drug information (DI)

how does DI fit into our careers?

• assist individual patients

• develop guidelines, policies, projects

• create education

• promote medication safety

what are the DI roles/responsibilities?

• analyze and apply literature and other information resources to answer patient care/drug-related questions
• provide evidence-based therapeutic recommendations to healthcare providers/public
• clinical decision-making, treatment planning, and MTM strategy development for patients
• use of technology and automation to optimize medication safety and efficiency
• clinical decision support (CDS): includes clinical monitoring tools within the EHR to prioritize and determine interventions needed; may include AI and machine learning tools
• clinical pharmacists document their medication-related assessments; accepted standards must be adhered to for the use of health information technology
  • clinical pharmacists maintain competence in clinical problem-solving, medical information evaluation, and management

what are problem-solving skills?

• triage and assessment
• systemic approach
• evaluation/critique of information
• organization and synthesis of responses
• communication (written, verbal)
• anticipation of follow-up

what is the evolving role of drug info services and AI?

• AI has the potential to enhance the ability to flag DDIs, recommend pt-specific dose adjustments, and identify pts at high risk for ADEs
• pharmacovigilance → "algorithmovigilance"
• moving toward future, including use of AI in our duties
• ultimately, you are responsible for patient care, not an AI program

what is the systemic approach to DI questions?

1. identify requester

• assess their knowledge base/previous approach

1. define true question and need

• ask for clarification
• may misunderstand, question, or miss follow-up if not explored

1. obtain background info

• research to better understand condition/med before approaching systematic response
• information on context of question from requestor

1. categorize question
2. perform search

• drug datasbses (e.g. Lexidrug, Micromedex) for administration instructions)
• "do not cruish" references like through ISMP
• specialty textbooks (e.g. Handbook of Drug Admin. via enteral feeding tubes)

1. analyze information

• review ≳2 resources to find consistent answer
• consider the validity/credibility of the resources
• understand why the recommendation exists

1. create a response
2. document
3. follow-up (as needed)

what is evidence-based practice (EBP)?

• evidence by itself doesn't make the decision, it helps support the decision-making process
• clinical expertise, best research evidence, patient values and preferences

what are primary resources?

• original research: clinical trials, case reports, abstracts, meta-analyses
• located in published journals

what are secondary resources?

• databases: indexing/abstracting services, a search engine for primary literature, points towards primary literature
• e.g. OvidSP, PubMed, Google/Yahoo/bing, IPA

what is the PICOS approach?

• systematic way of identifying searchable elements of a clinical/research questions
• Patient, population, problem
• Intervention, interest
• Comparator, control
• Outcomes
• Setting, study type

what are tertiary resources?

• summary and interpretation of primary literature
• first-line resource when answering a drug information question
• textbooks, review articles, internet websites, medication databases

what are the categories of tertiary resources?

• general product information
• pharmacology
• pharmacotherapy
• pharmacokinetics
• special populations
• adverse effects
• dosage form availability
• drug interactions
• foreign drugs
• drug identification
• compounding
• stability/compatibility
• OTCs/herbals/dietary supplements
• toxicology
• disease states

what are the advantages of tertiary resources?

• convenient
• easily accessible (electronic/mobile)
• most clinicians are familiar with them
• concise and usually complete
• often subject-specific

what are the disadvantages of tertiary resources?

• lag time (updates, publication delays)
• incomplete information
• subject to interpretation
• author expertise/bias
• may not be appropriately referenced

what are the best practices when finding resources?

answer questions using at least 2 (or more) resources that are:

• evidence-based and credible
• current and up-to-date
• appropriate to audience's health literacy

what is the structure and content of a DI response?

greeting:

• restatement of question
• pertinent background info on drug/disease
  body (main response):
• upfront recommendation
• summary of supporting evidence
• anticipation of follow-up questions or alternative answers
  closing:
• thank them for their question
• offer availability to answer follow-up questions