A device that changed my practice…………. (Applications for Handheld computers in clinical...
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Transcript of A device that changed my practice…………. (Applications for Handheld computers in clinical...
A device that changed my practice………….
(Applications for Handheld computers in clinical practice)
Scott Pegler
Pharmacy Department
Morriston Hospital, Swansea
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