1. A device that changed my practice…………. (Applications for Handheld computers in clinical practice) Scott Pegler Pharmacy Department Morriston Hospital, Swansea peglerscott@hotmail.com

2. 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

3. 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)

4. 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

5. 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……...

6. 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

7. ePocrates Rx display

8. 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

9. 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 Pharmkinetics/Dynamics Pharmacological Class Pregnancy Risk Factor Reference Level Special Geriatric Considerations Stability Test Interactions Unlabeled Use Usual Dosage Warnings/Precautions

11. 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

13. 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

14. King Guide display

15. 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

17. 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

18. 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

20. Whats 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)

21. 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

22. 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 GPs (especially on house visits) community pharmacists

23. 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

24. 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………..!