Professional Documents
Culture Documents
http://www.good4utah.com/news/local-news/flu-test-without-a-doctor
PHYSICAL ASSESSMENT
All tests performed should be interpreted in context with the patient’s clinical
presentation
Protocols often require physical assessment
Evidence of instability triggers a referral for more advanced care
May Include:
Visual assessment of patient (how does the patient look?)
Vital signs
Weight
Oxygen saturation
Lymph node evaluation
Currents in Pharmacy Teaching and Learning. 7 (2015) 131–136. Available at: https://ac.els-cdn.com/S1877129714001282/1-s2.0-
S1877129714001282-main.pdf?_tid=58958cc4-2da3-4643-8f49-559e35c6fb49&acdnat=1539029597_9db62638b0c27b663ca21fb1e44fc04a
VITALS
Vital Sign Normal Readings Abnormal Readings
Pulse 60-100 bpm Tachycardia >100 bpm
Regular rhythm Bradycardia < 60 bpm
Irregular rhythm
https://www.heart.org/-/media/data-import/downloadables/hypertension-guideline-highlights-flyer-ucm_497841.pdf
BODY TEMPERATURE RANGE BASED ON SITE OF MEASUREMENT
Referral Warranted > 104 °F
https://www.youtube.com/watch?v=tHiqdCKI00Q&feature=youtu.be
OXYGEN SATURATION (O2)
https://www.thoracic.org/patients/patient-resources/resources/pulse-oximetry.pdf
PULSE OXIMETER
Venous pulsations
Placement of a sensor on an extremity with blood pressure cuff, arterial catheter, or
intravascular line
The patient has hypotension, severe vasoconstriction, severe anemia, or hypothermia
The patient is in cardiac arrest or is in shock
Fingernail polish or fake fingernails
Weak pulse quality (low perfusion)
Low hemoglobin
• Pulse bar graph displays corresponds with the patient’s pulse beat, the height of
the bar graph shows the patient’s pulse strength
Cleaning
Use medical alcohol to clean silicon touching the finger inside the oximeter with a soft
cloth dampened with 70% isopropyl alcohol
Clean the test finger using alcohol before and after each test
Allow to dry before reuse
Replace the batteries in a timely manner when low voltage lamp is lighted
Clean surface of the fingertip oximeter before it is used in diagnosis for patients
Remove batteries inside the battery cassette if the oximeter is not operated for a long time
It is best to store product in -4F to 131F and ≤93% humidity
Keep in a dry place. Extreme moisture may affect oximeter lifetime and may cause damage
http://lafayettedentistchauvin.com/anatomy-mouth-dental-structure/
THROAT SWAB
1. Greet patient, introduce yourself, state title and ask
permission
2. Tell patient what you are doing and what to expect
(may cause coughing or gagging)
3. Sanitize hands and put on gloves
4. Ask patient to tilt head back and stick tongue out
5. Hold tongue depressor in non-dominant hand and swab
in dominant hand
6. Collect specimen by passing the swab along the Uvula
tonsillar arches, striking the Uvula. Then swab the
reverse direction. Try not to touch the sides of the
mouth.
7. Appropriately process specimen and dispose of
materials
8. Sanitize hands
http://eclinicalworks.adam.com/content.aspx?productId=39&pid=1&gid=003746
THROAT SWAB – SOME ADDITIONAL TIPS
Throat Swab Video:
https://www.youtube.com/watch?v=b
edJdXAK6F4
Be careful not to touch the tongue
or lips due to possible contamination
Tell patients to resist gagging and
closing their mouth when doing test.
Tell patients to close eyes as they are
less likely to be anxious.
Test should not be a painful. Your
patient may gag or cough but the
tests only takes a few seconds.
Drink of water afterwards may help.
https://www.graceer.com/what-is-strep-throat/strep-throat/
SAY “AHHH”
• “Ahh” Video:
https://www.youtube.co
m/watch?v=pvoZ04YIJzU
• Have the patient say
“ahh” to raise the uvula
and visualize the throat
better
• A short ah, ah, ah, ah is
more effective than a
long “ahhhhhh”
THROAT SWAB – SOME ADDITIONAL TIPS
Easiest if the patient is sitting and you are standing
Make sure you are using the recommended type of swab
for the specific test
Tongue depressors help if not able to see throat well
Hold swab like a pencil
Collect specimen by starting at the base of the arch (at
level of tonsils), then swab along the tonsillar arch,
striking the Uvula, continuing along the arch and ending
at the opposite tonsil. Immediately swab in the reverse
direction.
While it is optimal to swab in reverse direction, at least
get a solid swipe of the arch in one direction.
Try not to touch the sides of the mouth.
Don't need to get puss on swab from tonsil.
https://jcm.asm.org/content/53/2/573
NASAL SWAB
1. Greet patient, introduce yourself, state title and ask permission
2. Tell patient what you are going to do and what to expect (may be mildly uncomfortable, but should
not be painful)
3. Ensure patient has not blown their nose prior to the procedure
4. Ask patient if they have a preferred nostril
5. Sanitize hands and put on gloves
6. Have the patient tilt their head back and use your non-dominant hand to steady the head
7. Hold the swab in the dominant hand
8. Insert the cotton end of the swab straight into the nasal cavity until reaching the turbinates (roughly
one inch). Go up at 45 degree angle, then go straight in for one inch (will be 2 inches in from the tip
of the nose), then rotate swab quick half turn (to ensure the swab collects cells as well as mucous)
and back out
9. Process sample appropriately, then dispose of materials
10. Sanitize hands
NASAL SWAB
Nasal Swab Video: https://www.youtube.com/watch?v=ZK4xCbL0HWw
NASAL SWAB – SOME ADDITIONAL TIPS
Easiest if you are both sitting or standing. Helps to be at same level as patient.
Ask patient if they have a preferred nostril. Do you have anything that changes the
anatomy of the nose (for example, surgery on one side).
Hold in dominant hand like throwing a dart. May use non-dominant hand to steady
chin so patient does not pull back from you
You will feel a point of resistance, where hit the turbinates.
Note, this is a nasal swab NOT a nasal pharyngeal.
Should be mildly uncomfortable but not painful. Common to see patients wince or
eyes water.
Never had any nose bleeds with this. May give patient a Kleenex just in case.
PUTTING IT ALL TOGETHER
1. Collect: Patient interview to collect information regarding illness
2. Assess: Determine if they are a candidate for testing (do they meet
protocol criteria, are they likely to have the illness)
3. Collect: Perform appropriate physical assessment (vitals, pulse ox, lymph
node inspection)
4. Assess: Determine if candidate for testing (referral for critical
thresholds, etc)
5. Collect: specimen
6. Assess: Interpret results
7. Plan: Determine appropriate treatment
8. Implement: Prescribe medication based on protocol, recommends OTC
therapy for symptom management, administers vaccinations, and/or refer
patient to another health care provider, as appropriate
9. Implement: Document results and communicate as appropriate
10. Follow-up, Monitor and Evaluate: Follow-up with patient as
appropriate, for example call patient in 48 hours
PHAR 154 IPSA1:
PUBMED
PRIYA SHENOY, GRADUATE HEALTH PROFESSIONS LIBRARIAN
CLASS LEARNING OBJECTIVES
• Students will be able to differentiate between AND & OR. And they
will use both to find information in PubMed.
CLASS LEARNING OBJECTIVES
• Students will be able to list out and explain the PICO format for
creating a well built clinical question.
Books
• Drug Facts and Comparisons
• Trissel’s
• Briggs
• Sanford’s
• DI Handbook
• AHFS
RESOURCES COVERED
Electronic
• Micromedex
• Lexi Comp
• Access Pharmacy
• APhA Pharmacy Library
o Handbook of Non-Prescription Drugs
• Natural Medicines
• Dynamed
• Government websites
• Guidelines
WHY IS PUBMED IMPORTANT?
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000
326
• http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
LEVELS OF EVIDENCE
EBM PYRAMID
2
ANOTHER DESCRIPTION (EBM PYRAMID)
Look for Meta-Analysis and
Systematic Reviews first
http://guides.dml.georgetown.
edu/ebm/ebmclinicalquestion
s
3
SYSTEMATIC REVIEWS/META-ANALYSES
• http://guides.libraries.psu.edu/ld.php?content_id=36146097
• https://libguides.sjsu.edu/c.php?g=230370&p=1528399
SYSTEMATIC REVIEWS
• Meta-analyses
o Should be attached to a systematic review
LEVELS OF EVIDENCE
http://libgui
des.gwumc.
4
edu/ebm/pi
cot
THERAPY/INTERVENTION QUESTION
5
PUBMED CONTAINS :
6
Biomedical
publisher supplied
citations
MEDLINE
ePub ahead of
print
90% In process
citations
Other articles,
& NCBI/NLM
databases
PUBMED (MEDLINE)
• Database of abstracts
o Very limited full text
o Going through the Cowles Library websites increases what you have access to
“Check for Full Text @ Drake”
GET IT NOW VS. INTERLIBRARY LOAN
Get It Now
1. Articles only InterLibrary Loan
2. Articles = usually receive in 2-4 hours 1. Articles and books
2. Articles = usually receive in 2 days (up
to 5 days)
Books = usually receive in under 7 days
3. Sent to Drake email
3. Sent to ILL account
*If you can wait, choose ILL first
PUBMED
Foreground questions (patient specific question) are specific knowledge questions [PICO]
http://researchguides.uic.edu/c.php?g=252338&p=3954402 3
PICO (EVIDENCE BASED PRACTICE/MEDICINE)
• P = Patient/Population
• I = Intervention
• C = Comparison/Control
• O = Outcome
In _____________________ (P),
how does ______________ (I)
compared with _________ (C)
affect __________________ (O)?
PICO (EVIDENCE-BASED PRACTICE/MEDICINE)
• A 2-year old female with burns on 10% of her body is rushed into the
ER.You have recently read that honey has been used in such cases, but
the more common treatment is Silvadene dressing. Is there evidence
that supports the use of honey?
PICO SEARCH QUESTION
Filters
SEARCHING AS STRATEGIC
EXPLORATION
Initial Concepts
Broader Terms
Narrower Terms
Related Terms
MESH= MEDICAL SUBJECT
HEADINGS
• Controlled vocabulary or standard language used to describe
key concepts in MEDLINE
• Defines content within an article
• Easier to search medical literature
MESH MAIN BRANCES
• So that you will be more comfortable using it for APPE’s and beyond
o Use keywords over MeSH only:
Newer topics (No MeSH term yet)
LONG COMPLICATED SEARCHES IN
PRACTICE
• Can take time to become a good searcher
• Searches take time too
• Using Keywords and MeSH
• Keyword Searching = Synonyms are useful (Use OR to combine)
LONG COMPLICATED SEARCHES IN
PRACTICE
Similar Articles
LONG COMPLICATED SEARCHES IN
PRACTICE
What MeSH terms are applied to an article?
LONG COMPLICATED SEARCHES IN
PRACTICE
Understand what the database calls it
OTHER DATABASES TO SEARCH -
COCHRANE DATABASE OF SYSTEMATIC
REVIEWS
• Reliability?
• Quality?
• Peer Review?
• Finding Everything?
• Grey Literature
PubMed
THINGS TO REMEMBER WHEN SEARCHING PUBMED
• Make sure that the blue check mark shows. This means the “Filter” has been
applied to your search.
THINGS TO REMEMBER WHEN SEARCHING PUBMED
• You can see what MeSH Terms have been assigned to this article as well as article type.
THINGS TO REMEMBER WHEN SEARCHING PUBMED
AMA MANUAL OF STYLE
• Understanding the pieces of the different journal citations that you see
in PubMed will help you to be able to find and retrieve article content.
The PharmD curriculum supports the AMA citation style.
AMA MANUAL OF STYLE
100
Prevalence of Self-Reported Obesity Among U.S. Adults by State, 2017
101
https://www.cdc.gov/obesity/data/prevalence-maps.html
Lifestyle Changes to Prevent/Manage
Chronic Disease
102
Reflection Checkpoint
What are some reasons
patients don’t make lasting
healthy behavior change?
103
“We are generally better
persuaded by the reasons
we discover ourselves than
by those given to us by
others.”
104
Learning Objective #2:
105
Engaging Patients:
Changing the Focus of Patient Communication
Provider-Centered Patient-Centered
I am the expert I am your partner
You NEED to lose weight, stop What is the patient willing to do?
smoking, start taking all your meds What does the patient want and
on time, exercise… need?
106
It’s not about
what’s the matter with the patient
but what matters to the patient
Source: Patient-Centered Care: What It Means And How To Get There, avilaable at: http://healthaffairs.org/blog/2012/01/24/patient-centered-care-
what-it-means-and-how-to-get-there/. Accessed on August 20, 2017.
107
. 107
Learning Objective #1:
Define motivational interviewing and
describe how it can be used in
patient interactions.
108
Motivational
Interviewing
Follow Up:
Monitor &
Evaluate
Engaging
Patients in the
Pharmacist Implement
Patient Care
Process
11
110
0
Motivational interviewing
is a collaborative conversation style for
strengthening a person’s own motivation and
commitment to change.
Miller W. & Rollnick S. Motivational Interviewing: Helping People Change, 3rd Edition. New York, NY: Guilford Press; 2013.
111
111
Ambivalence and Resistance
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible Approach.
Washington, DC: American Pharmacists Association; 2013.
112
Resist the Righting Reflex
Miller W. & Rollnick S. Motivational Interviewing: Helping People Change, 3rd Edition. New York, NY: Guilford Press; 2013. . P. 36
11
113
3
Learning Objective #3:
Describe key motivational
interviewing skills needed to drive
engaging, patient-focused
conversations.
114
Effective communication
creates an
information exchange
vs. an
information dump
Motivational Interviewing Involves:
116
Reflective
Listening
Building Trust and Rapport
Through Reflective Listening
• Listening is an active process; hearing is a passive
process
• Each patient has unique concerns and beliefs
• Acknowledge what the patient tells you
• Treat the person, not the illness
• Avoid judging or evaluating the patient
Reflective
Listening
Process
Reflective
Listening
Process
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible Approach.
120 Washington, DC:
American Pharmacists Association; 2013.
Reflective Listening Opening Statements
It sounds like…”
“So, what I’m hearing you say is…”
“So, what I think you’re saying is…”
121
Reflective Listening Example
- Pt: The doctor just gave me a huge laundry list of things I
need to do NOW for this diabetes… take this medicine, quit
smoking, change my whole diet, and exercise every day!
How in the world am I going to do this?
122
Reflective Listening Example
123
Open-Ended
Questions
Open- vs. Closed-Ended Questions
OPEN CLOSED
What concerns to you have about Are you concerned about your
your medication? medication?
Tell me about how the past month Did you remember to take your
has gone with taking your medication the past month?
medication…
What may make it difficult for you to Are you good at remembering to take
remember to take your medications? your medications every day?
125
Asking Open-Ended Questions
- In the patient’s own words, how are they making sense of the illness?
What does it mean to them?
- What do they think of the treatment? Do they believe it will work? Do
they believe it is necessary?
- What is their understanding of what can happen if they don’t treat the
illness?
- If they are committed to treating the illness, especially a chronic
illness, what will keep them on track and what might get in the way
over the long term?
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible
126
Approach. Washington, DC: American Pharmacists Association; 2013.
Appreciative Inquiry:
Becoming mindful of
the questions we ask
AND
128
1
2
9
VS.
129
Changing the Way We Ask Questions
What has happened in the past? What successes have you had in the past
that you can leverage moving forward?
What do you want to avoid What would your future look like if you
replicating in the future? achieved your goals?
130
Learning Objective #4:
Apply motivational interviewing
skills to assist patients in
strengthening their own
motivation for change.
131
Steps in
Motivational
Interviewing
1
3
3
Steps in Motivational Interviewing
(Berger and Villaume 2013)
1. Develop rapport
- Create a trusting relationship
- Show the patient that you care about their well-being and respect them
- Assess motivation and confidence
- Ask about their questions and concerns
- Find the root of their ambivalence or resistance
2. Reflect back our understanding of the patient’s sense making and reframe the
issue
- Clarify the issue
- Shine a new light on the problem
- Say “You’re wondering….”
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible Approach.
Washington,133
DC: American Pharmacists Association; 2013.
Steps in Motivational Interviewing
1
3
4
(Berger and Villaume 2013)
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible Approach.
Washington, DC: American Pharmacists Association; 2013.
134
MI Process in Action
Patient comes to refill lorazepam, but not simvastatin which are both due for
refills
Steps 1 & 2:
- RPh: “Hello, Mr. Smith. It looks like you’re due for your simvastatin too.
Would you like me to get that one ready for you too?”
Develop
Rapport
- Pt: “No, I’m not taking that one anymore. I feel fine and I’m tired of taking
it.” and Reflect
- RPh: “It sounds like you are frustrated with having to take the medication
every day, when you don’t feel any better or different when you take it.”
- Pt: “Right, it’s just one more thing I don’t need to have to do every day.”
- RPh: “Would you mind if I share some information and you tell me what
you think?”
135
MI Process in Action
Patient comes to refill lorazepam, but not simvastatin which are both due for
refills
- RPh: “Hello, Mr. Smith. It looks like you’re due for your simvastatin too.
Would you like me to get that one ready for you too?”
- Pt: “No, I’m not taking that one anymore. I’m feel fine and I’m tired of taking
it.”
- RPh: “It sounds like you are frustrated with having to take the medication
every day, when you don’t feel any better or different when you take it.”
- Pt: “Right, it’s just one more thing I don’t need to have to do every day.”
- RPh: “Would you mind if I share some information and you tell me what you
think?”
Step 3: Ask
Permission
136
1
3
7 MI Process in Action Steps 4 and 5: Provide
new info and ask patient
what they think
- Pt: Sure. That would be ok.
- RPh: High cholesterol is a condition that does not have any symptoms until
something serious happens. Usually the first symptom is a stroke or heart attack.
We know that by lowering your cholesterol by ~50%, your risk of having a stroke or
heart attack goes down a lot. Your cholesterol today is not as low as we want it yet.
That puts you at a much higher risk of stroke or heart attack. I would hate to see that
happen, especially when it is preventable. Where does that leave you now in
wanting to lower your cholesterol?
- Pt: Nobody ever explained it like that to me. Now that you put it that way, I don’t
want to have a heart attack, I’ll go ahead and take that simvastatin today.
- RPh: This is great news. It sounds like you’re willing to give the simvastatin a new
start and you’ll be taking it regularly. When you come in next month, we can talk
about how the month went taking the medicine every day and discuss more ideas on
how to be compliant! 137
1
MI Process in Action
3
8 Step 6: Summarize &
Discuss Next Steps
- Pt: Sure. That would be ok.
- RPh: Unfortunately, high blood cholesterol is a condition that does not have any
symptoms until something serious happens. Usually the first symptom is a stroke or
heart attack. We know that by lowering your cholesterol by ~50%, your risk of having a
stroke or heart attack goes down substantially, even if you have no symptoms. Your
cholesterol today is not as low as we want it yet. That puts you at a much higher risk of
stroke or heart attack. I would hate to see that happen, especially when it is
preventable. Where does that leave you now in wanting to lower your blood pressure?
- Pt: Nobody ever explained it like that to me. Now that you put it that way, I don’t want
to have a heart attack, I’ll go ahead and take that simvastatin today.
- RPh: That’s great news. It sounds like you’re willing to give the simvastatin a new
start. When you come in next month, we can talk about how the month went taking the
medicine every day. Would you like to discuss more ideas on how we can assist you
with remembering to take your medicine? 138
Additional Resources for MI Training
- Berger B, Vallaume W. Motivational Interviewing for Health Care
Professionals: A Sensible Approach. Washington, DC: American
Pharmacists Association; 2013.
139
Key Points!
• Motivational interviewing can be integrated
into all steps of the Pharmacist Patient Care
Process to provide a patient-centered
approach to patient care
• Cigars
• Pipes
• Water pipe/Hookah
Nicotine Products
(smokeless tobacco)
• Chewing tobacco
• Dipping tobacco
• Snuff
• Snus
• Dissolvables
• Etc.
Nicotine Products
(Electronic Delivery)
• Vape Pens
• Modified e-cigarettes
‘MODS’
• Electronic Water Pipe/ Hookah
Electronic Examples
Juuling and Juul pods
Each cartridge contains 200 puffs and has as much nicotine as an entire
pack of cigarettes. Produces less ’smoke’, charges in a laptops USB port.
Pod flavors include tobacco, mint, mango, cucumber, crème, fruit, etc.
Reasons for Tobacco
Use (Then and Now)
• Medicinal Purposes
• Ceremonial Purposes
• Social Purposes
• Stress Reliever
https://www.fda.gov/tobaccoproducts/guidancecomplianceregulatoryinfor
mation/ucm297786.htm
Why all the junk?
• Naturally occurring
-Nicotine
• Additives
-Arsenic (found in soils, pesticides)
• By-Products
-Formaldehyde (due to burning)
Reality:
Nicotine is Awesome
Dopamine Pleasure, appetite suppression
Nicotine is Addicting
**Emotional
**Behavioral
**Physical
Withdrawal
Psychological Physical
• Anxiety • Sweating
• Agitation • Shaky
• Trouble Sleeping • Racing Heart
• Depression • Difficulty
• Irritability breathing
• Headaches • Muscle tension
• Poor • Chest Tightness
concentration • Nausea
• Social isolation • Vomiting
• Etc. • Etc.
*Withdrawals reveal within 1-2 days, peaking in the first week, and will slowly
subside over 2-4 weeks. Increased appetite or weight gain can be seen for
upto 6 months after quitting.
Health Benefits to Quitting
(Immediate)
• Inflated blood pressure and heart rate return to normal
• Exercise
• Counseling
A combination above as well as/or…
• Chantix (varenicline)
• Zyban (bupropion)
Rx Medications
(Nicotine Replacement)
• Nicotrol Inhaler
• Nicotine Nasal Spray
Chantix (Varenicline) tablets Rx
0.5mg, 1mg
Special Considerations: *Start the med 1-2 weeks before the quit date.
Zyban (bupropion SR) tablets Rx
Adverse Drug Reactions (a few)
• Insomnia –sleep hygiene recommendations
• Dry Mouth – manage by ice chips, etc.
• Nausea - manage with food, glass of water
Start at 1or 2 doses per hour upto 80 sprays (40 mg) per day.
Minimum = 8 puffs per day. Maximum doses per hour = 5.
Nasal Spray (Nicotine) Rx
Adverse Drug Reactions (smoking/Nicotine
related)
• Nasal irritation that may go away. Peppery sensation
• Dyspepsia, chest tightness, smell changes
• Headache, runny nose, watery eyes, coughing
• Nicotine Patches
• Nicotine Lozenge
• Nicotine Gum
*Upon initiation, patients
should completely stop smokin
Nicotine Patches
Step 1 = 21 mg, Step 2 = 14 mg, Step 3 = 7 mg
Extended-release patch (OTC)
Nicoderm CQ Nicoderm CQ
>10 cigs/day <10 cigs/day
Step 1 x 6 weeks Step 2 x 6 weeks
Step 2 x 2 weeks Step 3 x 2 weeks
Step 3 x 2 weeks
Mechanism of Action : Nicotine binds to receptors in the brain. Pathways
are activated and neurotransmitters are released resulting in a reward
effect. Peak = 3-12 hours
Administration: Place lozenge in mouth and allow to dissipate (20-30 minutes for
standard, 10 minutes for mini-lozenge
. 12 week dosing schedule
Weeks 1-6 Weeks 7-9
Weeks10-12
1 lozenge 1 lozenge
1 lozenge
Q 1-2 hours Q 2-4 hours
Q 4-8 hours
*For increased success, use
Nicotine Lozenges (OTC)
Adverse Drug Reactions (a few)
• Mouth irritation- rotate (may need to check in with Dr.)
Administration: Chew until the first sign of the flavor (15 chews). Park it between
the cheek and gum for absorption of the Nicotine. Repeat when taste or tingling
stops. 1 gum last approx. 30 minutes. Heavy smokers may need more pieces
Peaks 30-60 minutes
• Medical informatics
• Nursing informatics
• Pharmacy informatics
https://www.amia.org/applications-informatics/clinical-informatics
What is Pharmacy Informatics?
• Use of information, information systems, and automation
technology to ensure safe and effective medication usage.
• A system of
interconnected Purchase
Transcribe
/Supply Chain
parts that work Management
/Verify
together to
achieve the
common goal of
safe and effective Prepare
Monitor
medication /Dispense
therapy.
Administer
CDSS
Informatics in Prescribing
• CPOE
Prescribe
▫ Pros and Cons
Purchase
Transcribe
/Supply Chain
Management
/Verify • CDS/CDSS
▫ Key components
• Alert fatigue
Prepare
Monitor
/Dispense
• E-prescribing
Administer
Computerized Provider Order Entry (CPOE)
• Process allowing medical provider instructions to be entered
electronically for the treatment of patients under a provider’s
care
• To improve medication-related
decisions and outcomes
CDSS Primary Components
• Inference engine
▫ AKA reasoning engine – forms brain of the CDSS
▫ Links patient-specific information to knowledge base
• Knowledge base
▫ Composed of varied clinical knowledge
Tx guidelines, diagnoses, DDI, drug-disease interactions
• Communication mechanism
▫ Allows entry of patient information
▫ Responsible for communicating relevant info back to clinician
• Warning/alert overrides
• Pharmacists use:
▫ CDSS
Monitor
Prepare
/Dispense
▫ PIMS
• A. CPOE
• B. e-prescribing
• C. an ADC
• D. an eMAR
When a prescriber logs into the system to review her patient list, she notices a red flag on the column marked “labs”
for one of her patients. The notification indicates that the patient’s serum creatinine had increased from 0.9 to 1.5
mg./dL. What type of clinical decision support does this represent? (learning objective 4)
• A. passive
• B. Active noninterruptive
• C. action interruptive
• D. non-active
Pharmacy Informatics/Pharmacotherapy
• eMA
• ePrescribing • ADC
• Barcode Medication Verification
Administer
Interoperability
• The ability of disparate computer systems to exchange
information in a manner that allows the information to be used
meaningfully
Communication
standards are
necessary to achieve
desired level of
meaningful data
exchange
National Alliance for Health Technology report to Office of National Coordinator for HIT, 2008
Interoperability Standards
• NCPDP SCRIPT: e-prescribing standard for transmission of
prescription information
▫ Between prescribers, pharmacies and payers
• NDC: produced by manufacturers, registered with FDA