Drug information software systems have largely replaced print drug information references in many health systems. Their accessibility, robustness, and up-to-date information make these electronic tools an attractive and valuable source of drug information for hospital pharmacists. Choosing the ideal software depends on institution-specific factors, such as type of care provided, budget, and who will be using the system. Often, more than one system is required to satisfy all the needs of a facility.
Since being introduced to the market, these systems have evolved to capture more information, and they are continually being upgraded and tweaked to be more integrated, user-friendly, and efficient. Because each drug information software system has strengths and weaknesses, an in-depth review is necessary when considering which one(s) to purchase. While there are numerous systems available, the following is a comparative assessment of different elements of four of the available drug information software systems—Clinical Pharmacology (Elsevier/Gold Standard), Facts & Comparisons eAnswers (Wolters Kluwer Health), Lexicomp Online (Lexi-Comp Inc), and Micromedex 2.0 (Thomson Reuters). (For a complete list of all the drug information software systems available visit findit.pppmag.com.)
Software System Configuration
Understanding the similarities and differences of the various system configurations will help facilities decide which best suits their needs. Facts & Comparisons eAnswers is an online compilation of several print references (including Drug Facts and Comparisons, Drug Interaction Facts, The Review of Natural Products, Off-Label Drug Facts, A to Z Drug Facts, Cancer Chemotherapy Manual, and others); similarly, Lexicomp Online is a collection of multiple resources (including Drug Information Handbook, Pediatric Dosage Handbook, Geriatric Dosing Handbook, AHFS Drug Information, and others). Clinical Pharmacology, on the other hand, originated as an online database. The bulk of information in this system is presented in monographs (doses, indications, availability, etc), which is augmented by multiple reporting and clinical tools focused on drug interactions, adverse reactions, intravenous compatibility, and several other categories. Micromedex is a large system consisting of several online databases (including DRUGDEX, DRUG-REAX, DrugPoints System, ALTMEDDEX, REPROTOX, and others); the majority of the information is located within DRUGDEX, but use of the other databases is necessary for certain types of information, such as dietary supplements and toxicology.
Performing a Search
A search function is available on the main page of each of these systems, but the results of the searches and how to search the other system components varies. For example, a Clinical Pharmacology search returns the monographs (or a short list of monographs with a less specific search) and a separate list of how the drugs are supplied. The monographs include IV compatibility and drug interaction information. These components, and others, also can be searched separately. By contrast, searching for a drug name from the main search box in Micromedex returns a detailed list of everywhere the search term appears in the multiple databases. The generated list includes hundreds of results. Although the monograph sections are listed first, the correct result may not be immediately apparent in the list of possibilities. Facts & Comparisons eAnswers is the only system discussed that takes the requestor directly into the corresponding monograph; the complete system search results are available under a separate tab. Lexicomp Online results display as simple listings of which references contain the drug term searched. Monographs contain IV compatibility and drug interactions, and these components, and others, also can be searched separately.
Online monographs supply the majority of basic drug information (eg, doses, indications, pharmacology, pharmacokinetics) for all of the systems. Although the main monograph sections are similar, the depth of the content within each section varies by database, and there are trade-offs to the way each database displays content. While some are in-depth, the information may not be found as quickly as in a database that takes a more concise approach. However, the more concise databases may require use of an alternative source of information in some situations. For example, Lexicomp Online provides succinct information, often in list format (eg, off-label uses, adverse reactions list, incidence of adverse reactions list), which makes it easy to find quick, frontline information. However, other databases also may need to be used if more in-depth information is necessary. Micromedex provides fairly detailed information (eg, mechanism of action, detailed adverse reaction information, clinical efficacy), but the search process may be more complex.
Clinical Pharmacology and Facts & Comparisons eAnswers provide detailed information on how a medication is supplied (eg, strengths, dosage forms, manufacturer). This information is also supplied by Lexicomp Online, although the data is not as detailed. Micromedex provides less specific information than the other three systems.
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Over the last few years, there has been standardization of intravenous compatibility information among drug information software systems. Clinical Pharmacology and Micromedex use Trissel’s 2 Clinical Pharmaceutics Database, and Facts & Comparisons eAnswers uses Trissel’s IV-Chek, thus the content included is similar, although presented differently. Lexicomp Online uses the King Guide to Parenteral Admixtures. Checking the compatibility of intravenous drugs is similar among the databases in that the user builds a list of medications to check and the results indicate whether the drugs are incompatible, compatible, or variable/conflicting when combined in a syringe, an admixture, or at a y-site. All four programs provide details of studies with a single mouse click. The display of results varies among the databases, but all are user-friendly. In Clinical Pharmacology and Micromedex, the compatibility information within the monographs is from Trissel’s 2 Clinical Pharmaceutics Database, whereas Lexicomp Online and Facts and Comparisons eAnswers provide fewer stability and compatibility details directly within individual drug monographs, instead referring users to the more detailed reference source (King Guide or Trissel’s IV-Chek, respectively).
A product identifier is now available in all four of the drug information software systems discussed. All systems allow the user to search by markings, imprints, and other physical descriptions. Photos to confirm drug identity are available in all systems, although not for all medications.
All four systems provide off-label medication uses, but in different capacities. Micromedex provides in-depth off-label information within the monograph section. Clinical efficacy information—⎯including a review of the studies, an overall rating of the evidence to support off-label use, a recommendation, and the dose—⎯is provided for off-label therapeutic uses in a manner similar to that for labeled indications. Facts and Comparisons eAnswers provides a dose and/or a brief review of the clinical efficacy for limited off-label indications within the monograph, as well as a link to their reference Off-Label Drug Facts when it contains a relevant entry. Clinical Pharmacology provides an integrated list of off-label and labeled uses and dosing recommendations, but does not review clinical efficacy data. Conversely, Lexicomp Online provides a list of off-label uses and doses within the main monograph section, but to find in-depth reviews of the clinical efficacy, a link is provided to AHFS Drug Information or AHFS Essentials, which are integrated within the system.
Maximizing Use of Drug Information Systems
As the functionality and depth of content vary among databases, one system may provide strong information in one area and lack depth in other areas; each database does not contain all information about every available medication. Because the content varies among the systems and the information needed is likely in at least one of them (but maybe not all), many institutions choose to purchase more than one drug information software system. An additional benefit of having access to more than one system is that each system acts as a double check of the other for critical drug information.
Staff Training and Education
To ensure drug information software is used to its greatest capacity, education and staff training are vital during and after implementation. Because comfort level can play an important role in whether or not staff members use the system, providing initial training, as well as refresher sessions after implementation, is a good approach. Consider individual or group instruction, and live or recorded tutorials; one-on-one training sessions can be very beneficial. If human resources are not available for individual sessions, pharmacy students can provide individualized training. Additionally, ask the vendor to provide educational sessions for your employees that emphasize how to maximize use of the system.
Ensure easy access to the drug information software by putting a link to the software system in multiple places, such as your hospital and department intranet sites, on the formulary, and within the pharmacy system. Make sure the staff is able to access the software on rounds so that pharmacy can make an impact at the point of prescribing, and be sure the medical and nursing staff also take advantage of the software tools.
As with technology implementation, be sure to reassess your hospital’s needs periodically; generally, contracts for software systems should be reviewed on an annual basis.
Employing drug information software systems to access current data quickly increases staff productivity and helps ensure patients receive the correct medications and dosage. The capabilities of these systems vary widely, and each brings different strengths to the table. When undertaking the selection process, it is important to carefully research the abilities of each system and then weigh them against the needs of your facility—keeping in mind, that it is often necessary to employ more than one system to ensure all requirements are adequately satisfied.
Julie Karpinski, PharmD, BCPS, is the director of drug information and is an associate professor of pharmacy practice at Concordia University Wisconsin in Mequon, Wisconsin. In addition, she has a clinical practice in drug information and drug policy at Froedtert Hospital in Milwaukee.
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Facts & Comparisons eAnswers
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