Frequently asked questions about medicines — a pilot project for NHS Direct

Introduction

Part of the ethos of NHS Direct is that a patient telephoning the service should receive the same high quality information irrespective of which of the 22 sites in England is contacted. Inevitably, however, there can be some lack of consistency between individuals not only in how the information is retrieved, but also in how it is interpreted, presented and documented. In addition, NHS Direct also wants to provide patients with a speedy and efficient service without compromising quality or safety.

Approximately one-third of telephone calls to NHS Direct are concerned with medicines either directly or indirectly, yet many of the questions that are commonly asked by patients cannot easily be answered from a single reference source. Consequently, nurses at NHS Direct are trained to validate their answers to questions about medicines from more than one source to ensure accuracy, but this is time-consuming. Pharmacists in the United Kingdom Medicines Information network (UKMi) offered to work with NHS Direct nurses to develop a database of answers to frequently asked questions (FAQs) about medicines. These would be evidence-based answers that could be used as a single source of information when answering common questions from patients.

Method

A steering committee was formed to develop answers to FAQs, consisting of four senior representatives each from UKMi and NHS Direct. A detailed project plan was written and approved by the UKMi Executive, the national clinical team of NHS Direct, and a representative from the Department of Health. It was decided to pilot the project at two NHS Direct sites: Hampshire & Isle of Wight and North East London. NHS Direct staff at these two sites collected details of medicines enquiries that were received frequently during a two-week period. This was used to compile a master list of 24 enquiries which were adopted as FAQ topics (see Panel below).

The answers to the FAQs identified by the pilot sites were written by experienced UKMi pharmacists using the best evidence available. They followed detailed quality assurance protocols developed by UKMi to ensure that FAQs were written in a consistent manner and that all research quoted was valid and interpreted correctly. The work of the author pharmacist was checked by a second pharmacist. If a comprehensive answer to an FAQ was not possible because of insufficient evidence this was clearly stated.

The UKMi FAQ co-ordinator (SW) scrutinised each FAQ for consistency, completeness, relevance and presentation. Every FAQ was then appraised by two senior NHS Direct nurses for usability during telephone triage. They were then, finally, reviewed by an NHS Direct multidisciplinary professional advisory group, which assessed format, plain English and relevance to working practice.

Consideration was also given to interpretation of the FAQs. Scenario testing was used at one pilot site to determine if all those who read an FAQ would give the same answer to simulated NHS Direct enquiries. A random sample of 12 nurses were each given five mock telephone calls to handle. Each scenario required the use of a different FAQ. The answers given by the nurses were evaluated for accuracy and completeness and did not reveal any major inconsistencies.

During the pilot project, the final versions of FAQs were made available in both hard copy and electronically via the NHS Direct intranet. The project ran for three months and during this time staff at both pilot sites were asked to complete a questionnaire on each occasion an FAQ was used. NHS Direct staff were asked the following questions:

• Which FAQ was used?
• Did the FAQ address the caller’s query?
• Was the FAQ presented in a format that is easy to use?
• Do you think that this FAQ saved you time?

It was predetermined that scores for these questions should be positive for 90 per cent or more respondents for the pilot to be an unequivocal success. In this event the pilot project would be developed into a national information resource for NHS Direct. Lower scores would require redesign and a second pilot project.

In addition, participants were asked to identify other FAQs about medicines that they would like to see available in the future.

Results

Results from analysis of the 159 questionnaires received from NHS Direct staff who used an FAQ during the pilot project were extremely encouraging. Most users reported that an FAQ had helped them with a patient enquiry (90 per cent) and had also saved them time (93 per cent). Unfortunately, for technical reasons it was not possible for call lengths to be timed objectively. Most respondents (91 per cent) supported the format used in the pilot project.

The three most commonly used FAQs reported by respondents during the pilot project were:

• Does paracetamol interact with antibiotics? (used by 22 per cent of respondents)
• Can ibuprofen or paracetamol be taken with cough or cold medicines? (14 percent)
• Which cough and cold remedies can be taken while breast-feeding? (11 per cent)

Previously nurses would have needed to validate this information by confirming the same answer from more than one source.

In addition to the questionnaires returned, the steering group also received over 30 suggestions for new FAQ topics. Examples included:

• How can hay fever be managed in pregnancy?
• Does the herbal product Ginkgo biloba interact with conventional medicines?
• Which antibiotics can be taken while breast feeding?
• What guidance can patients be given if they miss a dose of their medicine?
• Can tea tree oil be applied to the skin at the same time as creams or ointments?

Discussion

It was not possible to determine how often FAQs had actually been used in practice since both paper and electronic versions were available. However, the feedback from those who completed questionnaires indicated high satisfaction in terms of relevance to calls received, time saved and presentation.

The positive results of the pilot study, which met the predetermined endpoints, has led to these FAQs being made available to all NHS Direct sites. It has also been agreed to share them with the whole NHS via the National Electronic Library for Medicines (NeLM) website, where UKMi will work to keep each FAQ up to date on an ongoing basis. Each one will be completely reviewed at least every two years. The FAQs from the pilot project and others written subsequently can now be viewed on the internet as part of a bigger, NHS-wide, “Medicines Q and A” scheme (at www. nelm. nhs. uk/search/product.aspx?id =116). A number of the topics identified in the pilot study have already been added to this database. In the future it is hoped to gather data on the popularity of individual FAQs by counting the number of website hits.

Anecdotally, we are aware that some nurses accessed the FAQs for personal education, rather than in response to enquiries from the public. Data on the frequency of this practice and its benefits were not captured in the pilot study, yet it does represent another unexpected advantage of FAQs, and one that merits further investigation.

Within senior levels of NHS Direct, feedback has been positive. This has led to UKMi working with NHS Direct Online to make patient versions of FAQs available for the NHS Direct website and some of these have already been completed. In case of misunderstanding, each patient version is prefaced with a sentence recommending that patients telephone NHS Direct or visit their pharmacist or GP if they do not understand the FAQ, or if they are not sure if the information applies to them.

Pharmacists and nurses both have a role in providing the public with information, and this project has identified an area where these two professions can work together to support each other to the benefit of patients and the wider NHS. FAQs empower nurses to answer commonly asked questions about medicines accurately and consistently, enabling them to provide a better service to callers and so, it is hoped, increase their own job satisfaction. Nurses believe that FAQs also improve efficiency by reducing call time, although this was not confirmed objectively. Finally, FAQs help NHS Direct staff to document the advice they give over the telephone more easily.