Transcript The pitfalls of pragmatic research: Pharm

The pitfalls of
pragmatic research:
Pharm-assist: Using
PDAs to assist in
Pharmacy decisions
Pip Divall
Clinical Librarian
University Hospitals of Leicester NHS Trust
PDAs in Leicester
• Previously run trials with
Foundation Year doctors
• Knowledge in the Palm of Your
Hand
• Personal Digital Assistants for
Foundation doctors: Handheld
knowledge in the clinical setting.
(Article in preparation)
Pharm-ASSIST
• Does using a PDA loaded with
drug information increase the
number of interventions made
by a Pharmacist on the medical
wards?
Primary Outcome
• To assess how often a Pharmacist on the
medical wards uses a PDA resources to
check, alter, or amend drug charts for
patients and for what reasons:
– Checking doses / frequency or duration and
safety.
– Checking guidelines
– Checking appropriateness of treatment for
patients
– Checking details of unfamiliar diagnoses
– Researching evidence for treatment
Design
• An evaluative before and after audit to
assess a PDA reference tool – Doctors
Companion. There will be a 28 day period
of data collection without the use of the
PDAs, followed by a 14 day lead-in period
to become used to the functionality of the
resources, and a further 28 day period in
which the resources will be evaluated in
the Pharmacy department at University
Hospitals of Leicester NHS Trust.
Pitfall #1
• Design of data collection tool –
we worked with Pharmacy team
to find out what we needed them
to record to measure our
primary outcome
• Issues of whether to record time
taken, which items most
important
Pitfall #2
• Having the resource ready to
use at the end of the 28 day
data collection period
• BNF 53 publication threw
schedules
Pitfall #3
• Working with an area the library
does not usually interact with
• Have Assistant Chief Pharmacist on
board, Head of Medicines
Information – very busy people!
• Difficult to get in touch with
Pharmacists, but much easier than
doctors!
Study materials
• Already have a stock of PDAs
used in previous trials
• Many staff now have PDAs of
their own
Pitfall #4
• Some of the existing PDAs are
old – run the software slowly.
• This may interfere with data
collection – add another barrier
to use of software
• Benefit: the new SD cards are
multiplatform, so not limited by
hardware
Additional
considerations
• Response rate – we have a
discrete group who are easy to
track, yet some baseline data
still missing
• All data collection tools should
be tested & ready to go!
Pitfall #5: Too many
cooks
• Design by committee can lead
to holes in methodology
• “Someone else was supposed
to be doing that”
• Clear roles
• Delegation
Audit or research?
• What’s the difference?
• Is ethical approval necessary?
• “Audit and research cannot be
distinguished in a reliable or
valid way.”
• Wade, DT, Ethics, audit, and research: all shades of
grey. BMJ 2005;330:468-471
The Outcome
• Watch this space!!