Clinician Use of a Palmtop Drug Reference Guide

Objective: Problems involving drug knowledge are one of the most common causes of serious medication errors. Although the information that clinicians need is often available somewhere, retrieving it expeditiously has been problematic. At the same time, clinicians are faced with an ever-expanding pharmacology knowledge base. Recently, point-of-care technology has become more widely available and more practical with the advent of handheld, or palmtop, computing. Therefore, the authors evaluated the clinical contribution of a drug database developed for the handheld computer. ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California) is a comprehensive drug information guide that is downloadable free from the Internet and designed for the Palm OS platform align="right".Design: A seven-day online survey of 3,000 randomly selected ePocrates Rx users was conducted during March 2000.Measurements: User technology experience, product evaluation and usage patterns, and the effects of the drug reference database on information-seeking behavior, practice efficiency, decision making, and patient care.Results: The survey response rate was 32 percent (n=946). Physicians reported that ePocrates Rx saves time during information retrieval, is easily incorporated into their usual workflow, and improves drug-related decision making. They also felt that it reduced the rate of preventable adverse drug events.Conclusions: Self-reported perceptions by responding clinicians endorse improved access to drug information and improved practice efficiency associated with the use of handheld devices. The clinical and practical value of using these devices in clinical settings will clearly grow further as wireless communication becomes more ubiquitous and as more applications become available.Medical knowledge is growing exponentially,¹ especially in the field of therapeutics. Pharmacologic advances have resulted in an ever-increasing variety of medications for clinicians to employ in patient care. Medications frequently have complex dosing regimens, changing indications, unique contraindications, and multiple drug–drug interactions and can cause serious adverse reactions. Because of the limitations of human memory,^2,3 it has become increasingly difficult for clinicians to keep up to date on the prescribing requirements of drugs, especially recently approved drugs.⁴Inquiries about drugs are one of the most frequent questions that clinicians have.⁵ This makes point-of -care technology—which can provide prescribing information at the bedside, on the hospital ward, and in the office examining room—especially attractive.⁶ Such technology has the potential to reduce the information search times of physicians, and such access may reduce the likelihood of incorrect and harmful drug-prescribing behavior.⁷Adverse drug events (ADEs), or injuries due to drugs, are frequent in a variety of patient care settings. Many are preventable and may be associated with significant patient injury.^8–11 Data suggest that drug knowledge deficiencies are the single most common systems cause of serious medication errors in inpatients.¹² Recent publicity has encouraged public and private support for patient safety improvements, including building safer medication practices.^10,11,13Several drug reference guides designed for use on handheld, or palmtop, computers have recently become commercially available, including ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California), a comprehensive drug information application. We sought to survey physician users to assess their experience incorporating handheld electronic drug reference guides into routine patient care.