My medicines information placement experience

During her preregistration training, Sadia Naeem completed a medicines information placement at one of the UK’s regional medicines information centres. In this article, she describes her experience and provides tips for trainees doing similar placements

During her preregistration training, Sadia Naeem completed a medicines information placement at one of the UK’s regional medicines information centres. In this article, she describes her experience and provides tips for trainees doing similar placements

I was fortunate to be able to undertake my three-week medicines information (MI) placement at one of the UK’s 14 regional MI centres, namely the Northern and Yorkshire Regional Drug and Therapeutics Centre (RDTC) in Newcastle upon Tyne. These regional centres, around 250 local MI centres and two national MI centres in Cardiff and Belfast make up UK Medicines information (UKMi), a national medicines information service for healthcare professionals.

The role of MI centres

The main role of MI centres is to answer enquiries. A programme called MiDataBank is usually used to input data from the enquirer, and has sections to add in research and a formulated answer. The enquiry is then saved for future reference. However, there is much more to MI than just enquiries. MI centres can also be asked to identify medicines using TICTAC, a tablet or capsule identification programme, and be involved in education and patient safety.

Most regional centres focus on medicines use in a specific clinical area, such as psychiatry (the Maudsley Hospital) and dentistry (the North West Medicines Information Centre, based in Liverpool). For a full list, see the. Regional centres are also involved in evidence appraisal, staff training, producing national guidelines and newsletters and horizon scanning for new drugs. They possess a wide range of reference sources, such as AHFS Drug Information, Natural Medicines Database and handbooks on drug administrations by different routes. Local MI centres can refer to regional centres if they cannot find the answer using their resources. During my placement, I was able to see all this and more.

My experience at the RDTC

The RDTC houses the UK teratology information service and prescribing support, poisons information and “yellow card” centres. Consequently, a variety of queries are received every day.

UKMi produces a workbook on the basics of answering an MI enquiry, how to research and formulate an answer, and some practice queries to complete. Hospital preregistration trainees always receive it through their respective MI department and it is also available on the UKMi website for organisations with a password (including all MI departments).

During my first week, I spent most of my time completing the workbook tutorials and acquainting myself with the local enquiry-answering guidelines and standard operating procedures. I also received access to Medicines information Computer Assisted Learning, a training version of MiDataBank. It functions in exactly the same way, except it is not “live” and saved enquiries are not available to all members of the centre. In this way, I was able to practise researching and formulating answers to both mock and real enquiries. By the end of my placement, I had completed four real enquiries: two on adverse drug reactions, one on an interaction and one on a “special”.

Aside from learning how to answer enquiries, I critically appraised an article under an MI scientist’s supervision and learnt about the roles of the UK teratology information service and prescribing analysis and support offices. I also completed yellow cards for the Medicines and Healthcare products Regulatory Agency concerning the two adverse drug reaction enquiries I had completed. One involved a patient who had experienced facial swelling a few days after starting alendronate and the possibility of it being a side effect.  On researching, I came to the conclusion that the swelling was likely an effect of the drug and filled out a yellow card form electronically.

I also received an enquiry about ciprofloxacin-induced tendonitis, a well documented side effect with a British National Formulary “blue box” warning. Because the yellow card criteria states that all documented serious reactions should be reported, I completed a yellow card form.

Perhaps my favourite part of the placement was with the National Poisons Information Service (NPIS). The NPIS has some pharmacy input. There are four NPIS centres in the UK: Newcastle, Cardiff, Edinburgh and Birmingham. Since I was not trained in poisons, I could only listen in on calls. I found it somewhat disconcerting listening to the strange items that the UK population had been ingesting, including moth balls, dishwasher rinse and industrial-strength floor cleaner.

Many of the calls, however, related to ingestion of drugs and the MI scientists used Toxbase and other specialist poisons resources to determine the toxic dose and the appropriate route of action. A fair proportion of the calls received in the weeks I was at the RDTC concerned paracetamol toxicity, the poisoning guidelines having been changed less than two months earlier. The most shocking was a doctor calling up about a paracetamol overdose patient with an alanine transaminase value of over 10,000.

Advice to preregistration trainees

Hospital trainees undertaking a placement with an MI department will receive the UKMi workbook and I urge those who do to use it efficiently. Many of my colleagues found it rather dull and I admit that I did, too, initially. However, I realised its importance in our training. It gave me a lot of practice through the practice queries. Importantly, it provided me with a lot of evidence for my training portfolio.

Community trainees undertaking a cross-sector placement in a hospital with an MI department are likely to be provided with selected chapters from the workbook because their time in MI will probably be more limited than hospital trainees. MI pharmacists usually order sufficient workbooks each year to help train other pharmacy staff and students, and they can also download workbook chapters from the UKMi website. The UKMi training workbook is available for anyone to buy. Contact a regional centre for more information if you are interested.

If you are scheduled to complete a hospital placement, be proactive beforehand. Find out whether your hospital has an MI pharmacist and, if you are able to organise your own placement, aim for a hospital with an MI department.

Preparation for your placement

I would advise that you prepare adequately beforehand. In preparation for my placement, I sought the performance standards that I would need to demonstrate in advance. For example, the standards “use resources effectively”, “base your actions, advice and decisions on evidence” and “actively provide information and advice to healthcare professionals” are just some of the standards that can be demonstrated in MI. Completing real queries, appraising evidence, completing yellow cards  and even self-initiated education all make great evidence for your tutor.

Also, your time within an MI department, particularly if you are a community trainee, is likely to be fairly short, so ensure that you plan ahead and do all that you desire to in that period. Three weeks flew by for me. Organise everything with the MI pharmacist well in advance of your placement. Do not wait until you get there. Preparation speaks volumes.

Lastly, the is an under-recognised treasure trove of information. Some content is password-protected, but a lot is not and is therefore accessible to community professionals. Medicine supply issues, a whole section on conducting research, pandemic influenza drugs and National Patient Safety Agency alerts are just some examples. In addition, UKMi “Medicines Q&As” are always a good source of information regarding a query from everyday practice, whether it be the evidence concerning enteric-coated prednisolone over uncoated prednisolone or whether tricyclic antidepressants can cause tinnitus. is also a great source.


Acknowledgements Hayley Johnson, MI pharmacist, Regional Drug and Therapeutics Centre, Newcastle upon Tyne, and Joanne McEntee, MI pharmacist, North West Medicines Information Centre, Liverpool


Sadia Naeem is a newly registered pharmacist. She is also a blogger for PJ Online

 

Citation: Tomorrow's Pharmacist URI: 11124671

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  • Many of the calls received at the National Poisons Information Service relate to the ingestion of drugs

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