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The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions

The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions. Pip Divall Clinical Librarian University Hospitals of Leicester NHS Trust. PDAs in Leicester. Previously run trials with Foundation Year doctors Knowledge in the Palm of Your Hand

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The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions

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  1. The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions Pip Divall Clinical Librarian University Hospitals of Leicester NHS Trust

  2. PDAs in Leicester • Previously run trials with Foundation Year doctors • Knowledge in the Palm of Your Hand • Personal Digital Assistants for Foundation doctors: Handheld knowledge in the clinical setting. (Article in preparation)

  3. Pharm-ASSIST • Does using a PDA loaded with drug information increase the number of interventions made by a Pharmacist on the medical wards?

  4. Primary Outcome • To assess how often a Pharmacist on the medical wards uses a PDA resources to check, alter, or amend drug charts for patients and for what reasons: • Checking doses / frequency or duration and safety. • Checking guidelines • Checking appropriateness of treatment for patients • Checking details of unfamiliar diagnoses • Researching evidence for treatment

  5. Design • An evaluative before and after audit to assess a PDA reference tool – Doctors Companion. There will be a 28 day period of data collection without the use of the PDAs, followed by a 14 day lead-in period to become used to the functionality of the resources, and a further 28 day period in which the resources will be evaluated in the Pharmacy department at University Hospitals of Leicester NHS Trust.

  6. Pitfall #1 • Design of data collection tool – we worked with Pharmacy team to find out what we needed them to record to measure our primary outcome • Issues of whether to record time taken, which items most important

  7. Pitfall #2 • Having the resource ready to use at the end of the 28 day data collection period • BNF 53 publication threw schedules

  8. Pitfall #3 • Working with an area the library does not usually interact with • Have Assistant Chief Pharmacist on board, Head of Medicines Information – very busy people! • Difficult to get in touch with Pharmacists, but much easier than doctors!

  9. Study materials • Already have a stock of PDAs used in previous trials • Many staff now have PDAs of their own

  10. Pitfall #4 • Some of the existing PDAs are old – run the software slowly. • This may interfere with data collection – add another barrier to use of software • Benefit: the new SD cards are multiplatform, so not limited by hardware

  11. Additional considerations • Response rate – we have a discrete group who are easy to track, yet some baseline data still missing • All data collection tools should be tested & ready to go!

  12. Pitfall #5: Too many cooks • Design by committee can lead to holes in methodology • “Someone else was supposed to be doing that” • Clear roles • Delegation

  13. Audit or research? • What’s the difference? • Is ethical approval necessary? • “Audit and research cannot be distinguished in a reliable or valid way.” • Wade, DT, Ethics, audit, and research: all shades of grey.BMJ  2005;330:468-471

  14. The Outcome • Watch this space!!

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