- Email: [email protected]
An Overview of Electronic Drug Information Resources
An Overview of Electronic Drug Information Resources Clinicians are challenged to operate from a base of knowledge and readily identify what they do not know.1 Access to reference drug information (DI) is a key factor for improving patient care, especially regarding safe medication use.1 Ease and rapidity of use at the point of care appear to be improving because handheld devices are now widely used. A brief overview of electronic references is discussed to help clinicians select references that best meet their needs. Most institutions subscribe to at least 1 online database for on-site access to general DI as well as the institution’s formulary. The most commonly subscribed online databases include Micromedex, Lexicomp, and Facts and Comparisons (F&C). In addition to general information similar to the package insert (PI), these databases are searchable by drug/disease/indication and offer special tools such as multiple drug interaction, intravenous (IV) compatibility checkers, drug identification tools (based on imprint or description), patient counseling information (available in other languages), and medical calculators (eg, ideal body weight, creatinine clearance, advanced life support calculators for adult/children/neonates, and drug dosing tools).2-4 Micromedex is a comprehensive, evidencebased online database. The monograph layout has an outline index on the left, allowing for quick access to specific sections (eg, dosing and pregnancy). Other distinctive tools include extensive off-label information, clinical guidelines, personalized patient information in 15 languages, Poisindex (toxicology; Truven Health Analytics, Denver, CO), NeoFax (neonatal DI; Truven Health Analytics), and a drug interaction checker, including allergies.2 Lexicomp online provides concise DI, including information from other references such as the American Hospital Formulary Service Essentials/DI and the Natural Products Database. The monograph layout is similar to Micromedex with an outline index for quick access. The usefulness of this reference highly depends on familiarity with section contents, such as the www.npjournal.org
“nursing considerations” section hidden under “patient and therapy management.” Some features of Lexicomp include patient handouts in 19 languages, drug shortages, toxicology, neonatal/ pediatric DI, and nursing considerations.3 F&C provides drug comparison tables and an extensive drug interaction checker that allows for patient-specific information such as age, comorbidities, and allergies. F&C also offers resources for chemotherapy, immunizations, orphan drugs, and a “Don’t Crush/Chew” product list.4 Individual subscriptions of Lexicomp and
PRESCRIPTION PAD Leah Loeffler, and Suzanna Gim, PharmD, MPH F&C are available for off-site access. Only Micromedex and Lexicomp offer mobile applications. The mobile Micromedex is free but requires subscription for select features such as drug interaction checker, IV compatibilities, pediatric essentials, and Neofax essentials. The mobile Lexicomp features vary based on the subscription purchased (see Supplementary Table 1, available online at http://www.npjournal.org).2,3 If you do not have a subscription or access to the aforementioned databases, several free online references provide general DI (eg, DailyMed [www.dailymed.nlm.nih.gov/], Drugs. com [www.Drugs.com/], Epocrates [www. epocrates.com/), Medscape (www.Medscape. com/), and the Food and Drug Administration [FDA] Web site [www.fda.gov]) and more. DailyMed, Drugs.com, Epocrates, and Medscape provide general DI from the PI. Drugs.com, Epocrates, and Medscape provide additional features such as drug interaction checkers and free mobile applications. Drugs.com also offers drug identification, a medical dictionary, natural product database, patient information (available in Spanish), and a “Drugs by Condition” search tool The Journal for Nurse Practitioners - JNP
1
JNP
that identifies medication management for disease states. To access the “Drugs by Condition,” click on the “Drugs A-Z” tab. Epocrates.com offers a free and subscription version. Some unique features include retail drug prices/insurance formulary options, history of disease, diagnostic tests, treatment plans (under the “Disease” tab), and guidelines (under the “Tables” tab). Medscape provides general DI but is most useful for disease state information. The DI is under the “Reference” tab. Additional features include insurance formulary information, health calculators, disease pathophysiology, and treatment plans. Medscape also offers patient information, a pill identifier, symptom checker, and information on supplemental products through Rxlist at the bottom of the Web site.5 The FDA Web site is not the easiest place to find general DI. The “Drugs@FDA” link under the “Drugs” tab provides access to the PI. It is more useful for other information such as new and generic drug approvals, drug shortage information, patient medication guides, and biological product information. It is most useful for up-todate safety alerts (“MedWatch” link) and reporting adverse drug events directly to the FDA. When using free databases, look for references, disclaimers, and a “Contact us” link for accountability. In addition, look for a Health on the Net Foundation (HON) code certification. The HON code of ethics guides site managers in setting up a minimum set of mechanisms to provide quality, objective, and transparent medical information.6 The HON code is the most widely accepted reference for online health and medical publishers.6 For example, the Drugs.com Web site references Micromedex, Cerner Multum, Wolters Kluwer, Harvard health, American Society of Health-System Pharmacists, FDA, and Stedman’s and is certified by the HON code. The appropriate use of DI references improves safe medication use, resulting in the highest quality of patient care. Some useful features include calculations, including infusion rates and special population dosing (renal/hepatic/weight based/pediatric/elderly); IV compatibilities; and drug-drug/food/allergy/pregnancy/lactation/ disease interactions. 2
The Journal for Nurse Practitioners - JNP
The following is a summary of key learning (see Supplementary Tables 1 and 2, available online at http://www.npjournal.org): DI references requiring subscription B Micromedex, Lexicomp, and F&C are the most reputable DI references B Micromedex and Lexicomp have mobile applications Free DI references include DailyMed, Drugs.com, Epocrates, Medscape, and the FDA Web site (but none include IV compatibilities) Select a reference based on your personal practice needs and preferences. Consider the limitations of any reference based on availability of evidence. The ultimate goal is to base care on best practices, which combine evidence-based practice with the clinician’s judgment and the patient’s preferences.1 The benefits of regular use of an electronic drug reference application include better drug knowledge, improved drug-related decisions, and avoidance of serious adverse drug events. SUPPLEMENTARY DATA
Supplementary tables associated with this article can be found in the online version at http://dx. doi.org/10.1016/j.nurpra.2014.02.011. References 1. Thompson C, Cullum N, McCaughan D, et al. Nurses, information use, and clinical decision making—the real world potential for evidencebased decisions in nursing. Evid Based Nurs. 2004;7(3):68-72. 2. Truven Health Analytics Inc. Micromedex Solutions Web site. www. micromedexsolutions.com. Accessed January 26, 2014. 3. Wolters Kluwer Health. Lexicomp Web site. http://www.lexi.com. Accessed January 26, 2014. 4. Wolters Kluwer Health. Facts & Comparisons Web site. http://www. factsandcomparisons.com. Accessed January 26, 2014. 5. RXList, Inc. RxList Web site. http://www.rxlist.com/script/main/hp.asp. Accessed January 26, 2014. 6. HONcode. The commitment to reliable health and medical information on the internet. Health on the Net Foundation Web site. http://www.hon. ch/HONcode/Patients/Visitor/visitor.html. Accessed January 22, 2014.
Suzanna Gim, BA, PharmD, MPH, is an associate professor and a pharmacy practice/drug information specialist at Long Island University/Brookdale Hospital in Brooklyn, NY, and can be reached at [email protected]. Leah Loeffler is a PharmD candidate at Long Island University.
1555-4155/14/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2014.02.011
Volume
-,
Issue
-, -/-
2014
Supplementary Table 1. Drug Reference Mobile Subscription Packages and Costs Drug Reference
Description
Cost
Lexicomp Lexi-COMPLETE þ Lexicomp Online
Mobile and online subscription; Lexicomp databases plus calculations, 5-minute clinical consult, Stedman’s medical dictionary, AHFS
$595/y
Lexi-COMPLETE
Mobile only; 2 devices maximum
$285/y
Lexi-SELECT
Lexicomp databases only
$215/y
Lexi-NURSING SUITE
Medication administration, monitoring, patient education, perform a detailed interactions analysis on a patient’s drug profile
$175/y
Various packages
See Web site for details (http://webstore.lexi.com/Store/ON-HAND)
$40-$175/y
Drug information
General summary drug information
Free
Drug interactions
Multiple drug interactions checker
$9.99
Micromedex
IV compatibility
Checker based on Trissel’s Handbook on Injectable Drugs
$9.99
Pediatrics essentials
Pediatric drug information
$9.99
Neofax essentials
Neonatal drug information
$29.99
Rx
General summary drug information including manufacturer/pricing and pill pictures
Free
Essentials
Epocrates Rx þ evidence-based disease content Treatment guidelines; access laboratory tests and panels with reference ranges, tables, and approximate test costs
$159.99/y
Epocrates
AHFS ¼ American Hospital Formulary Service; IV ¼ intravenous.
Supplementary Table 2. Electronic Drug Information Resource Comparison Chart Patient Education Drug Pill IV Free Disease Off-label Interaction (Number of Clinical Use Checker Languages) Calculator Identifier Compatibility mobile Subscription Info Lexicomp
X
X (19)
X
X
X
Micromedex
X
X (15)
X
X
X
F&C
X
X (2)
X
X
X
Drugs.com
X
X (2)
Epocrates
X
X (2)
X
Medscape
X
X (1)
X
X X
X
X X
X X
X
X
X
X
X
X
X
X
X
X
F&C ¼ Facts and Comparisons; IV ¼ intravenous.
www.npjournal.org
The Journal for Nurse Practitioners - JNP
2.e1
“nursing considerations” section hidden under “patient and therapy management.” Some features of Lexicomp include patient handouts in 19 languages, drug shortages, toxicology, neonatal/ pediatric DI, and nursing considerations.3 F&C provides drug comparison tables and an extensive drug interaction checker that allows for patient-specific information such as age, comorbidities, and allergies. F&C also offers resources for chemotherapy, immunizations, orphan drugs, and a “Don’t Crush/Chew” product list.4 Individual subscriptions of Lexicomp and
PRESCRIPTION PAD Leah Loeffler, and Suzanna Gim, PharmD, MPH F&C are available for off-site access. Only Micromedex and Lexicomp offer mobile applications. The mobile Micromedex is free but requires subscription for select features such as drug interaction checker, IV compatibilities, pediatric essentials, and Neofax essentials. The mobile Lexicomp features vary based on the subscription purchased (see Supplementary Table 1, available online at http://www.npjournal.org).2,3 If you do not have a subscription or access to the aforementioned databases, several free online references provide general DI (eg, DailyMed [www.dailymed.nlm.nih.gov/], Drugs. com [www.Drugs.com/], Epocrates [www. epocrates.com/), Medscape (www.Medscape. com/), and the Food and Drug Administration [FDA] Web site [www.fda.gov]) and more. DailyMed, Drugs.com, Epocrates, and Medscape provide general DI from the PI. Drugs.com, Epocrates, and Medscape provide additional features such as drug interaction checkers and free mobile applications. Drugs.com also offers drug identification, a medical dictionary, natural product database, patient information (available in Spanish), and a “Drugs by Condition” search tool The Journal for Nurse Practitioners - JNP
1
JNP
that identifies medication management for disease states. To access the “Drugs by Condition,” click on the “Drugs A-Z” tab. Epocrates.com offers a free and subscription version. Some unique features include retail drug prices/insurance formulary options, history of disease, diagnostic tests, treatment plans (under the “Disease” tab), and guidelines (under the “Tables” tab). Medscape provides general DI but is most useful for disease state information. The DI is under the “Reference” tab. Additional features include insurance formulary information, health calculators, disease pathophysiology, and treatment plans. Medscape also offers patient information, a pill identifier, symptom checker, and information on supplemental products through Rxlist at the bottom of the Web site.5 The FDA Web site is not the easiest place to find general DI. The “Drugs@FDA” link under the “Drugs” tab provides access to the PI. It is more useful for other information such as new and generic drug approvals, drug shortage information, patient medication guides, and biological product information. It is most useful for up-todate safety alerts (“MedWatch” link) and reporting adverse drug events directly to the FDA. When using free databases, look for references, disclaimers, and a “Contact us” link for accountability. In addition, look for a Health on the Net Foundation (HON) code certification. The HON code of ethics guides site managers in setting up a minimum set of mechanisms to provide quality, objective, and transparent medical information.6 The HON code is the most widely accepted reference for online health and medical publishers.6 For example, the Drugs.com Web site references Micromedex, Cerner Multum, Wolters Kluwer, Harvard health, American Society of Health-System Pharmacists, FDA, and Stedman’s and is certified by the HON code. The appropriate use of DI references improves safe medication use, resulting in the highest quality of patient care. Some useful features include calculations, including infusion rates and special population dosing (renal/hepatic/weight based/pediatric/elderly); IV compatibilities; and drug-drug/food/allergy/pregnancy/lactation/ disease interactions. 2
The Journal for Nurse Practitioners - JNP
The following is a summary of key learning (see Supplementary Tables 1 and 2, available online at http://www.npjournal.org): DI references requiring subscription B Micromedex, Lexicomp, and F&C are the most reputable DI references B Micromedex and Lexicomp have mobile applications Free DI references include DailyMed, Drugs.com, Epocrates, Medscape, and the FDA Web site (but none include IV compatibilities) Select a reference based on your personal practice needs and preferences. Consider the limitations of any reference based on availability of evidence. The ultimate goal is to base care on best practices, which combine evidence-based practice with the clinician’s judgment and the patient’s preferences.1 The benefits of regular use of an electronic drug reference application include better drug knowledge, improved drug-related decisions, and avoidance of serious adverse drug events. SUPPLEMENTARY DATA
Supplementary tables associated with this article can be found in the online version at http://dx. doi.org/10.1016/j.nurpra.2014.02.011. References 1. Thompson C, Cullum N, McCaughan D, et al. Nurses, information use, and clinical decision making—the real world potential for evidencebased decisions in nursing. Evid Based Nurs. 2004;7(3):68-72. 2. Truven Health Analytics Inc. Micromedex Solutions Web site. www. micromedexsolutions.com. Accessed January 26, 2014. 3. Wolters Kluwer Health. Lexicomp Web site. http://www.lexi.com. Accessed January 26, 2014. 4. Wolters Kluwer Health. Facts & Comparisons Web site. http://www. factsandcomparisons.com. Accessed January 26, 2014. 5. RXList, Inc. RxList Web site. http://www.rxlist.com/script/main/hp.asp. Accessed January 26, 2014. 6. HONcode. The commitment to reliable health and medical information on the internet. Health on the Net Foundation Web site. http://www.hon. ch/HONcode/Patients/Visitor/visitor.html. Accessed January 22, 2014.
Suzanna Gim, BA, PharmD, MPH, is an associate professor and a pharmacy practice/drug information specialist at Long Island University/Brookdale Hospital in Brooklyn, NY, and can be reached at [email protected]. Leah Loeffler is a PharmD candidate at Long Island University.
1555-4155/14/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2014.02.011
Volume
-,
Issue
-, -/-
2014
Supplementary Table 1. Drug Reference Mobile Subscription Packages and Costs Drug Reference
Description
Cost
Lexicomp Lexi-COMPLETE þ Lexicomp Online
Mobile and online subscription; Lexicomp databases plus calculations, 5-minute clinical consult, Stedman’s medical dictionary, AHFS
$595/y
Lexi-COMPLETE
Mobile only; 2 devices maximum
$285/y
Lexi-SELECT
Lexicomp databases only
$215/y
Lexi-NURSING SUITE
Medication administration, monitoring, patient education, perform a detailed interactions analysis on a patient’s drug profile
$175/y
Various packages
See Web site for details (http://webstore.lexi.com/Store/ON-HAND)
$40-$175/y
Drug information
General summary drug information
Free
Drug interactions
Multiple drug interactions checker
$9.99
Micromedex
IV compatibility
Checker based on Trissel’s Handbook on Injectable Drugs
$9.99
Pediatrics essentials
Pediatric drug information
$9.99
Neofax essentials
Neonatal drug information
$29.99
Rx
General summary drug information including manufacturer/pricing and pill pictures
Free
Essentials
Epocrates Rx þ evidence-based disease content Treatment guidelines; access laboratory tests and panels with reference ranges, tables, and approximate test costs
$159.99/y
Epocrates
AHFS ¼ American Hospital Formulary Service; IV ¼ intravenous.
Supplementary Table 2. Electronic Drug Information Resource Comparison Chart Patient Education Drug Pill IV Free Disease Off-label Interaction (Number of Clinical Use Checker Languages) Calculator Identifier Compatibility mobile Subscription Info Lexicomp
X
X (19)
X
X
X
Micromedex
X
X (15)
X
X
X
F&C
X
X (2)
X
X
X
Drugs.com
X
X (2)
Epocrates
X
X (2)
X
Medscape
X
X (1)
X
X X
X
X X
X X
X
X
X
X
X
X
X
X
X
X
F&C ¼ Facts and Comparisons; IV ¼ intravenous.
www.npjournal.org
The Journal for Nurse Practitioners - JNP
2.e1