A device that changed my practice………….

(Applications for Handheld computers in clinical practice)

Scott Pegler

Pharmacy Department

Morriston Hospital, Swansea

peglerscott@hotmail.com

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

– 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– cardiology– mental health– oncology– advanced practice nursing

Lexi-Drugs Platinum• Administration

• Adverse Reactions

• Breast Feeding Implications

• Contraindications

• Dietary Considerations

• Drug Interactions

• Ethanol/Nutrition/Herb Interactions

• Lactation

• Mechanism of Action

• Monitoring Parameters

• Patient Information

• Pharm’kinetics/Dynamics

• Pharmacological Class

• Pregnancy Risk Factor

• Reference Level

• Special Geriatric Considerations

• Stability

• Test Interactions

• Unlabeled Use

• Usual Dosage

• Warnings/Precautions

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.hopkins-abxguide.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 point-of-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

• 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