • Brief detail of information found.

  • Brief detail of what was said to caller.


Example documentation
Example documentation

Is ibuprofen safe in 3rd trimester of pregnancy?

eBNF: Malformations.

eMC: No monograph.

netdoctor: Do not use.

Toxbase: Malformations.

Advised to speak to GP / Dentist by end of day.


Referral to the mi service
Referral to the MI Service

  • 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.


Examples of complex medicines calls

Complex drug history

Lots of medicines

Unclear what is taken

Unlicensed medicines

Not on formulary

Side effects

Symptoms due to medicines

Drug interactions

Narrow therapeutic range medicines e.g. digoxin, warfarin

Pregnant

Medicines taken but info sources say avoid is to avoid

Breastfeeding

Medicines taken but info sources say to avoid

Baby pre-term / unwell

Uses / choice

Contra-indicated

Doses outside norm

Examples of Complex Medicines Calls


Morning timetable5
Morning Timetable

Introduction & learning outcomes

What is a medicine

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Analgesia
Analgesia

A state of insensitivity to pain stimuli

  • derives from Greek

    • an-, "without", and -algia, "pain"


Analgesics paracetamol
Analgesics - Paracetamol

  • Adult dosage:

    0.5–1 g every 4–6 hours to a max. of 4 g daily;

  • Childs dosage:

    Dependent on age of child

  • Strength of paracetamol product

  • Form of paracetamol

  • Multi-constituent preparations


Analgesics nsaids
Analgesics - NSAIDs

Non-Steroidal Anti-Inflammatory Drugs

Ibuprofen

  • Adult dosage:

    • 400mg three times daily

    • Higher doses on prescription

  • Children from 3 months:

    • Dependent on age


Contraindications cautions to nsaids
Contraindications & Cautions to NSAIDs

  • Allergy to any NSAID or Aspirin

  • Asthma

  • Stomach ulcer or bleed

  • Kidney, liver or heart conditions

  • Blood clotting defects

  • Hypertension

  • Pregnancy or Breast feeding


Adverse effects of nsaids
Adverse effects of NSAIDs

  • Gastrointestinal effects:

    • Nausea, diarrhoea, discomfort, bleeding

  • Allergy:

    • rashes, breathing difficulties

  • Fluid Retention

    TAKE WITH OR AFTER FOOD


Analgesics aspirin
Analgesics - Aspirin

  • Adult Dosage:

    • 300 - 900mg every 4-6 hours

    • Maximum 4g daily

    • Analgesic and antiplatelet dosages

    • OTC products will recommend lower doses

  • Child Dosage:

    • Not to be given to children under 16 years old

    • Reyes Syndrome

  • Adverse effects and cautions similar to NSAIDs


Analgesics combination products
Analgesics – Combination products

BEWARE

Not only painkillers contain analgesics



Morning timetable6
Morning Timetable

Introduction & learning outcomes

What is a medicine

Navigating key information sources Quiz

Tea break

Handling calls about medicines

Medicine Calls Workshop 2

Lunch


Afternoon timetable1
Afternoon Timetable

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Adverse drug reactions

Type A – predicted by mode of action, dose-related, common but not severe e.g.

Diarrhoea with antibiotics

Type B – unpredictable, not dose-related, can be severe/fatal e.g.

Anaphylaxis with penicillins

Adverse Drug Reactions

Unwanted effect that drug has on a person


Incidence of adverse effects
Incidence of Adverse Effects but not severe e.g.


Afternoon timetable2
Afternoon Timetable but not severe e.g.

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Workshop 3 adverse effects
Workshop 3 - Adverse Effects but not severe e.g.


Afternoon timetable3
Afternoon Timetable but not severe e.g.

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Afternoon timetable4
Afternoon Timetable but not severe e.g.

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Drug interactions
Drug Interactions but not severe e.g.

One drug modifies the effect(s) of a second drug.

More likely if taking several medicines.

 Toxicity

  • warfarin + erythromycin = greater risk of bleeding

  • miconazole + quinidine = greater risk of arrhythmias

 Efficacy

  • penicillin + microgynon® = reduced contraception

  • levothyroxine + rifampicin = more levothyroxine needed


One way medicines interact absorption of the drug
One way medicines interact: but not severe e.g.Absorption of the drug

  • Antacids can absorb other drugs e.g. Ciprofloxacin

  • Cholestyramine (Questran) binds to many drugs so give 1 hour before or 4-6 hours after cholestyramine


More ways medicines interact metabolism of the drug

DRUG LEVEL but not severe e.g.

Metabolic Enhancers

Smoking

Alcohol

Carbamazepine

Phenytoin

Rifampicin

More ways medicines interact:Metabolism of the drug


More ways medicines interact metabolism of the drug1

Metabolic but not severe e.g.

Inhibitors

Cimetidine

Ciprofloxacin

Erythromycin

Metronidazole

DRUG LEVEL

More ways medicines interact:Metabolism of the drug


Narrow therapeutic range drugs
Narrow Therapeutic Range Drugs but not severe e.g.

CARBAMAZEPINE

CICLOSPORIN

DIGOXIN

LITHIUM

PHENYTOIN

THEOPHYLLINE

WARFARIN


Afternoon timetable5
Afternoon Timetable but not severe e.g.

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Workshop 4 drug interactions
Workshop 4 - Drug Interactions but not severe e.g.


Afternoon timetable6
Afternoon Timetable but not severe e.g.

Adverse drug reactions Workshop 3

Tea Break

Drug interactions Workshop 4

Where are the risks?

Close


Where are the risks when handling a medicines call
Where are the risks when handling a Medicines Call? but not severe e.g.

Record

all stages

Clarify the question

Refer to MI

Plan search strategy

& research problem

Evaluate the information

Tailor the answer/advice


Learning outcomes1
Learning Outcomes but not severe e.g.

  • Gather the necessary background information to clarify the question and minimise the risks when advising the caller.

  • Navigate the key medicines information sources.

  • Interpret information about medicines and turn it into appropriate advice.

  • Know when and how to refer to the MI Service.

Handle medicines calls safely and effectively


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