Use of Personal Digital Assistants to Assess Potential Drug Interactions in the Emergency

DepartmentRachel Dern

Department of Biological Sciences, York College of Pennsylvania

Introduction:•Approximately 40,000 deaths occur annually as a result of medical errors according to the Institute of Medicine

•Nearly impossible for physicians to keep up-to-date on new medications due to the exponential growth of the pharmaceutical industry

•Previous studies have:

•Used computer-based programs to obtain information on potential drug interactions (PDIs) (Abarca et al. 2004, Gaddis et al. 2002)

•Evaluated the effectiveness of handheld drug interaction programs in identifying PDIs (Rothschild et al. 2002)

Objectives:•To assess usefulness of Personal Digital Assistants (PDAs) for identification of PDIs as a possible cause of morbidity and mortality

•To survey the use of PDA-based drug interaction (DI) programs by ED staff

Inclusion Criteria:•Patients age ≥ 60 years old taking three or more medications•Patients any age taking five or more medications

Exclusions Criteria:•Incomplete/illegible medication list•Patients age ≥ 60 years old taking less than three medications•Patients age ≤ 60 years taking four or fewer medications•Patients unable to relate a medication list

Program Total DIs ED-related DIs

ePocrates 2,349 1,022

iFacts 1,010 378

Potential Drug Interactions

Severity* Total DIs ED-related DIs

1 10.1% 5.8%

2 32.0% 33.3%

3 10.3% 8.5%

4 21.5% 15.6%

5 26.1% 36.8%

TOTALS 1,010 378

Potential DI Severity UsingiFacts

Category Percent

CNS depression/impairment 19.5%

Alteration in drug level/effect

18.1%

Alteration in glucose level 13.9%

Alteration in potassium level

9.7%

Hypotension 8.3%

Frequency of Drug Interaction Using ePocrates

Results:

Provider Use:•41 ED providers surveyed•16 never used PDA to check for DIs•23 used PDA-based DI programs “some” of the time•2 used PDA-based DI programs “most” of the time

Methods:

•IRB-approved retrospective review of 400 patient charts from April of 2004

•Two random letters of the alphabet were selected as starting points and 200 charts were pulled consecutively from each letter that met the inclusion criteria

Conclusions:

•ePocrates was reliable in finding a large quantity of PDIs while iFacts identified fewer PDIs and categorized them by severity

•PDA programs identified many potential DIs in ED patients

•ED providers do not make adequate use of PDA drug interaction programs

•We recommend liberal use of PDA-based DI programs for patients taking and/or prescribed multiple medications

*1 being the most serious

Literature Cited:

Abarca, J et al. 2004. Concordance ofSeverity Ratings Provided in Four Drug Interaction Compendia. J AM Pharm Assoc. [Serial online] 44:136-141. Available from: PubMed.

Gaddis, G et al. 2002. Drug Interactions in At-risk Emergency Department Patients. Acad Emerg Med.[Serial online] 9(11): 1162-7. Available from: PubMed.

Rothschild, JM et al. 2002. Clinician Use of a Palmtop Drug Reference Guide. J Am Med Inform Assoc. [Serial online] 9(3): 223-9. Available from: PubMed.

Acknowledgements:Ronald Benenson, M.D. Emergency Department, York Hospital, York, PA

Patient Medications:AspirinAmbien

Patient admittedto ED

ED Prescribed Medications:

MorphineSkelaxin

PDA used to check for Potential DIs

ePocrates:Ambien & Skelaxin(CNS Depression)(Hypotension)

Ambien & Morphine(CNS Depression)

iFacts:Ambien & Skelaxin (4)

Ambien & Morphine(5)

Analysis:

•ePocrates•PDA program•Used to identify potential drug interactions•Evaluates current patient medications and ED

prescribed medications

•iFacts•PDA program•Used to identify potential severity of drug

interactions•Evaluates current patient medications and ED

prescribed medications

Hypothetical Example: