pills, bills & quills - department of...
TRANSCRIPT
PILLs, BILLs & QuILLs
CHOICE AND MEDICATION
Margaret England
Acting Medication Safety & Audit Pharmacist
North Metropolitan Health Service – Mental Health
STOKES REVIEW 2012
Professor Bryan Stokes delivered a report to the WA
government regarding admission, transfer and
discharge practices in the public mental health services
in WA
Jointly commissioned by Mental Health Commission
and the Department of Health in Nov. 2011 to ensure
that effective services, policies & practices were in
place & implemented
The Stokes Review made 117 recommendations
Recommendations from the Stokes
Review (2012)
Recommendation 2: Patients
2.5 ‘A detailed explanation of the advantages and side effects of psychiatric
drugs is given to patients and the need to maintain medication regimes is
comprehensively discussed.’
Deputy Coroner’s Recommendation 7.10:
7.10.14 ‘Practitioners prescribing medications should ensure they
comprehensively discuss compliance issues and discontinuation issues as
well as any other relevant information associated with the particular
medication prescribed. I would prefer both providers and dispensers of
medication ensured up to date CMIs [consumer medicine information] or
other written information be provided to patients and/or carers as a written
record, approved by TGA [the Therapeutic Goods Administration] of the
advice given.’
Background
The chief psychiatrist was informed about the UK version of
the Choice and Medication website by our previous drug
information pharmacist, and saw the value in simplified CMIs
for patients.
Complies with NSQHS standards: Communicating with
patients and carers Standards 4.13, 4.14 and 4.15
Complies with the Stokes Review 2012 recommendations
The local version has been modified for Australian context
Website is maintained by specialist pharmacists and
endorsed by the UK College of Mental Health Pharmacy
Choice and Medication website
Main author is Professor Stephen Bazire (consultant
pharmacist and also author of Psychotropic Drug Directory)
Run by an independent organisation of qualified
professionals & specialists in mental health & mental health
medicines
No affiliations with any pharmaceutical company
Choice and Medication Group
Have developed a suite of consumer medication information
leaflets (CMIs) for psychotropic medications
Website provides multiple flexible options for a range of
diverse consumer needs
Used in other states of Australia and within WA Child &
Adolescent MHS
Over 300 information sheets – covering psychotropic
medications & related issues
Operational Directive OD 0591/15 (Feb 2015)
Mental Health Consumer Medication
Information
Every patient must be provided with both verbal and written
information regarding each new medication commenced
The mental health consumer when prescribed medication
must give informed consent
The consumer needs to be provided with appropriate
comprehensive, accessible and readable information
Must include what is prescribed, the benefits, the risks of
treatment & non-treatment and other options
Operational Directive OD 0591/15 (Feb 2015) cont.
A brief summary of this conversation, reasons for medication
use & dosage must be documented in the patient’s notes
The Chief Psychiatrist and Office of Mental Health have
recommended the use of Choice and Medication CMIs
Access at www.choiceandmedication.org/wadoh Or via the
Healthy WA public website
Choice and Medication Website
PILLs – standard Patient Information Leaflets
BILLS – Brief or Basic Information Leaflets
QuILLs – Quick Information Leaflets
30 common questions regarding 140 psychotropic
medications
Answers to 14 of the most common questions regarding 21
mental health conditions
‘Handy Charts’ for comparing the main medicine options for
each condition
CMIs in languages other than english
Some BILLs are available in Lithuanian, Mandarin Chinese, Polish,
Portuguese, Punjabi, Romanian, Somali, Spanish and Urdu.
European Medicines Agency (link for some medications) EPAR
Overview for the public, in Bulgarian (BG), Croatian (HR), Czech
(CS), Dutch (NL), Estonian (ET), Finish (FI), French (FR), German
(DE), Greek (EL), Hungarian (HG), Italian (IT), Latvian (LV),
Lithuanian (LT), Maltese (MT), Polish (PL), Portuguese (PT),
Romanian (RO), Slovak (SK), Slovenian (SL), Spanish (ES) and
Swedish (SV).
PILL - standard Product Information Leaflet
BILL – Brief or Basic Information
Leaflet
QuILL - Quick Information Leaflet
Handy Charts Comparison table of all the main medicine options for each condition
Alcohol dependence
Alcohol withdrawal
ADHA
Dementia and Alzheimer’s disease
Anxiety
Acute psychiatric emergency
Bipolar depression
Bipolar mania
Bipolar mood disorder
Depression
Insomnia
OCD
Panic
Psychosis and schizophrenia
PTSD
Seasonal affective disorder
Social anxiety
Handy Chart - shows a comparison of all the main
medicines for each condition
Handy Guides and Fact Sheets
Specific topics where useful information is harder to find
Clozapine and constipation
Generic medicines (information about generics vs brands)
Hyperprolactinaemia (raised prolactin in the body)
Medicines over the internet – some guidance on buying medicines over the
internet
Metabolic syndrome (eg. Weight gain, high cholesterol, diabetes)
QTc prolongation with antipsychotics
Ramadan (taking medicines safely during Ramadan)
Smoking and clozapine e.g. stopping smoking
Smoking and olanzapine e.g. stopping smoking
Weight gain advice
Handy Fact Sheet
‘Learn More About Your Medicines’
Booklet
A eBook for consumers of how psychotropic medicines work
Sections on
How the brain works
How we think medicines work
Tolerance, dependence & addiction
The whole book can be printed or just relevant sections
Example of a page from the eBook
Feedback from Clinical Pharmacists
‘I find the PILLs, BILLs and QuILLs helpful and this is what I give patients now.
Depends on their capacity and mental state as to which one I give. If not high
functioning I will give the QuILL, if they can take in more information I’ll give the PILL or
BILL.’
‘Mainly use the PILLs and BILLs’
‘Have used the Choice Medication website. Have only have used the PILLs as it's
concise and only 2 pages. The side-effects are also not daunting.’
‘I understand the doctors use this website to provide patients with information on any
psych meds they are prescribed, as this is mandatory now.’
‘I have used PILLs and BILLs, particularly useful for HiTH patients.’
References
Choice and Medicines website http://www.choiceandmedication.org/wadoh/
Mental Health Consumer Medication Information Operational Directive OD 0591/15
Stokes Review http://www.mentalhealth.wa.gov.au/Libraries/pdf_docs/Mental_Health_Revi
ew_Report_by_Professor_Bryant_Stokes_AM_1.sflb.ashx
Thanks to the pharmacists at Graylands Hospital for their
input