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Transforming Clinical Practice with Handheld Devices: Insights and Applications

This presentation aims to encourage healthcare professionals to consider innovative applications of handheld devices in clinical practice. It highlights practical scenarios where clinical information accessed via handheld computers can enhance patient care. Discussion points include selecting suitable devices, exploring available clinical databases, and reviewing features that make these gadgets appealing, such as durability, long battery life, and programmability. It provides insights into popular handheld models and valuable clinical information resources available for them, empowering professionals to make informed decisions.

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Transforming Clinical Practice with Handheld Devices: Insights and Applications

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  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

  10. 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

  11. 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

  12. King Guide display

  13. 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

  14. 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

  15. 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

  16. 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)

  17. 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

  18. 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

  19. 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

  20. 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………..!”

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