NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
Guidance to Support National
Policy for Handling
Medicine Calls
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 1 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
1
Introduction
1.1
The National Policy for Handling Medicine Calls is intended to support front
line staff to assess and manage calls about medicines and the therapeutic
use of medicines for all 0845 4647 and out of hours (OOHs) calls.
1.2
The introduction of call streaming and Version 10 (V10) management
system since the policy was introduced April 2005 now demands some new
guidance for regions to be able to manage medicine calls using the new
systems available. A condensed version of the National Policy for Handling
Medicine Calls will follow this document.
1.3
A medicines and pharmacy microsite is also now available on the NHS
Direct Microsite: http://nwww.intranet.nhsdirect.nhs.uk/medpharm . The site
lists:
 Approved resources and search strategies to handle medicine calls
 UKMI Q&As list with links to the National Electronic Library for Medicine
(NeLM)
 Learning Outcomes for medicine and pharmacy training programmes
 Health Information Advisor Medicine and Pharmacy Protocols
1.4
Health Information Advisor Medicine and Pharmacy Protocols
The protocols have been developed as a tool to support medicine
information calls handled by Health Information Advisors once they have
undergone specific training in medicine information skills and the use of the
protocols. The protocols are an interim measure until a revised medicine
algorithm is released for health information advisors to use in CAS.
1.5
Medicine Information Calls- P4 Queue management
When the Health Advisor sends a medicines information call to the P4
queue, the call reason will be annotated with the prefix MEDS. The queue
supervisor will then be able to sort the calls to the appropriately
trained/experienced Health Information Advisor. The nominated clinical
member of staff who is responsible for the safety of all site based calls
placed in any of the public or private queues should monitor local calls
placed in queues regularly for safety. Where a call is deemed to be of a
clinical risk the clinical shift lead should allocate the call to an individual with
appropriate skill level to deal with the call. The priority of the call should not
be changed.
Health information advisors who are taking medicine information calls from
the P4 queue must be sure they have had the appropriate training and/or
experience in medicines information calls before selecting a call. A national
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 2 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
training package and competency framework are under development for all
health information advisors for medicine information calls.
1.6
General principles for handling medicine calls
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Nurse Advisors and Health Information Advisors must consult the eBNF
or BNF for Children appropriate to age for all medicine calls, paper
copies can be used for contingency provided it is latest edition.
Nurse Advisors and Health Information Advisors should use the
recommended search strategies for medicine calls.
Nurse Advisors may use a single source of information if they are
confident that it is the best source of information available for the
question.
Health Information Advisors must confirm the information in a second
source.
The eBNF is the prime reference source for all medicine calls, but may
not always provide the necessary information.
The NHS Direct Medicines Common Health Questions located on the
NHS Direct website and the UKMI Q&As may be used as a sole source.
Nurse Advisors and Health Information Advisors must document all
information sources that were looked in including those where nil of note
was found.
Third party or intermediary calls that involve requests to identify the
possible uses for specific medicines should be handled with due
concern for patient confidentiality. Some medicines may be prescribed
for a variety of conditions, e.g. medicines used to treat cancer, and do
not indicate a particular condition.
If Health Information Advisors pick up any calls that subsequently
require nurse assessment, e.g. symptoms are identified that were not
described during CSPT, the call is warm transferred to the “warm
transfer queue”
for nurse assessment with a verbal handover
describing details of any information provided and subsequent dialogue
with patient.
Guidance for Specific Medicine Call Types
2
Access to Medicines
2.1
Health Advisors:
Follow protocol in CSPT:
 Repeat prescription requests
 Emergency supply of medicines enquiries
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 3 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
The following enquiries can be dealt with as P4QC:
 Pharmacy opening times
 Where to buy over the counter medicines
 Where to obtain a supply of medicines through a local NHS scheme,
e.g. minor ailments service.
 Where to have a prescription dispensed
 Requests for access to emergency contraception only.
 Availability of oxygen therapy.
2.2
Health Information Advisors:
If the information is not immediately accessible, e.g. no details in Doris LOC
for any of the above call types the call should be transferred by Health
Advisor to Health Information Advisor as a P4. Other access to medicines
P4 enquiries that should be transferred to Health Information Advisor
include:
 Availability or cost of a medicine including non-UK licensed products
 Availability of travel vaccines
 Availability of a new medicine, unlicensed medicine or trial drug
 Use of Emergency Contraception using the algorithm in CAS version
14.5
 What to do if missed a dose(s) of the oral contraceptive pill using
algorithm in CAS version 14.5
2.3
Nurse Advisors:
This call type would not normally be completed by a Nurse Advisor. Once a
symptomatic call has been assessed some calls may require information
and are then transferred to health information advisor.
3
Exposure to toxic substance
3.1
Health Advisor:
Follow protocol in CSPT: Managing exposure to toxic substance in
conjunction with additional reference sources for swallowed toxic
substances in the Low Tox poster and NHS Direct supplementary
information. Clinical supervisor assesses call reason as soon as possible
for all P2 end points, in conjunction with Toxbase and assign to nurse for
urgent call back or return to first advice queue. The priority level must not
be changed. All exposures including eye contact, skin, inhalation to be
assigned call reason and assessed appropriate to needs.
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 4 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
3.2
Nurse Advisors:
Advice in Toxbase to be followed for toxic agent or medicine. Additional
advice can be provided by the National Poisons Information Service (NPIS)
where the caller is asymptomatic and the information in Toxbase is
inadequate. UKMI are able to provide advice about adverse effects from
normal doses of medicines and accidental minor overdoses. Information
about exposure to toxic substances in pregnancy can be accessed after
discussion with the NPIS and onward referral to the National Teratology
Information Service (NTIS). The NTIS is not able to provide a 24 hour
support. See section 4 for information about medicines in pregnancy.
4
Side effects of medicines and interactions
4.1
Health Advisor:
Caller has no new symptoms or any change or worsening of condition refer
to Health Information Advisors.
4.2
Health Information Advisor and Nurse Advisor:
Some calls about medicines are of a complexity that may require onward
referral to UKMI. These include:
 Caller/patient is taking 3 or more prescription only medicines. Health
Information Advisor calls may identify additional prescription medicines
after taking call from Health Advisor.
 Dose(s) involved are outside normal range
 High risk medicines are involved, e.g. commonly aminophylline,
carbamazepine, ciclosporin, digoxin, lithium, methotrexate, phenytoin,
theophylline, warfarin.
 Enquiry involves medicines in pregnancy or breast feeding
 High risk condition, e.g. suppressed immune system
 Medicine is listed in the eBNF with a Black Triangle i.e. newly available
medicine that requires special monitoring for adverse effects.
5
Pregnancy and Breast feeding
5.1
Health Advisor:
All symptomatic calls are to be transferred to a Nurse Advisor. All callers
requesting information, who have no symptoms, to be transferred to Health
Information Advisor. If Health Information Advisor’s P4 queue is very busy
(e.g. OOHs period when some sites do not have Health Information
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 5 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
Advisors available) asymptomatic calls to be assessed as soon as possible
by clinical supervisor and transferred to Nurse Advisor or put back into
Health Information Advisor’s queue as appropriate.
5.2
Health Information Advisor:
On Monday to Friday between 9am to 5pm, collate relevant information
from caller and refer to UKMI as per national guidance. At all other times on
weekdays, weekends and bank holidays discuss timescale for UKMI call
back with caller and suggest call back NHS Direct at a time when referral to
UKMI is possible. The complex call queue P5 should not be used to queue
calls at site to wait for UKMI call back. Advise caller to contact their local
community pharmacist if request more immediate advice. The UKMI Q&As
located via hot links from the medicine and pharmacy microsite can be
used as a sole reference source to support pregnancy and breast feeding
enquiries.
5.3
Nurse Advisor:
Assess symptoms and use medicines algorithm to support assessment for
medicines used in pregnancy and whilst breast feeding. Refer to UKMI as
per national guidance if require more detailed advice and to support
complex enquiries. For calls taken outside working hours for UKMI, refer to
local community pharmacist.
6
Therapeutic choice of medicine
6.1
Health Advisor:
Use same criteria as side effects and interactions (Section 3). Calls about
travel requirements, e.g. vaccinations, malaria prophylaxis refer to a Health
Information Advisor.
6.2
Health Information Advisor and Nurse Advisor:
Refer to guidance on side effects and interactions (Section 4). Advice to
support self care may include advice about the therapeutic use of
medicines that have not yet been prescribed. Specific prescription only
medicines should not usually be recommended by name, but a therapeutic
class of medicines may be suggested. Certain enquiries do require specific
brand names to be used to ensure the caller is aware of the licensed
indications for a particular product. E.g. Calpol for Children is licensed for
particular age groups, only specific brands of a medicine can be purchased
over the counter (e.g. chloramphenicol eye drops, simvastatin products), or
only particular brands have a license for use in children or information to
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 6 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
support use in pregnant women. When enquiries involve discussions about
dosage and administration it is important to always check the brand name
of the medicine used by the caller.
7
Dental medicine calls
7.1
Health Advisor:
Advice in call streaming to be followed as for all dental calls.
7.2
Dental Nurse Advisors:
Refer calls to Nurse Advisor that require advice about medicines not
included in the Dental Practitioners Formulary or the caller wants more
complex advice, e.g. caller is taking other medicines that may interact with
their dental treatment, or they are pregnant or breast feeding. Specific
medicine information training to support dental nurse advisors will support
practice.
8
Identification of medicines
8.1
Health Advisor:
Caller has no new symptoms or any change or worsening of condition refer
to Health Information Advisors.
8.2
Health Information Advisor and Nurse Advisor:
Calls that involve requests to identify suspected illicit drugs, contraception
and any other medicine(s) should be advised to speak to a community
pharmacist once it is established there is no immediate or urgent clinical
risk to anyone.
9
Approval
Helen Young
Clinical Director
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 7 of 8
NHS Direct
Guidance to Support National Policy for Handling Medicine Calls
Annex 1: Flow of Medicine Calls
0845 4647 and Out of Hours Medicine Call Flow
P4Quick Call
CSPT
Access to pharmacy services and
Medicines, e.g. Emergency Hormonal
Contraception, Repeat medication,
Oxygen supply, emergency supply of
medicine
Priority 4 “MEDS”
Priority 1, 2, 3
No symptoms, two prescription medicines or
Less, normal dosage range.
National pilot Medicine and Pharmacy protocols
CAS algorithm for symptoms
&
Medicine Algorithm
-Access as for P4QC
-Identification
-Travel
-Administration & dosage
-Therapeutic dose, e.g. pregnancy, breast feeding
-Interactions
-Side effects
- Emergency contraception information
- Missed doses of contraceptive pills
-Wrong dose
-Side effects
-Interactions
-Therapeutic dose, e.g.
pregnancy, breast feeding
-Administration and dosage
-Contraception advice, inc.
emergency contraception
-Travel advice
-Identification
Referral
Local procedure
Medicines Information Service (UKMI)
Reason for referral:
 Caller has complicated medicine
history and/or PMH
 Medicine used in pregnancy or when
breast feeding
 Information cannot be found,
contradictory, unclear or confusing.
 Enquiry is outside professional
competence
 Referral within NHS Direct
inappropriate
 Enquiry is unclear or difficult to
understand
Guidance to Support National Policy for
Handling Medicine Calls
Status: Final
Creation Date: 21/02/06
Review Date: 01/2007
When refer to MI confirm:
 Name of medicine
 dose frequency,
 duration of treatment
 reason for treatment
 pregnancy trimester
 age of breast fed baby
 allergies
 any OTC and alternative medicines
Version 1
Implementation Date:08/03/06
Circulation: Units
Author Anne Joshua, National
Pharmaceutical Advisor
Page 8 of 8