UNIT 4

1. HARAMAYA UNIVERSITY HIWAT
FANA COMPREHENSIVE SPECIALIZED
HOSPITAL CLINICAL PHARMACY AND
DRUG AND POISON INFORMATION
SERVICE (DPIS) UNIT
BY SALAHADIN A. (B.PHARM)
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2. DRUG INFORMATICS
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3. At the end of this lecture the student will
be able to:
• Describe need for drug information service
• Describe skills needed for drug information service
• Describe what is the modified systematic approach
used in answering drug information questions
• List the 7 steps involved in the MSA in answering DI
questions, and discuss the rational of each step
• Use the modified systematic approach in answering
drug information questions
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4. INTRODUCTION TO DRUG INFORMATION
SERVICES
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5. • Providing medication information is among the
most fundamental responsibilities of pharmacists
The information can be given for;
• patient specific, as an integral part of
pharmaceutical care,
• a group of patients, such as in the development of
a therapeutic guideline, publishing an electronic
newsletter, or updating a website.
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6. Definition of Terms
Drug information: The process of provision of
unbiased, well-referenced, and critically evaluated
information
Drug informatics: A technologically advanced version
of drug information. This often denotes the electronic
management of drug information.
It emphasizes the use of technology as an integral tool
in effectively organizing, analyzing, and managing
information on medication use in patients.
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7. • Drug information centre (DIC): A physical location
where pharmacists have the resources (e.g., books,
journals, and computer systems) to provide drug
information service.
• Drug information service (DIS): A professional
service aimed at providing drug information usually
located DIC.
• Drug information Specialists: The individual
responsible for operation of the DIC…….The one
who store, retrieve, select, evaluate, and
disseminate drug information
Definition of Terms ….
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8. • In 1960s, the availability of new drugs (first
generation cephalosporin) was providing challenges
for practitioners to keep in line and make
appropriate decisions for their patients
• No way to effectively communicate the wealth of
information to those needing it…. drug information
specialist was viewed as a person who could bridge
the gap and effectively communicate drug
information
History
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9. History…
• In 1962, the first drug information center was
established at the University of Kentucky Medical
Center…..area separated from pharmacy
• It acted as a “major source of selected,
comprehensive drug information for staff physicians
and dentists to allow them to evaluate and compare
drugs”
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10. • In following years various centers were opened
• The centers were given the role of retrieving,
selection, evaluating, and dissemination
• Information would be disseminated to respond to
specific questions, to assist in the evaluation of drugs
for use in the hospital, or to inform others through
newsletters of current developments related to
drugs.
History…
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11. In Ethiopia
• HIV/AIDS Twinning Center partners at Addis Ababa
University and Howard University of Washington…..
opened a model Drug Information Center 2009 at
Black Lion Hospital.
History…
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12. WHY DRUG INFORMATION SERVICE NOW??
• In our modern world, information is everywhere… but the
source and the interpretation may not be reliable
• ……..selecting and organizing the information in
manageable way needs systematic approach
• As a pharmacist we have responsibilities to provide
reliable and accurate drug information…. For health
professionals, patients, careers and the public in general
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13. WHY DRUG INFORMATION….
• Accessing, reviewing, analyzing, evaluating, and
interpreting the clinical drug literature are important
responsibilities of pharmacist, who are the “drug
experts”.
• To accomplish this, pharmacists need to know how
and where to find clinical drug literature, how to
evaluate it, and how to put it in practice.
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14. Other deriving factors;
• Change in philosophy of pharmacy practice( from
product to patient focused care)
• Occurrences of adverse drug events
• Growth of information technology
• Changes in the health care environment with a
focus on evidence-based medicine
• The sophistication of medication therapy
• The self-care movement
WHY DRUG INFORMATION….
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15. Services under DIS
• Support for clinical services/ Information for
practitioners
– Answering drug related questions
– Developing criteria/guidelines for medication use
• Development of medication use policies, formulary
management
• Publications--- newsletter, journal columns, websites
• Education in-services for health professionals, students,
consumers
• Medication use evaluation
• Coordination of reporting programs, e.g., adverse
medication reactions
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16. DIS is both Reactive and proactive
• Information or advice given in response to questions
or enquiries about medicines is referred to as
‘reactive’ drug information.
• ‘Proactive’ drug information involves the
preparation of newsletter, websites, etc. in an
attempt to educate or raise awareness of key
therapeutic issues.
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17. WHAT MEDICATION INFORMATION SKILLS DO
WE NEED?
• Assess available information and gather situational
data needed to characterize question or issue
• Formulate appropriate question(s)
• Use a systematic approach to find needed
information
• Evaluate information critically for validity and
applicability
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18. SKILLS WE NEED…
• Develop, organize, and summarize response for
question or issue
• Communicate clearly when speaking or writing,
considering the audience level
• Anticipate other information needs
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19. DIC ESTABLISHMENT
Facilities and personnel
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20. 20
Space
 Sufficient for storage of reference
collection and provision of service
Office Equipments
 Computer
 Photocopier
 Telephone
 Filing cabinets
 Shelving
 Desks, chairs
 Journal display rack
 Internet access

21. Location
– Should be readily accessible to all prospective
users
– Located within;
• The Hospitals
• Medical or Pharmacy association
• Drug regulatory Authority
• Ministry of Health
– Located to have ready access to a good
facilities like internet
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22. Personnel
• Requires a Registered Pharmacist
– Education and Training
• Formal DI training
• Computer-based information System
• Experience –ward and clinical-based
experience is particularly desirable
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23. • Competence in evaluation, selection and utilization
of the Professional literature
• Good written and verbal communication skills
• Knowledge of clinical drug use and therapeutics
• Knowledge and acceptance of the legal and ethical
responsibilities
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Particular Skills Needed

24. 2. RECEIVING AND ANSWERING DRUG
INFORMATION REQUESTS
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25. • An essential component within drug information
service is the ability to effectively answer
questions posed by health care professionals and
individual patients
• There are various methods for receiving,
researching, and providing answers to drug
information questions. ……However, most DICs and
pharmacists follow a basic pattern.
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26. • More than providing an answer to a question, they
should provide solutions to therapeutic problems
• Isolated therapeutic answers do not usually provide
adequate solutions
• Responses should follow thoughtful process that
aims at extracting the relevant information and
synthesizing relevant answers
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27. In 1975, Watanabe et al. presented a systematic
approach for responding to drug information
requests. The systematic approach comprised of five
steps
Step 1: Classification of the request
Step 2: Obtaining background information
Step 3: Systematic search
Step 4: Response
Step 5: Re-classification
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28. Modified systematic approach
Step 1: Secure demographics of requestor
Step 2: Obtain background information
Step 3: Determine and categorize the ultimate question
Step 4: Develop strategy and conduct search
Step 5: Perform evaluation, analysis and synthesis
Step 6: Formulate and provide response
Step 7: Conduct follow-up and documentation
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29. Step 1: Secure demographics of requestor
• Gather general demographic information about the
requestor.
• Assessing the sophistication of the requestor allows
information to be provided that best meets an
individual’s needs…. determine the requestor’s
position, training, and anticipated knowledge
• Secure a mechanism for delivery of the response….
telephone number(s), fax number, and/or address
(mail or e-mail) or location
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30. Example 1:
• If a patient and a physician inquired about how the
new medication Prandin®/Repaglinide works (i.e.,
pharmacology), the depth of the response would
differ for each individual.
Answer 1
• The new medication is the first agent approved in
the meglitinide class and is a nonsulfonylurea
insulin releasing oral hypoglycemic agent for type 2
diabetes mellitus.
Answer 2
• The new medicine acts by improving the way your
body processes sugar. 30

31. Step 2: Obtain background information
• The responder must utilize good communication
skills and ask thoughtful, pertinent questions of the
requestor to characterize fully precise information
need.
• Background information helps to clarify the
question and is a critical step in the process.
• When background questions are utilized
appropriately, the response to information requests
or inquiries is very efficient.
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32. Obtain background information…
• The requestor’s name
• The requestor’s affiliation (institution or practice) if
a health care professional
• The resources that the requestor already consulted
• Whether the request is patient specific or academic
• The patient’s diagnosis, other medications, and
pertinent medical information
• The urgency of the request (i.e., negotiate the time
response)
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33. Example 2:
• A pharmacist is asked, "what is the dose of
amoxicillin (Amoxil®)?”
• This question could be answered quickly (and
potentially inaccurately) by stating that the normal
dosage as 500 mg every eight hours.
• The question also could be answered by gathering
background information concerning the origin of
the question.
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34. • If an information request pertains to a
specific patient, the following patient-
specific background Information might be
required in order to formulate an
appropriate response:
–age, weight, type of infection, concurrent
disease states, other medication
–relevant past medical history including
allergies
–preferred dosage form 34

35. Step 3: Determine and categorize the ultimate
question
• Determining the ultimate question is accomplished easily
once sufficient background information is obtained.
• Often the initial question differs significantly from the
ultimate of final question.
• Once the ultimate question is identified and clear, the
drug information specialist can then quickly categorize
the request into various categories before begin the
search.
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36. The questions can be categorized under:
• Adverse drug reaction,
• Availability,
• Complementary and Alternative medicine,
• Compounding,
• Dose,
• Drug compatibility/stability,
• Drug interactions,
• Drug identification,
• pediatric dose, etc..
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37. • The major purpose of this categorization is to
minimize the search timing and increase the
specificity.
• Example: In the previous example above, the
amoxicillin request pertains to a dose. Therefore,
this question would be classified as Dose.
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38. Step 4: Develop strategy and conduct
search
• The categorization of the request or enquiry prompts
(on time) the resource selection process. For
example, the categorization of a question as “adverse
effect” suggests the use of adverse effect oriented
resources.
• Once resources have been selected, they are
prioritized based on the probability of their
containing the information or data desired.
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39. Example 3:
• In the previous example above, the amoxicillin
request pertains to a dose.
• The following are examples of references that
provide this information:
– American Hospital Formulary Service (AHFS),
– Facts and Comparisons,
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40. Step 5: Data evaluation, analysis and
synthesis
• The pharmacist should confirm information with
other references to assure consistency between
various resources.
• The pharmacist should apply his or her techniques
and skills for literature evaluation and clinical
application for statistical analysis
• This step requires strong literature evaluation skills
• Knowledge of Evidence based medicine, study
design, research, and statistical concepts is essential
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41. Step 6: Formulation and provision of response
• After careful analysis and synthesis of
information, the drug information specialist
formulates a response and then accurately
conveys the response back to the requestor of
information.
• This requires strong verbal and written
communication skills.
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42. Format for logical argument in response
formulation
Step I. Present the competing viewpoints or considerations
Step II. State the assessment of the literature or
information reviewed and claim the superior viewpoint
Step III. Briefly disprove the major strengths and present
weaknesses of the inferior viewpoint
Step IV. Defend the major weaknesses and promote the
strengths of the superior viewpoint
Step V. Restate the final assessment in support of the
superior viewpoint.
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43. Step 7: Follow-up & documentation
• Follow-up is the process of verifying the
appropriateness, correctness, and completeness of
a response following the communication.
Certain circumstances command follow-up:
• Patient-specific requests especially if judgmental
(i.e., therapeutic assistance or dosing
recommendations)
• Any situation in which a therapeutic decision was
dependent on assumptions or “soft” data
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44. • Thorough documentation is essential for reducing
liability and potentially promoting the development
of a continual service.
• The ultimate question (as verified by the requestor),
the materials searched (with pertinent findings
noted), the response, and follow-up should be
documented.
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45. Assignment
1) A caller requests information regarding the use of aspirin
for the prevention of preeclampsia.
• What specifics regarding caller demographics should be
secured?
• What questions should be asked to obtain background
information from the caller?
• Categorize the question and develop possible search
strategies.
2) Select pertinent drug related issues and prepare news
letter
3) Use given format and systematic approach to fill the drug
query and response
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46. Reference
• C. R. Kothari, Research Methodology, Methods
and Techniques, 2nd Revised Edition, 2004.
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47. THANK YOU !!!
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