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 yourown 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. Administration Adverse Reactions Breast Feeding Implications Contraindications Dietary Considerations Drug Interactions Ethanol/Nutrition/Herb Interactions Lactation Mechanism of Action Monitoring Parameters Patient Information Pharm’kinetics/Dynamics Pharmacological Class Pregnancy Risk Factor Reference Level Special Geriatric Considerations Stability Test Interactions Unlabeled Use Usual Dosage Warnings/Precautions Lexi-Drugs Platinum

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. What’s 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 • GP’s (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………..!”