Cwm Taf Pre-registration MI Training October 21st 2015 Claire Ganderton Helen Morteo

Aims of day Increase knowledge of reference sources – how to access via sharepoint Increase awareness of questions to ask enquirer. Know how to record enquiries on MI Databank. Develop skills in writing an answer

Reference Sources - Sharepoint MI Resources eBNF/eBNFC eMC IV Guide – nursing staff and pharmacists Shared Care Protocols and Guidance Toxbase Travax WMIC site for Drugs in Porphyria NICE Evidence Cwm Taf UHB Primary Care Portal C&V Good Prescribing Guide Neonatal Drug Withdrawal Handbook TDM bulletin NICE Evidence Freely available search engine that provides access to evidence Developed by NICE Links to a broad range of documents, guidelines and resources Updated daily or as new information becomes available Use to find evidence based or evaluated information, in particular: Guidelines, Medicines Q&A’s, Cochrane reviews, New product evaluations To use it effectively, it is almost essential to become familiar with it through practice – will demonstrate in a few slides time! Neonatal Drug Withdrawal Handbook Introduction to neonatal drug withdrawal plus drug monographs (as a result of maternal drug use during pregnancy – usually drugs of abuse but could also be therapeutic drugs such as benzodiaepines, opioid analgesics, antidepressants) – very old and probably needs removing TDM bulletin Practical guide to therapeutic drug monitoring NB, old now 1996 eg digoxin, lithium, theophylline – very old and probably needs removing Cwm Taf UHB Primary Care Portal - one stop place for useful local and national resources and information for primary care prescribers and community pharmacists in Cwm Taf. C&V Good Prescribing Guide Use with caution as relates to practice in C&V. However, may be useful in situations where we have no local protocol/guideline etc. and doctors who have worked in C&V are referring to practice within C&V.

Sharepoint Formulary Antimicrobial Guidelines There are also lots of external links on the Medicines Management Page incl: NICE Guidance National Patient Safety Agency AWMSG Micromedex Drug Safety Update (MHRA) HOWIS General Medical Council Yellow Card Online Formulary Lists all medicines approved for local use in Primary and Secondary care in  Cwm Taf UHB. Can either look through BNF chapters or search using search box Links to the following sources have been added to help: BNF/BNFC, eMC, NICE & AWMSG guidance, Injectable Medicines Guide,local protocols/procedures/guidelines Antimicrobial Guidelines Antimicrobial Guideline - Antimicrobial Therapy (Adults) in Secondary Care Guidelines for Intravenous to Oral Antimicrobial Therapy Switch Procedure (Adults) Procedure for the Stop and / or Review of Antimicrobials Prescribed for Adults in Secondary Care at Five Days Antimicrobial Guideline - Surgical Prophylaxis Obstetric & Gynaecology Gentamicin Prescription Chart - 5mg per kg Guidelines for Vancomycin dosing and monitoring in Adult Guidelines for Teicoplanin dosing and monitoring in Adult There are also lots of external links on the Medicines Management Page (see slide)

Reference sources Medicines Complete HOWIS Micromedex AHFS, Stockley, Herbal Medicines, Dietary Supplements, Handbook on Injectable Drugs HOWIS Directory E-journals/ books Travax Micromedex Martindale, Drugdex, AltMedDex, Reprorisk Drug interactions tool, IV compatibility database NB, only one person can be logged into Medicines Complete at any one time (due to subscription) NB that Reprorisk on MicroMedex is only available for use by MI pharmacists.

Reference sources Websites www.ukmi.nhs.uk www.evidence.nhs.uk NICE Evidence www.evidence.nhs.uk WMIC www.wmic.wales.nhs.uk UKMI website: This is the website of the UKMi (UK Medicines Information) national network. Some areas of the website can be freely accessed and some require a username and password. NHS healthcare staff may obtain these from their regional MI centre. Highlight UKMi directory, drugs in lactation database, fridge database, Medicine Q&As NICE Evidence: Searching: Enter a term into the search bar or browse using the Medicines A-Z (or topics A-Z). Filtering search results For more in-depth and tailored searches you can use the filters on the left hand side of the page to narrow down your search results by - Source e.g. UKMi, Royal Colleges - Type of information e.g. evidence summary, drug safety. Demonstrate how to find a medicine Q&A - filtering by Type of information ‘Evidence Summaries’ and Source ‘UKMi'. Eg to find the Q&A on Lactose-free lipid-regulating preparations search “lactose” and narrow to Source ‘UKMi’. It is the second result from the top WMIC: Publications/ Resources (bulletins/ journals etc)

Reference sources NEWT www.newtguidelines.com Log-in details are site specific Email went around a few weeks ago. Username:          cellar82 Password:           cocktail

Beware of the internet! Some websites may contain information which is poorly evaluated, inaccurate and/or biased Always consider: Who are the authors? Are key statements referenced? Are the references reputable? Is the information current? Who owns or sponsors the site? Is the site referred to by another authoritative site? Always try and check an answer in another resource

The internet may be good for... Branded or foreign products Identification of drugs and herbal products Hospital guidelines or formulary evaluations News regarding ‘unusual’ treatments Street drugs and substance misuse

The Internet is not good for... Drug interactions ADRs Formulation and compatibility queries Pharmacoeconomics

Question Time Have go questions

Enquiry Answering Documentation – MiDatabank Background information Research Answering the enquiry

Documentation of enquiries Why should MI enquiries be documented? Ask the group Reasons listed in the Workbook are: Enquirer returns, e.g. forgot what you said, lost your reply, new information regarding the same enquiry Work-saving – use past enquiries for enquiry answering Complaints – have documentation to support what you found and what you advised in case of someone complains that you gave incorrect or misleading advice. Especially important if there is any risk of there being a legal case Education – trainees can look at how experienced pharmacists answer enquiries. Workload statistics

What MI work should be documented? UKMi Clinical Governance Working Group document Would you record… Is hydrochlorothiazide on the formulary and is it stocked in pharmacy? Is there a PIL available for Hydroxycarbamide capsules? Can glycopyrronium be used for hypersalivation? No Yes

How and what to document UKMi standards Clear explanation of the question Resources: Books/Journals: specify edition/ date & page numbers. Databases: specify dates searched/accessed/state search terms used. People: include full name & title of people you speak to e.g. company MI Departments/ specialist doctors/ pharmacists. Other electronic resources e.g. websites: specify name and/or full address of website(s) used/date accessed/search terms used. NB. Full address is not necessary for those websites used regularly or those listed in the minimum resources list (e.g. eMC etc.). “Beware of the ‘cut & paste’ technique” Be specific – if nothing found say so Summary of answer given (include any subsequent points discussed).

Mi Databank 4 virtual “trays” In tray In progress Awaiting authorisation Reply authorised Get students to log in to MiDatabank Trainer

Input – Background detail For all enquiries: Who is calling? Name, designation, contact details etc. Patient specific or general? Patient name, DoB, Hospital number Question Prospective or retrospective? Negotiate when you will provide an answer. Also: Enquiry category Keywords Other background information will depend on the nature of the enquiry

Research Add the most appropriate resources in a logical order eg Past enquiries Medicines Q&A BNF SPC Micromedex Resources specific to enquiry type Literature search Standard search patterns and UKMi Enquiry Answering Guidelines can help

Answer Gather data, evaluate it and present in a clinically useful manner Advice vs information Be aware and openly acknowledge limitations to answer given Tailor answer to enquirers needs Meet deadline or communicate that answer delayed Document attempts at contacting enquirer Anticipate further questions Can attach letters/emails

Verbal communication When is verbal answer appropriate? Prepare answer prior to speaking to enquirer Introduce yourself Present information in logical manner Ensure answer is understood Consider offering written reply

Writing skills When is written reply appropriate? Letter vs e-mail Ensure confidentiality Open with summary of question Present information in logical order Write clearly and concisely Summarise at end References?

Communication skills When writing (or speaking), consider using phrases such as: “As you will know,...” “As you will be aware,...” Avoid using phrases such as: “There are no reports of ...” Instead, use phrases like: “Following a detailed literature search, I have been unable to locate any reports of...”

Completion Stats Time taken On time Complexity level Keywords Origin Follow up

Enquiry 1 - administration A staff nurse on the acute medical unit rings MI to ask how to administer phenytoin 1.4g IV What further information do you need?

Enquiry 1 Enquirers name and contact details SN John Jones, ext 3506 Patient: William Williams, DOB 1/1/40 Hosp no: M1234567 Prescribed on stat side of drug chart, no diluent, no volume, no rate of administration

Enquiry 1 continued Prospective – needs to administer asap Indication: status epilepticus Urgency – ASAP (next half an hour) Enquirer has checked leaflet in product box but no information Manufacturer: Mercury Pharma 50mg/ml injection

Search strategy Past enquiries BNF SPC IV guide Prepare your answer for verbal communication