Communication Briefing

Background

Following the launch of CAS clinical release V15 a revised medicine algorithm has been available for nurse advisors to use to support practice where calls primarily involve requests for specific medicines information.

Nurse advisors (NAs) are trained to select an algorithm based on the presenting symptoms, however it may not be evident until they are in discussion with the caller that medicines may form an important element of the call. The nurse will usually then rely on their clinical knowledge and experience to support the medicines discussion and access resources such as the eBNF without using the medicines algorithm as they are already using another symptom based algorithm to support the call.

Feedback from Serious Adverse Incidents (SAIs) and call review has indicated that nurse advisors require support for handling the specific medicines elements of calls. Training by UK Medicines Information (UKMI) and the option to refer a call to UKMI has been available across all sites through a nationalSLA with UKMI since 2005. In spite of this it has taken some time to implement consistently across the service as other training priorities, such as the introduction of CAS V10 in 2005 have competed with time to deliver this service.

The outcome of a symptomatic call is dependent on how far NHS Direct is able to complete that call within its own resources. There are two important issues that have been highlighted since April 2006;

  • Referral of complex calls to UKMI from nurse advisors is minimal.
  • Use of the eBNF according to the recommended practice of accessing MedicinesComplete is variable across the service.
  • Some sites have registered no usage with a significant increase only in the sites where health information advisors have been handling medicine information calls(Medicine Complete data).
  • Anecdotally nurse advisors prefer using the hard copy BNF to support practice and often rely on own knowledge to support the call.

The organisation is actively seeking ways of improving clinical sorting of calls and a recent workshop of the CSI (Clinical Sorting Improvement) group highlighted some specific areas that may help the NA complete the call more efficiently with the potential for sorting at a lower priority, e.g contact a pharmacist, referral to UKMI.

The following areas for improvement were identified:

  • more specific medicines information in symptomatic algorithm rationale;
  • easy to access and easy to use resources to support calls;
  • referral.to UKMI with extended hours support.

UKMI Review of NHS Direct Medicines Related Calls handled by Nurse Advisors

A review of NA medicine related calls has been agreed by the Clinical Directorate as an important first step in understanding the real medicine issuesto support practice for NAs. UKMI lead pharmacists from regional MI centres will undertake the review working with clinical leads at sites taking part to take this forward. (See table for clinical lead or NHSD nominated link for this audit).

Purpose of the review

To identify how calls involving medicines are handled by nurse advisors in terms of clinical effectiveness and quality of service.

The review aims to answer the following questions:

  1. Are the standards used to review the call appropriate?
  2. Is the tool used to review the call appropriate for the medicine calls handled by NAs?
  3. Are the information resources available to NAs appropriate/ effective?
  4. Are there any gaps/changes required for the medicine algorithm for NA practice?
  5. Could referral of the call to UKMI provide any additional support to the call/ changes to end point?
  6. How are the medicine calls for NA streamed at the front end?
  7. Could the call have been sorted to a lower disposition within the resources available to NA, e.g. should the call have gone to the Health Information Service?

Process

The review will be conducted in two phases:

Phase 1: Review of calls where the medicine algorithm (v15)was used.

Phase 2: Review of calls where medicines discussion should have been a part of the assessment using other algorithms, i.e. contraception, fever, pain, and calls that ended “contact a pharmacist”

Sites identified for participation in audit

NHSD Region / NHSD site / UKMI lead / NHSD link
North West / NWC / Jill Rutter / Janet Crow
North West / West Midlands / Kelly Broad / Angie Wallace
North East / Newcastle / Paula Russell / Caroline Hayman
North East / Wakefield / Matt Haggerty / CarysMurray
North East / SYSH / Jane Farris / Hilary Fawcett
Eastern / Beds and Herts / Wynn Pevreal / Stuart Toulson
South Region / Hants IOW / Simon Wills / Debbie Scott
South Region / TVN / Ruth Cheema / Mary O’Dell
South Region / AGW / Alison Alvey / Cecily Cook
South Region / West Country / Caroline Metters / Pauline Lambell
London / South London / Davina Wraight / Julie Froggat

Sites have been selected and agreed in discussion with the NHSD Regional Directors of Nursing for their region and based on the UKMI resource to undertake the call review work.

Evaluation of calls

The NA medicine call review tool which has been developed by UKMI and NHS Direct will be used to assess the calls using the CAS report and audio. The tool has been successfully piloted with Health Information Advisor calls and modified to take account of nurse advisor practice for handling symptomatic calls. The following areas will be assessed:

  • Initial screening
  • Analysis and critical thinking
  • Information sources used
  • Referral
  • Answer including a qualitative assessment of risk to caller.
  • Documentation/record

The review will take into account whether the NA has received medicines training from UKMI.

Phase 1

Phase 1 will be undertaken by the end of January 2007.

  • 15 calls that used the medicine algorithm to support the call will be generated at sites from a random selection of 0845 calls where the NA completed the call.
  • Calls will be selected from 1st September 2006 until the time the CAS records are accessed to generate the call report for the review.

Phase 2

Phase 2 will be undertaken after January 2007.

  • The difficulties in generating the calls for Phase 2 may be helped with the implementation of Verint across NHSD sites.
  • When Verint is fully available at sites a further 15 calls will be drawn from the other algorithms as follows
  • Contact a pharmacist (6 calls)
  • Contraception (5 calls)
  • Fever (2 calls)
  • Pain (2 calls).

Contacts:

The audit is being led by the NHSD Medicine and Pharmacy Group

Chair: Anne Joshua, National Pharmaceutical Advisor, NHSD

UKMI audit project lead: Jill Rutter, NWC/GM UKMI lead

Date of preparation October 2006 v1.2

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