1. Role Preparation for Nurse Advisors Handling Medicines Calls Day 1 NAME Medicines Information Pharmacist NAME Medicines Information Service

2. Role Preparation for Nurse Advisors - Day 1 Medicines Training for Nurses TrainingDurationTrainer Week 4Using Toxbase® to support poisons calls½ dayNHSD Week 5/6Handling Calls about medicines and the Medicines Algorithm Trainer evaluation Further medicines case scenarios 1 ½ days ½ day UKMI UKMI + NHSD Self directed Week 10Handling calls about Hormonal Contraception and Emergency Contraception EC algorithm – further scenarios ½ dayUKMI Self directed 3-6 monthsMedicines calculations for NAs e-Toxbase® One-to-one medicines training on request Self directed UKMI 6 monthsHandling calls about medicines during pregnancy and breastfeeding ½ dayUKMI

3. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

4. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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

5. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 2 Morning 9.30Welcome & re-cap 9.45Handling calls about Adverse Effects & Drug Interactions Workshop 4: Case scenarios on Adverse Effects and Drug Interactions 11.15Break 11.30Handling calls about analgesia Workshop 5: Case scenarios on analgesia 1.00Lunch

6. 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

7. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

8. 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

9. 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 medicinesSteroids in sport

10. 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

11. 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

12. 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

13. Role Preparation for Nurse Advisors - Day 1 NHS Direct’s Pharmacy and Medicines Services Health AdvisorsP4 “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 ingestions Interim care instructions for dental pain Health Information Advisors P4 Calls (M1, M2 or M3): Information about medicines No new or worsening symptoms. Nurse AdvisorsP1-4 Calls: Advice or information about medicines Symptoms. No new or worsening symptoms. Dental Nurse Advisors Information about medicines for dental conditions

14. 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

15. 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?”

16. 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 callEg ‘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?’

17. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

18. 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

19. Role Preparation for Nurse Advisors - Day 1 What is UK Medicines Information? Alana AdamsWales Alison AlveyBristol Kelly BroadLeicester Ruth CheemaLeicester Jane FarrisBirmingham Matt HaggertyLeeds Wynn PevrealLondon Caroline RiddleBristol Paula RussellNewcastle Jill RutterLiverpool Davina WraightLondon

20. 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 - 8.00pm Weekends 9am – 3pm Except Bank Holidays Speed Dial 004

21. 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

22. 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?

23. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

24. 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

25. 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….?

26. 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

27. 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?

28. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

29. 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 ……..

30. Role Preparation for Nurse Advisors - Day 1 What is a medicine? Naming medicines GenericBrand AmoxicillinAmoxil ® SalbutamolVentolin ® FluoxetineProzac ® OmeprazoleLosec ® MefloquineLariam ®

31. 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 Only P May be sold in a pharmacy but not a general shop e.g. Piriton® Prescription Only POM May only be supplied on prescription e.g. Amoxicillin

32. Role Preparation for Nurse Advisors - Day 1 What is a medicine? Controlled Drugs (CDs) Class Aeg heroin, LSD, ecstasy, morphine, Class Beg amphetamines, barbiturates, codeine, Class Ceg anabolic steroids, cannabis, Misuse of Drugs Act 1971 CDs are POMs with stricter controls on production, supply or possession

33. Role Preparation for Nurse Advisors - Day 1 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 What is a medicine?

34. 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?

35. 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?

36. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

37. Role Preparation for Nurse Advisors - Day 1

38. Timetable - Day 1 Morning Welcome & 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

39. Role Preparation for Nurse Advisors - Day 1 Key Information Sources on Medicines

40. 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 Sources on Medicines Electronic British National Formulary (eBNF)

41. 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 Sources on Medicines Electronic Medicines Compendium (eMC)

42. 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 Sources on Medicines NetDoctor

43. Role Preparation for Nurse Advisors - Day 1 Key Information Sources on 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

44. Role Preparation for Nurse Advisors - Day 1 Key Information Sources on 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

45. Role Preparation for Nurse Advisors - Day 1 Key Information Sources on 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

46. 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 Sources on Medicines

47. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

48. Role Preparation for Nurse Advisors - Day 1 Workshop 2 – Navigating Key Resources

49. Role Preparation for Nurse Advisors - Day 1 MeritsDisadvantages eBNF Gold standard Some opinion Care when searching Jargon eMC Easy to search Comprehensive info Technical Unlicensed / off label Not all medicines NetDoctor Easy to search Layman’s terms Use, side effects, drug interactions Pregnancy Breastfeeding Medicines Chest Good for details on active ingredients of OTC products Very little clinical information Q&As Saves time Difficult to find info Limited number Need prompt updating Key Information Sources on Medicines

50. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Morning Welcome & 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

51. Role Preparation for Nurse Advisors - Day 1

52. Timetable - Day 1 Afternoon Overview 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

53. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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

54. 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 Record all stages

55. Role Preparation for Nurse Advisors - Day 1 This is what the caller may ask Baseline knowledge for handling medicines calls The Iceberg Theory This is the rest of the story!!

56. 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

57. 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

58. 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

59. 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

60. 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 pregnancy Toxbase: Malformations. Advised to speak to GP by end of day. Baseline knowledge for handling medicines calls

61. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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

62. 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?

63. 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

64. 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 essential Medicines whilst Breastfeeding Unnecessary drug use should be avoided Assess benefit/risk ratio for both mother and infant Handling medicines calls

65. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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

66. Role Preparation for Nurse Advisors - Day 1 Workshop 3 – Case Scenarios

67. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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

68. Role Preparation for Nurse Advisors - Day 1

69. Timetable - Day 1 Afternoon Overview 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

70. 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

71. 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 medicinesSale or supply of the ‘morning after pill’ Needle exchange schemes Blood pressure monitoring Pregnancy testingDisposal of unwanted medicines Selling over-the-counter medicines Supervised administration of medicines Advising on minor ailments Incontinence suppliesStoma careCare Home support Patient recordsSmoking cessationTruss fitting

72. Role Preparation for Nurse Advisors - Day 1 Staff in a community pharmacy Sales assistantsTrained 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 techniciansTrained to dispense and check prescriptions PharmacistResponsible for all sales and Rx of medicines Overview of Community Pharmacy Services

73. Role Preparation for Nurse Advisors - Day 1 NHS Prescription Charges £6.85 for each NHS Prescription from 1 st 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

74. 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.

75. 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

76. 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

77. 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

78. 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

79. Role Preparation for Nurse Advisors - Day 1 Timetable - Day 1 Afternoon Overview 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