Maisha Kelly Freeman,
PharmD, MS, BCPS, FASCP
Pharmacy Purchasing & Products: What are the benefits of having a drug information specialist on staff?
Maisha Freeman: The role of a drug information (DI) expert is to evaluate the literature, analyze statistics, assess prescribing patterns, and troubleshoot drug information issues. Unlike other pharmacy staff members, who have multiple responsibilities, the DI specialist is dedicated to this one capacity. When a DI expert is on staff, drug safety issues, adverse drug effects, drug shortages, drug alternatives, and all other medication-related concerns receive the focused, in-depth attention they increasingly demand. In addition, the DI specialist ensures that necessary information reaches practitioners and pharmacists. Ultimately, the most important benefit of having an in-house DI specialist is improved medication safety.
PP&P: What are the primary functions of a DI specialist?
Freeman: One of the DI specialist’s principle responsibilities is determining the most appropriate products to be used in a health-system pharmacy. The DI specialist also serves as an information resource for house staff and communicates P&T issues to staff via newsletters. If a medication safety specialist is unavailable, the DI specialist can assist by conducting medication use evaluations in the hospital setting to determine how drugs are being used and whether that use is appropriate. If it is determined that a drug is not being used appropriately, the DI specialist follows through to ensure corrections are made. The DI expert is also an important addition to a hospital’s quality assurance program—he or she works to determine and troubleshoot the root causes of adverse drug reactions and reduce or prevent medication errors in the future.
When there is a change to the hospital formulary, the DI expert coordinates the change within the pharmacy and educates pharmacy staff on appropriate uses of new products. The DI specialist also might be responsible for keeping the hospital’s electronic formulary up to date.
Supply chain issues, which are commanding more pharmacy attention in recent years, are also the DI specialist’s area of expertise. When a drug shortage occurs, the DI expert serves as a key resource for practitioners and pharmacy staff. He or she researches the shortage and identifies a strategy for managing it, using the ASHP and Food and Drug Administration Web sites. If the hospital needs to identify an alternative drug due to a shortage, the DI expert searches the literature for a replacement that is equally safe and efficacious.
PP&P: How important is the role of the DI expert as a pharmacy educator?
Freeman: Communicating with and educating pharmacy and hospital staff are important functions in the DI expert’s purview. In addition to day-to-day communications, the DI specialist may publish an informal newsletter periodically to update pharmacists and other medical staff on formulary changes, report on P&T committee meetings, or announce upcoming P&T issues that will be addressed. The DI expert might also subscribe to and distribute pertinent literature to pharmacy staff, such as Pharmacist’s Letter,1 reports on adverse drug reactions and medication errors from the Institute for Safe Medication Practices (ISMP), bulletins from the American Journal of Health-System Pharmacy (AJHP), and reports from the FDA.
PP&P: What DI resources are hospitals required to have access to?
Freeman: Hospitals must have DI resources available, though they need not be electronic. The Board of Pharmacy in each state identifies the types of resources it allows for particular pharmacies. Best practice is for hospitals to have at least one resource with multireference functionality. Multireference functionality increases the likelihood of resolving information discrepancies, in addition to ensuring a more comprehensive response to every query, since each resource has its particular strengths and weaknesses.
For instance, DI specialists regularly are queried about the appropriateness of an order written for a patient. While several resources will be evaluated, it is not unusual to find the use in only one of the references searched. Keep in mind that one reference may have more information about reproductive risks and incompatibility issues associated with IV drug products, while another may be a valuable resource for information pertaining to IV medications, off-label drug use, and clinically significant drug-drug interactions.
PP&P: Why is it vital to implement a DI-driven approach to provide quality information?
Freeman: Hospitals need to take a systematic approach to gathering and communicating DI. Such a process encourages researchers to think broadly about how to classify a particular question and identify the optimal resources needed to answer it (see Figure 1).
PP&P: What additional responsibilities do you anticipate will be in the DI expert’s sphere in the future?
Freeman: Looking ahead, the DI department is likely to be expected to provide more support to hospital informatics, such as guidance in developing the decision support within CPOE systems and assistance in the optimization of bar code technology. The DI specialist also should seek to increase the support provided to ensure quality patient care and improved outcomes, as pharmacists will be increasingly relied on to delineate appropriate guidelines to prescribers that maximize patient outcomes. The DI expert will become more involved in optimizing formulary decisions, ensuring they are appropriate, and in evaluating the literature to support those decisions. Above all, DI experts will be increasingly relied on to make sure patients receive appropriate drug treatment to reduce medication errors and the incidence of adverse reactions. Medication information retrieval and evaluation will become even more important as additional drug products are approved. In addition, the lack of head-to-head clinical trials makes decision-making difficult. A DI specialist can offer his or her expertise by providing appropriate, rational, evidence-based recommendations to guide formulary choices.
Maisha Kelly Freeman, PharmD, MS, BCPS, FASCP, is the director of the Samford University Global Drug Information Service. She is a 2002 graduate of the University of North Carolina at Chapel Hill. Maisha’s professional interests include drug information education, cultural competency, pharmacoeconomics/outcomes research, and geriatrics.
Systemic Approach for Answering a Drug Information Request2,3