Pharmacy Support Staff Training Guide - myilearn.co.uk · Symptoms-check Questionnaire P24 Patient information leaflet P25 Registration card P26 References Back cover. P3. Pharmacy

For product information see back cover

Pharmacy Support Staff

Training Guide

P2

Contents

Introduction P3

Section 1: What is BPH? P5

Section 2: What is tamsulosin? P9

Section 3: The role of Pharmacy P11

Section 4: Self assessment questions and case studies P20

Appendix: Glossary of terms P23 Symptoms-check Questionnaire P24 Patient information leaflet P25 Registration card P26 References Back cover

P3. Pharmacy Support Staff Training Guide.

Around 1 in 4 men over the age of 40 years experience symptoms. These lower urinary tract symptoms (LUTS) can seriously affect a man’s quality of life. However, relatively few men ask their GP for help.

Flomax Relief (tamsulosin) is a new POM to P medicine for BPH, which means that the pharmacy, for the first time, can offer sufferers a proven effective treatment to relieve their urinary symptoms.

As a member of the pharmacy support team, you can make an immense contribution to helping men with BPH by encouraging them to seek help and treatment advice from the pharmacist.

Benign prostatic hyperplasia (BPH) is a very common condition in older men, which causes them to experience difficulties when urinating (peeing).

Introduction

P4

To equip pharmacy support staff (medicines counter assistants and dispensary staff) with the knowledge and skills to create the right environment for dealing with BPH in the pharmacy, and to refer potential sufferers to the pharmacist for BPH treatment advice.

The training will also help you develop the skills to screen customers with sensitivity and help in the consulting process.

This training is accredited by the College of Pharmacy Practice (CPP) and has been awarded the National Pharmacy Association (NPA) training seal.

These materials have been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society’s CPD competency framework.

The NPA training seal is an approval of the training content. The NPA in no way endorses any product(s) or range of products listed. Also the NPA cannot guarantee the content of any website listed.

Learning objectives

• To ensure you have the appropriate level of relevant knowledge to be able to talk about the supply of Flomax Relief (tamsulosin), engage potential sufferers and refer them to the pharmacist

• To be aware of an individual’s role in dealing with BPH in the pharmacy

• To help equip you with the communication skills required for engaging men with BPH and their partners

• To raise awareness of prostate health among customers

Estimated number of hours to complete: 1.5 hours

Aim of training

Prostate

UrineBladder

Urethra


Section 1:

What is BPH?

Benign prostatic hyperplasia (BPH) is an overgrowth of cells of the prostate gland, causing it to become larger. The gland is found only in men and is involved in the production of semen.

The prostate gland is normally about the size and shape of a walnut. It sits at the base of the bladder and wraps around the urethra, which is the tube that carries urine away from the bladder to the outside.

In many men the prostate gradually gets bigger after the age of about 40. It is rare in the under 40s. The cause of BPH is unknown but ageing and the male hormone testosterone both play a part.1

Normal prostate

Enlarged prostate

P6

Signs and symptoms

As the prostate gland gets bigger it can squeeze the urethra and interfere with the flow of urine, causing a variety of difficulties when urinating. The table below lists some of the words that men are likely to use to describe their symptoms:2

Impact of symptoms

BPH symptoms may start as simply an inconvenience but then can get worse as the condition progresses. Many men try to adjust their lives and develop coping strategies, such as ‘toilet mapping’ to deal with the problem. Some men may be unable to leave home without worrying about where the next toilet will be, and many may know the location of every single service station on the motorway or toilet along a particular tube line for their journey to work.

Men with BPH and their partners often find the consequences of the condition bothersome and that it impacts their quality of life. In a survey, more than two-thirds of men aged 51-60 years with urinary problems found the condition is always at the back of their mind and made them anxious.* Some men find their symptoms more of a problem than others, and how bothered they are can influence which treatment they are given.

*Based on a sample of 102 men aged 51-60 years with LUTS due to BPH

What the sufferer might say:

• Having to wait before I start to pee

• Stopping and starting when peeing

• Having to push or strain to pee

• Having a weak flow or weak stream of urine

• Feeling like my bladder is never quite empty

• Dribbling at the end of passing water

• Having to pee more often than before

• Finding it difficult to put off peeing

• Having to get up at night to pee

• Being desperate to pee


Section 1:

The symptoms of BPH can often be relieved by lifestyle changes, with medication, and if necessary by surgery.3

Not all men with LUTS will require treatment. Management should include a combination of reassurance, lifestyle advice and assessment of the need for medication. The pharmacist is well-placed to give sufferers lifestyle tips to help manage their symptoms. However, if the man has taken the time to seek advice from a healthcare professional it is likely that he is bothered or concerned by his symptoms and may benefit from treatment.

If medicine is required, BPH is usually treated with a drug known as an alpha1-blocker, such as tamsulosin (the active ingredient in Flomax Relief). This relaxes the muscle of the prostate and bladder outlet. Another type of drug called a 5-alpha-reductase inhibitor, such as finasteride (available on prescription), may also be used for men with larger prostates with urinary symptoms. It works by shrinking the prostate. In some cases both drugs are used together.

There are some alternative therapies, such as herbal remedies, homeopathy and acupuncture, that are available without prescription for treating urinary symptoms. However, these have not been clinically proven to be effective for LUTS in men.

BPHtreatments

General notes:

P8


Section 2:

What is tamsulosin?

Tamsulosin treats the symptoms of BPH, so that men do not need to urinate as often and it is made easier for them when they do. Side effects are few and generally mild.4

Tamsulosin is the most widely recommended drug for BPH in the UK5 and has been a POM (Prescription Only Medicine) for over 10 years. It is now reclassified as a Pharmacy only medicine under the brand name of Flomax Relief, so it can be sold to appropriate customers under the strict supervision of a pharmacist.

The dose is one 0.4mg capsule, taken after the same meal each day. The capsule should be swallowed whole, not crunched or chewed as this will interfere with the modified release of the drug. Modified release means that the drug is released over an extended period of time.

Tamsulosin works quickly, with most men noticing improvement within a week or two of starting treatment, but if symptoms do not improve within 14 days of starting treatment the man should visit his GP.4

Certain conditions apply to the pharmacy sale of tamsulosin (Flomax Relief):

• It is only for men aged 45 to 75 years

• Customers cannot buy more than 6 weeks’ supply without checking with their GP that the doctor is happy for them to continue long-term with over-the-counter (OTC) tamsulosin treatment

• Customers who are taking the medicine are advised to have a consultation with their GP every 12 months

In some people, tamsulosin may cause drowsiness, blurred vision and in rare cases fainting, so men taking this treatment should take extra care if they will be driving or operating machinery.

P10

Action point

Ask your pharmacist or pharmacy technician:

a) How many of our customers are getting prescriptions for BPH? How many receive tamsulosin on prescription?

b) How many of our male customers might suffer from BPH?

Notes

Certain groups of men with BPH should not be supplied with tamsulosin OTC. These include:

• Men who are experiencing symptoms that might point to a more serious condition (for example, pain on urination, bloody or cloudy urine, and unexplained fever)

• Men who experience urinary incontinence (uncontrolled leaking of urine)

• Men with unstable or undiagnosed diabetes

• Men who have had a prostate operation

• Men with liver, kidney or heart problems

• Men with a history of postural hypotension (when suddenly standing causes a feeling of dizziness or weakness)

• Men who are about to have an operation on the eye for cloudiness of the lens (cataract)

• Men who have recently had blurred or cloudy vision that has not been examined by a GP or optician (because this could be an undiagnosed cataract)

• Men who are allergic (hypersensitive) to tamsulosin or any other ingredients of Flomax Relief

• Men taking the following drugs: doxazosin, indoramin, prazosin, terazosin or verapamil

• Men already diagnosed with BPH who are taking tamsulosin on prescription, or are taking another prescribed drug for BPH


Section 3:

Men do not generally take an active interest in their health and are reluctant to seek help from their GP for a number of reasons, including fear or embarrassment.

By raising awareness of men’s health issues such as BPH, you can help these men to see your pharmacy as the first port of call for their health concerns. If men are aware that they can purchase an effective OTC treatment for their symptoms, they have another opportunity to seek healthcare advice by asking for help at the pharmacy rather than doing nothing about it.

The role of Pharmacy

Dealing with BPH in the pharmacy

The symptoms of BPH can have a significant impact on the quality of life of a sufferer, and their partner too, yet many men are reluctant to talk about their symptoms because they find them embarrassing. Should your male customers look uncomfortable, it may be appropriate to make them aware that a consulting room is available where they can discuss their symptoms with the pharmacist discretely and in confidence.

Urinary difficulties must be discussed sensitively, yet honestly. Remember that:

• Some men simply accept their symptoms as an inevitable part of getting older

• Many men are unaware that something can be done to relieve their condition

• Some men may be concerned about their chances of developing prostate cancer, and although this will need to be checked out by their GP, they can be reassured that men with urinary symptoms due to BPH are no more likely to develop prostate cancer than those without symptoms1

• Many men will use colourful terms to describe their symptoms. It can be helpful to repeat some of the words they use in conversation e.g. ‘problems peeing’ to put them more at ease

P12

Role of support staff

• Learn about BPH and Flomax Relief (tamsulosin) and refer appropriate customers to the pharmacist

• Give appropriate customers the Symptoms-check Questionnaire and help them fill it in if necessary

• Give customers Flomax Relief reading materials where appropriate

• Check customer’s registration card when they ask for further supplies of Flomax Relief and refer to the pharmacist if necessary

• After the pharmacist has assessed the patient with the SQ, found them to be suitable for OTC treatment and offered lifestyle advice, sell customers supplies of Flomax Relief

• Bring customers to the attention of the pharmacist who are asking for further supplies of Flomax Relief and whose doctor has said that they are happy for them to continue OTC treatment long-term. Sell customers supplies of Flomax Relief where appropriate

• Display information leaflets on BPH

• Learn communications skills to help you deal with customers sensitively

• Make the pharmacy more ‘male friendly’

Action point

Read all the Flomax Relief materials available so that you are familiar with the medicine and the symptoms it treats and the paperwork that may be given out to customers. Think about the language you are comfortable using when talking to sufferers. The materials include:

• The customer Symptoms-check Questionnaire (SQ), which is used to identify the severity of the urinary symptoms, any reasons why Flomax Relief (tamsulosin) should not be given, and where men need immediate referral to a GP

• A GP referral slip from the pharmacist – found on the customer SQ which the customer can use to inform their GP that they are taking Flomax Relief or if they are considered unsuitable to take it

• Men’s Health Booklet – found inside each pack of Flomax Relief, it gives information on prostate health and where to get more information

• Registration card – found on the back cover of the Men’s Health Booklet, it shows the date the customer started taking Flomax Relief and can remind them of when they need to have a check up with their doctor. The customer can also use it to record any other medicines they are taking


Section 3:

Supplying Flomax Relief

If a customer asks about Flomax Relief (tamsulosin) or wants to discuss urinary symptoms, they should be quickly but sensitively referred to the pharmacist.

Although Flomax Relief is used to treat urinary symptoms in men only, female customers wanting treatment for their male partners should still be referred to the pharmacist for advice, and the pharmacist may want to talk to the customer confidentially.

A strict protocol must be followed when selling Flomax Relief. Follow the Flomax Relief guideline and keep it near the pharmacy counter in case you need to refer to it. Speak to your pharmacist to find out what level of involvement they would like you to have.

Man presents with urinary symptoms

Prostate health counselling by pharmacist with

Symptoms-check Questionnaire

Suitable

Suitable

Suitable

Flomax Relief 2 week supply

Refer to GP

Refer to GP

Refer to GP

Flomax Relief 4 week supply

Week 2 symptoms and side effect review

Week 6 symptoms and side effect review

Check BPH diagnosis has been confirmed by GP

Flomax Relief up to 52 week supply

Pharmacist to remind patient to visit GP for

annual prostate and general health check

Unsuitable

Unsuitable

Unsuitable

Pharmacist to remind patient to visit GP by

week 6 for confirmation of BPH diagnosis if not already

done so

Week 0

Week 2

Week 6

Week 52

Pharmacist consultation is to rule out red flag conditions and assess severity & duration of LUTS*

*Lower urinary tract symptoms

P14

Pharmacistsupervision model


Section 3:

Communicating with men on embarrassing problems

A piece of communication material, such as a consumer leaflet on BPH or Flomax Relief, can help to take the focus away from the male customer’s personal symptoms. Alternatively, some men would prefer to initially take away a leaflet to read at home rather than discuss a health issue that they are unsure or uncomfortable about. You could also recommend that the man visits the www.flomaxrelief.co.uk website, which contains information about BPH and advice on how to manage symptoms.

If you sense that a man wants to discuss something but is embarrassed, offer him the opportunity to talk to the pharmacist privately, perhaps in the consultation room.

• Be aware when your colleagues are talking to an embarrassed customer so that you can move out of earshot

• Using the language that men use to talk about their urinary symptoms can make them feel more comfortable. Using technical terms they don’t understand may make them feel awkward

P16

Common statements about the impact of urinary difficulties on quality of life of sufferers

“ It is embarrassing”

“ This condition controls me and my life”

“ It makes me feel angry”

“ I am afraid that it is a sign of something more serious”

“ It is depressing”

“ It is just part of getting older and I just have to live with it”

Source: Research survey amongst 213 men. Conducted for Boehringer Ingelheim (2007)

Action point

• Discuss with colleagues the best approach to discussing the subject of urinary problems if it is raised in the pharmacy

• Create your own script that you feel comfortable following when speaking to a man with LUTS


Section 3:

• Discuss with your pharmacist the possibility of advertising health services such as blood pressure monitoring, cholesterol testing, and MURs to men

• Use Flomax Relief point-of-sale material and information leaflets to encourage male customers to ask the pharmacist about BPH

• Use your window displays to encourage men into the pharmacy by including, for example, sporting items

• Display as many leaflets as you can on men’s health issues in a place where they are easily visible and make sure that Flomax Relief Symptom-check Questionnaires and information packs are kept in the consultation room

• Display men’s toiletries more prominently, for example, on a gondola end

Action point

Write down three things you could do to make your pharmacy more ‘male-friendly’

Tips to make your pharmacy more men friendly

• Whenever a female customer asks for Flomax Relief or advice on behalf of a male partner or family member politely suggest that if the man himself could spare the time to drop by, the pharmacist would be happy to talk about any health concerns. However, ensure she picks up literature to take away for her partner or family member

P18

Section 3:

WWHAM questions for Flomax Relief

WWHAM question Flomax Relief Considerations

Who is the product for? Flomax Relief is only for men aged 45 to 75 who have symptoms of BPH.

What are thesymptoms?

Men with BPH will have difficulties urinating which include needing to go more often than before and being desperate to go, finding it difficult to put off urinating and having to get up at night to urinate.

A customer with any of these symptoms (or those mentioned earlier) should be referred to the pharmacist.

How long have symptoms been present?

Symptoms can start at any time after the age of 40 and usually get gradually worse. Some men may have been suffering for years before they come to the pharmacy. Men should have the symptoms for longer than 3 months, to rule out acute conditions that may have similar symptoms e.g. urinary tract infections. Refer to the pharmacist if customers have been suffering from symptoms for less than 3 months.

Has any Action beentaken so far?

Men may have been trying to cope by drinking less and never straying far from a toilet. Some may have tried a herbal remedy, and others may already have been treated by their GP with a prescription medicine. Refer to the pharmacist if the customer has tried anything previously.

Are any Medicinesbeing taken?

Customers taking certain medicines should not take tamsulosin. Refer to the pharmacist if the customer is on any other medication. The pharmacist can ask the customer or he or she may be able to check on their Patient Medication Record (PMR).


Section 3:

For more information on BPH and Flomax Relief visit www.flomaxrelief.co.uk

The following websites may also be helpful:

Men’s Health Forum

www.menshealthforum.org.uk

NHS Clinical Knowledge Summaries

www.cks.nhs.uk

NHS Direct

www.nhsdirect.nhs.uk

Prostate Help Association

www.prostatehelp.me.uk

Prostate Research Campaign UK

www.prostateuk.org

More information

General notes:

P20

Please answer TRUE or FALSE to the following statements:

1) A man’s prostate gland is the size and shape of a peanut

2) If a man has LUTS, it is most probably due to prostate cancer

3) Tamsulosin capsules should be swallowed whole

4) Flomax Relief can be used in men under 45 years old

5) All sufferers must complete a questionnaire before they can purchase Flomax Relief

6) Customers suitable for Flomax Relief can only purchase 14 capsules at first visit

7) If a customer has seen his GP but has lost his registration card he can still purchase Flomax Relief from you, without seeing the pharmacist

8) Men who want to discuss their urinary symptoms should be given the chance to talk to the pharmacist in a private area

9) All leaflets on men’s health issues should be kept in the dispensary where they can’t be seen

10) If a man cannot come to the pharmacy for an initial consultation about their urinary symptoms, their partner can buy the first pack on their behalf

Section 4:

Self assessment questions and case studies

T

T

T

T

T

T

T

T

T

T

F

F

F

F

F

F

F

F

F

F

Answers: FFTFTTFTFF


Example 1Mr Smith, a regular customer of about 60 years old, looks anxious and is taking a rather long time to choose some cough medicine. When the only other customer in the shop leaves, he says very quietly: “I’m having some problems peeing, I need to go several times a night!”

Considerations:

• Mr Smith is obviously embarrassed about his symptoms, so try to deal with the matter as quickly and efficiently as you can

• Reassure Mr Smith that you can probably help and show him to a private area, such as the consultation room where the pharmacist will discuss his concerns

• Tell the pharmacist that Mr Smith is waiting to discuss a concern about his urinating problems in the consultation room. Give Mr Smith a leaflet on BPH or Flomax Relief while he is waiting for the pharmacist consultation

• Having completed a questionnaire and discussed the matter with Mr Smith, the pharmacist tells you that you can sell him a 14 day starter pack of Flomax Relief

• Tell Mr Smith that he should make an appointment to see his GP, in order to check out his prostate

• Tell Mr Smith that there is more information inside the booklet and to phone the pharmacist if he has any questions. Advise him to read the Flomax Relief ‘Men’s Health Booklet’. Remind him that he will need to return in two weeks’ time for a further supply and that he should bring his registration card (from the Men’s Health Booklet) when he comes

Example 2A man in his twenties who you have never seen before asks for some Flomax Relief and he tells you he has blood in his urine and pain on urination.

Considerations:

• This man is unsuitable for Flomax Relief because of his age alone, but should still be referred to the pharmacist to discuss his symptoms

• Offer the man the opportunity to talk to the pharmacist in private

• The pharmacist will refer any man with ‘red flag’ symptoms, which include blood in the urine and pain on urination or urinary symptoms occurring in young men (below 45 years), to their GP and give them a referral letter to take with them

Example 3Mr Smith, your regular customer of about 60 years old has now been taking Flomax Relief for the past 8 months. He would like to buy another pack but wants to know if he should see his GP soon?

Considerations:

• As long as Mr Smith is still happy that his medication is working and there aren’t any other symptoms disturbing him, he can continue to take Flomax Relief. Customers who are taking Flomax Relief must be advised to consult a doctor every 12 months for a prostate check

• Ask Mr Smith if he has any other concerns he would like to discuss with the pharmacist

• Inform the pharmacist that Mr Smith is asking for a further supply of Flomax Relief and that he has been taking it for 8 months

• Give Mr Smith a further supply of Flomax Relief and explain that if he is worried at all he should come back and talk to the pharmacist or visit his GP

Case studies

Section 4:

P22

Example 4A man who looks like he is in 60s asks you if there is something he can buy to stop him feeling like he needs to go to the loo all the time.

Considerations:

• The man may be referring to an urge to urinate all the time or he may be referring to a problem with his bowels, so this needs to be confirmed

• Explain to the man that you can probably help and ask him if he wants to go to a private area, such as the consultation room where the pharmacist will further discuss his symptoms

• Tell the pharmacist that the man is waiting to discuss a concern about needing to go to the toilet

• After the man has completed a Symptoms-check Questionnaire and discussed the matter, the pharmacist tells you that you can sell him a 14 day starter pack of Flomax Relief

• Tell the man that he should now make an appointment to see his GP in order to get a prostate check

• Tell the man that there is more information inside the pack for him to read, and to phone the pharmacy or come back if he has any questions. Tell him that he needs to return in two weeks time to review his medication and maybe get a further supply, and remind him to bring his registration card when he comes in

Example 5Mrs Wells has come in for her regular prescription but says she feels quite tired. She asks you if there is something you can recommend to help her sleep because she keeps getting woken up by her husband who gets up to pee three or four times a night.

Considerations:

• Mrs Wells is probably only having trouble sleeping and feeling tired because her husband keeps waking her up when he visits the toilet, and this is something that needs to be tackled. Her husband probably suffers from disturbed sleep as well

• Politely ask that if her husband could spare the time to drop by, the pharmacist may be able to give him something to stop him needing to urinate so frequently, and perhaps this will help them both get a better night’s sleep

• Explain to Mrs Wells that her husband can pop in at any time or book an appointment to see the pharmacist. Ask her to reassure him that any discussion is confidential and can be carried out in a private area or consulting room in the pharmacy

• Give Mrs Wells some appropriate men’s health leaflets, the Flomax Relief reading material and the customer Symptoms-check Questionnaire. Mr Wells can fill in the questionnaire and bring it with him when he comes to see the pharmacist


Glossary of terms

BPH: Benign Prostatic Hyperplasia

LUTS: Lower Urinary Tract Symptoms

MUR: Medicines Use Review

OTC: Over-The-Counter

PIL: Patient Information Leaflet

POM: Prescription Only Medicine

PMR: Patient Medication Record

SPC: Summary of Product Characteristics

SQ: Symptoms-check Questionnaire

Appendix:

P24

Symptoms-check Questionnaire (SQ)

Appendix:


Patient information leaflet (PIL)

Appendix:

P26

Registration card

Appendix:

Registration card can be found on the reverse of the Men’s Health Booklet

References1. Clinical Knowledge Summaries. Prostate – Benign hyperplasia

http://www.cks.nhs.uk/prostate_benign_hyperplasia/view_whole_topic# Date accessed 7th October 2009.

2. Best Treatments. Prostate, enlarged. http://www.besttreatments.co.uk Date accessed 7th October 2009.

3. National Institute for Health and Clinical Excellence. Lower urinary tract symptoms - the management of lower urinary tract symptoms in men. NICE clinical guideline CG97. May 2010.

4. Summary of Product Characteristics for Flomax Relief MR.

5. Department of Health. Prescription Cost Analysis: England 2004. Health and Social Care Information Centre. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassetts/@dh/@en/documents/digitalassett/dh_4107626.pdf.

These materials have been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society’s CPD competency framework.

The NPA training seal is an approval of the training content. The NPA in no way endorses any product(s) or range of products listed. Also the NPA cannot guarantee the content of any website listed.

Date of preparation: August 2011/FMX0291

Flomax Relief® MR – Product Information. Presentation: Flomax Relief MR containing 0.4mg of tamsulosin hydrochloride in a modified release capsule. Indication: Treatment of functional symptoms of benign prostatic hyperplasia (BPH). Dosage: For men aged 45-75 years. For oral use. One capsule daily. Contraindications: Hypersensitivity to any ingredients of the product; a history of orthostatic hypotension; severe hepatic insufficiency. Warnings and Precautions: Men taking an antihypertensive alpha1-adrenoceptor blocker should consult a doctor before taking Flomax Relief. In individual cases a fall in blood pressure can occur. Do not give to a man who experiences postural hypotension. Consult a doctor before taking Flomax Relief if a man has heart, renal, or liver disease, uncontrolled diabetes, urinary incontinence, or has had prostate surgery. Do not supply Flomax Relief to a man whose symptoms are of less than 3 months’ duration. Do not supply to a man who reports dysuria, haematuria, or cloudy urine, in the previous 3 months, or who has a fever that might be related to urinary tract infection. Do not initiate treatment in a man planning cataract surgery, or who has recently experienced blurred or cloudy vision not examined by a doctor or optician. If urinary symptoms have not improved within 14 days of starting treatment the patient should be referred to a doctor. Medical review is required for diagnosis of BPH: Patients must see their doctor within 6 weeks of starting treatment for assessment of their symptoms and confirmation to continue taking Flomax Relief long-term from their pharmacist. Every 12 months, patients should be advised to consult a doctor. Adverse Effects: Common: dizziness. Uncommon: headache, palpitations, postural hypotension, rhinitis, constipation, diarrhoea, nausea, vomiting, rash, pruritus, urticaria, abnormal ejaculation, asthenia. Rare: syncope, angioedema. Very rare: priapism. Drowsiness, blurred vision, dry mouth or oedema can occur. IFIS has occurred in some patients during cataract surgery. RRP (ex VAT): 14 capsules £7.65, 28 capsules £14.46 Legal Category: P Product Licence Number: PL 00015/0280. Date of revision: December 2009. Further information available from: Boehringer Ingelheim Limited, Consumer Healthcare, Ellesfield Avenue, Bracknell, Berkshire RG12 8YS.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Boehringer Ingelheim Drug Safety on 0800 328 1627 (freephone).

Documents

Pharmacy Support Staff Training Guide - myilearn.co.uk · Symptoms-check Questionnaire P24 Patient information leaflet P25 Registration card P26 References Back cover. P3. Pharmacy