Activities

Activities

The activities of MI services can arbitrarily be divided into two main groups, reactive and proactive, although this presents an oversimplified picture.

Reactive

The reactive service is mainly focused on enquiry-answering for the broad range of users of the service described previously. Most enquiries to the MI service are directly related to individual patient care, although many are concerned with developing policy and guidelines, pharmacy practice, pharma-ceutical issues, pharmaceutical and medicines research and teaching support. The service will answer enquiries on any aspect of the prescribing, supply, formulation and administration of medicines, where possible from an evidence-based perspective. Common types of clinical enquiry are listed in Table 8.5.

Providing an effective response to a clinical problem is a multiple-stage process and requires a wide range of skills and knowledge. The main com-ponents of the enquiry-answering process can be simplified as:

·      contact with the enquirer

·      identification of the problem

·      acquiring appropriate and adequate background information

·      establishing the urgency of the enquiry and prioritising with other enquiries

·      retrieval, utilisation and critical appraisal of information relevant to the enquiry. This may include referral to a subject specialist if appropriate

·      preparing the response

·      presentation of response in most appropriate form, e.g. letter or verbally

·      documenting the whole process

·      feedback and follow-up if necessary to determine outcome and need for further information.

Guidelines and standard procedures have been established nationally to facili-tate this process being undertaken to a consistent and high-quality level across the UK. Enquiry-answering is the main activity on which various quality control and audit processes are performed to ensure that the service is meeting its objectives, within a clinical governance framework, in facilitating safe and effective medicines use in patients.

Proactive

The proactive part of the service includes a wide range of outputs, which can be partly or wholly produced by the MI service. The involvement of individual local MI services in these activities varies, depending on both local need and service resourcing. Proactive outputs aim to provide support to prescribing policy and strategy construction, guideline production and implementa-tion, and education, knowledge and professional development support. These activities include bulletins and newsletters; standardised, evidence-based answers to common questions (over 200 ‘Medicines Q&As’ are pub-lished on NeLM and updated regularly); current awareness publications; horizon-scanning and evidence-based appraisals of new medicines; and vital tools in strategic medicines management and part of proactive MI outputs.