Transcript A device that changed my practice………….

A device that changed my
practice………….
(Applications for Handheld
computers in clinical practice)
Scott Pegler
Pharmacy Department
Morriston Hospital, Swansea
[email protected]
Scope & aim of presentation:• Hopefully, just to make you think……..?!
– highlight some situations in which clinical
information on Handhelds may be useful in
your own clinical practice?
– which Handheld? (cost, memory, system?)
– briefly discuss some of the clinical information
& databases available for Handhelds
– given from the perspective of a “user”
Features of Handhelds which
make them attractive
• Robust
– long battery life (~ 2 months or rechargeable
lithium battery)
– durable
– not prone to crashes
• highly programmable
– custom developed packages of information
– own data
• relatively inexpensive
– £100 - £200 (8MB memory)
Which Handheld (PDA)?
• Palm Operating System (Palm OS) or
Pocket PC
– not Psions (use EPOC)
• Minimum memory = 8MB
• Best known:
– Palm Vx, Handspring Visor, Palm m500/505
– HP Jordana, Compaq iPaq
What clinical information is
available for Handhelds?
• Widely available (free & commercial)
– www.handheldmed.com, www.memoware.com
• Drug information databases
– both general & specialist:- iv compatibility,
paediatrics, antibiotics guide, herbal etc.
• Medical reference material
– 5 Minute Clinical Consult, Clinical Evidence,
Merck Manual, MedCalc, heart failure
guidelines, cancer staging etc etc etc……...
ePocrates Rx
(www.epocrates.com)
• >1500 drug monographs (1.7MB) (free)
• Fields include
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adult dose
paeds dose
contraindications/cautions
drug interactions
adverse reactions
“multicheck” feature for checking multiple
drug interactions
ePocrates Rx display
Lexi-Drugs Platinum
(www.lexi.com)
• >1600 drug monographs ($75-00/year)
• choice of “essential” or “comprehensive”
installations (2MB - 4MB)
• updated on a daily basis
• additional “specialist” fields optional
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cardiology
mental health
oncology
advanced practice nursing
Lexi-Drugs Platinum
• Administration
• Adverse Reactions
• Patient Information
• Breast Feeding
Implications
• Pharm’kinetics/Dynamics
• Contraindications
• Pregnancy Risk Factor
• Dietary Considerations
• Reference Level
• Drug Interactions
• Special Geriatric
Considerations
• Ethanol/Nutrition/Herb
Interactions
• Pharmacological Class
• Stability
• Lactation
• Test Interactions
• Mechanism of Action
• Unlabeled Use
• Monitoring Parameters
• Usual Dosage
Lexi-Interact
• >850 monographs (2.5 MB) ($40-00/year)*
– summary:- indication of severity with ranking
(A,B,C,D,X) & time to onset
– patient management:- action to be taken
– interacting members:- both proven (refs),
extrapolated, and exceptions
– discussion:- including suggested mgt. strategies
– references
• “Analyse” function
– allows full prescription review
King Guide to Parenteral
Admixtures
• Lists compatibility of >350 injectable drugs
in over 10,000 combinations (1.09MB)
($85-00/year)
• intended as a quick reference, where an
immediate “yes/no” answer is required
• intended as a companion product to full text
reference
– book, CD-ROM or Internet formats
King Guide display
Lexi-Natural Products
• Monographs on 175 herbs etc. (228K)*
• Fields include:• Reported Uses
• Summary
• Pharmacology
• Toxicities, Warnings and Interactions
• Theoretical Cautions and Contraindications
• General Warnings
• Reported Interactions
• Theoretical Interactions
• References
Antibiotics Guide (www.hopkinsabxguide.org)
• Subset of the database which is viewable in
its entirety on the web (free)
• aims to provide “concise, clinically useful
and up-to-date information……..consisting
of digested & layered information, which
quickly assists clinicians in making pointof-care decisions”
• adult dosing information only
Others
• Clinical Evidence (www.avantgo.com)
– 850K (free)
– reviews the evidence about “common &
important clinical questions”
• MedCalc (www.medscape.com)
– 205K (free)
– >50 formulas (BMI, Creatinine Clearance, etc)
– formulas sorted by category
What’s on my Palm Vx?
• Clinical information databases:
– Lexi-Drugs Platinum (Comp. 3.4MB)
– Lexi-Interact (2.1MB)
– Lexi-Natural Products (228K)
– King Guide to IV Admixtures (1.09MB)
Cont…...
• Memo pad allows Word documents to be
HotSynced to Handheld
– policies & guidelines
• Digibind, Dantrium, obtaining leeches…….!
– ward stock lists
– emergency drug cupboard contents
– emergency contact numbers
• BOC, Unichem/Vestric, transport etc etc ……….
• “Find” facility allows free text searching
Who might find a use for them?
• Clinical pharmacists
– medical admissions, ITU, Committee meetings
(D &T, LREC, Directorate etc)
• pharmacists running clinics
– e.g. pre-admission clinics
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pharmacists in GP surgeries
on-call pharmacists
GP’s (especially on house visits)
community pharmacists
The future……….?
• Government preparing to introduce
electronic patient records in all short stay
hospitals by 2005
– Handhelds will be a reality sooner than we
think!
• Handhelds could be used for maintaining
patients notes & clerking
• Handhelds could be used to “beam” patient
information & tasks at handover using the
in-built infrared ports
Conclusions
• Handhelds have the potential to
revolutionise the professional lives of
Healthcare workers
• this is not “technology for the sake of
technology!”
• Pharmacists will have to explore the
potential for Handheld Computers within
their own practice
• I predict that a Handhelds will be “a device
that changes your life………..!”
Three Cliffs Bay, Gower