teaser
Kristine E Keplar
PharmD
Clinical Pharmacist
St Anthony’s Memorial Hospital
Effingham, IL
Adjunct Associate Professor of Pharmacy Practice
Butler University College of Pharmacy and Health Sciences
Indianapolis, IN
USA
E:[email protected]
Personal digital assistants (PDAs) or handheld computers are now becoming very popular with healthcare providers. It is estimated that approximately 45–85% of healthcare professionals use PDAs.(1) PDAs can be key in obtaining quick, accurate drug information. PDAs are generally small enough to fit in a pocket, so they are ideal for the pharmacist who works in a fast-paced hospital or community pharmacy and/or where computer terminals are in high demand. The PDA provides an address book, date book, memo pad, calculator and internet access. In addition, huge arrays of drug information references are available for the PDA.(2,3) Unfortunately, the cost and memory requirements of these programs limit the number one can utilise. Consequently, there are important factors to consider when evaluating applications to purchase.
Evaluating medication references
Many PDA applications offer a free trial version. A trial version aids in determining whether a program is user-friendly, assessing how long it takes to retrieve the desired information, such as drug interactions or monitoring information, examining the types of information provided and the layout, such as drop-down menus, tables/graphs, icons and cross-referencing, and determining whether information is current, complete and accurate.(4) Some applications omit off-label indications, pharmacokinetic/pharmacodynamic, compatibility, administration and monitoring information. This is a buyer-beware market, so determine what references/authors are involved. Updates may be weekly, quarterly, annually or nonexistent. Updates occur by simply starting the PDA’s “Hot Sync” button or can be complicated processes.
Recommendations
Pharmacists usually benefit from having two general drug information programs. For new PDA users, the ePocrates program would be an excellent start because it is free, easy to download from the website and is easy to use.(5) It is not a comprehensive program but it is a quick reference to use to obtain a drug name, dose, adverse effect, drug interaction or cost. Therefore, it is beneficial to both new and experienced users.
It would be wise to possess a comprehensive drug information program in order to address more detailed questions such as renal/hepatic dosing, pharmaco‑kinetics, compatibility, monitoring issues and incidence rates of adverse effects. There are many to choose from that are PDA versions of reputable drug information sources such as Lexi Comp, Facts & Comparisons, Micromedex and Mosby Drug Consult.(5–7) A comprehensive program involves yearly fees, which are often comparable to the cost of the corresponding hardbound book. Table 1(5–11) lists some general drug information applications.(7)
[[HPE29_table1_23]]
Additionally, a few specialised drug information programs are recommended for the pharmacist. The pharmacist may choose programs that match the specialty that corresponds most to his/her work environment and/or programs that the pharmacist rarely deals with. Websites such as handheldmed.com, handango.com, lexi.com, palmgear.com, skyscape.com and tucows.com provide a large array of specialised drug information PDA applications. Types of specialised programs include: cardiology, dermatology, geriatrics, infectious disease/HIV, obstetrics/gynaecology, ophthalmology, psychiatry, toxicology, as well as others.
PDA programs for patient management
The PDA can be more than a drug information resource. PDAs offer patient management or patient tracking programs. These are programs that allow for the organisation of patient data such as medications, laboratory values, microbiology reports, vitals and disease states. They allow for the transfer of information from pharmacist to pharmacist, which facilitates easy cross-coverage of patients. These programs are excellent tools for the pharmacist involved in tracking patients for patient rounds, aminoglycoside/vancomycin pharmacokinetics, narrow therapeutic agents, anticoagulation, cardiology, diabetes, pulmonary and nutrition management. They do require some manual labour in inputting the data unless there is the ability to have data downloaded from computer systems.
Many patient management programs are available. Some are universal tracking programs (Patient Tracker, Patient Keeper), whereas other programs are available for disease- or discipline-specific programs such as anticoagulation, general cardiology, blood pressure and diabetic patient management. These programs vary significantly in what they offer as far as what data is managed, and the cost differences range from just a few dollars to hundreds of dollars. Table 2(10,12–15) lists several patient management applications.
[[HPE29_table2_25]]
The risk of patient data becoming vulnerable is a major concern. There is a security function on PDAs (located under “Prefs” in Palm PDAs and under “Settings” in Pocket PC PDAs), and additional security programs can be purchased; however, it falls upon the user to employ these safety features.(16)
Medical calculators
Medical calculators are a must for pharmacists, as they make complex calculations a breeze. Three excellent (free) medical calculators are Archimedes, MedCalc and MedMath. They are all recommended.(7,11,17,18) Some examples of medical calculations often provided include: body surface area (BSA), creatinine clearance, corrected calcium, sodium, glucose and phenytoin levels, drip rates and osmolality, among others. Other calculators are specialised for a particular area such as pregnancy, anticoagulation and emergency codes. Some drug information programs now include a medical calculator. Tables 3 and 4 list some medical calculators (7,10,11,18,19)
[[HPE29_table3_26]]
[[HPE29_table4_27]]
Evidence-based programs
Other resources include evidence-based medicine applications that provide the best evidence from clinical trials, studies and other types of resources, which facilitates enhanced pharmaceutical care of patients. Example of programs are: Clinical Evidence, FIRSTConsult, InfoRetriever and UpToDate.(20,21) One specifically for medications is AHFS Essentials.(8)
Summary
PDA resources are excellent, up-to-date tools for pharmacists. They provide fast, accurate drug information tools. They also aid the pharmacist by addressing decisions regarding the proper dosing/handling of medications, medication monitoring and patient education. Furthermore, the PDA is a complex device that can manage patients and allow transferring of data between healthcare providers.
References
- Garritty C, Emam KE.J Med Internet Res 2006;8:e7.
- Lapinsky SE, et al.Critical Care 2001;5:227-31.
- Keplar KE, Urbanski CJ.Ann Pharmacother 2003;37:287-91.
- Adatia F, Bedard PL. CMAJ 2003;168:727-34.
- ePocrates, Inc. Available at: http://www.ePocrates.com
- Micromedex. Available at: http://www.micromedex.com/products
- Keplar KE, et al.Ann Pharmacother 2005;39:892-907.
- American Society of Health-System Pharmacists. Available at: www.ashp.org
- Lexi-Comp Inc. Available at:www.lexi.com
- Handango Inc. Available at:www.handango.com
- Skyscape.com Inc. Available at: www.skyscape.com
- Spikol L. Take your personal digital assistant to the next level. Fam Pract Manag 2005;12:39-41.
- Softmed32. Available at: http://www.softmed32.com
- PDA Center. CollectiveMed. Available at: http://www.collectivemed.com
- Biomedical Informatics Resources. Biohealthmatics. Available from:http://news.biohealthmatics.com
- Thompson BW. HIPPAA guidelines for using PDAs. Nursing 2005;35:24-5.
- Lin AB. The top PDA resources for family physicians. Fam Pract Manag 2006;13:44-6.
- PDA Cortex. Available at: http://www.PDACortex.com
- Rick Tharp. Available at: http://www.rxkinetics.com
- Burkiewicz JS, Vesta KS, Hume AL. Update in handheld electronic resources for evidence-based practice in the community setting. Ann Pharmacother 2005;39:2100-4.
- Honeybourne C, Sutton S, Ward L. Knowledge in the palm of your hands: PDAs in the clinical setting. Health Info Libr J 2006;23:51-9.
