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

2. 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

3. 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.

4. 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)

5. 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.

6. Reference sources Websites www.ukmi.nhs.uk www.evidence.nhs.uk
NICE Evidence
WMIC
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)

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

8. 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

9. 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

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

11. Question Time
Have go questions

12. Enquiry Answering Documentation – MiDatabank Background information
Research
Answering the enquiry

13. 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

14. 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

15. 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).

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

17. 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

18. 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

19. 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/ s

20. 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

21. 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?

22. 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...”

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

24. 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?

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

26. 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

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