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Practitioner access to the Internet: A necessity in a modern hospital

From the March 20, 2002 issue

PROBLEM: A patient was scheduled to donate platelets at a hospital lab. During the process, patients are asked about the types of medication that they are taking because certain ones exclude them from donating. The patient reported that he had been taking ULTRACET (acetaminophen 325 mg and tramadol 37.5 mg), a relatively new analgesic from Ortho-McNeil. Lab staff was unfamiliar with this product and called the pharmacy to determine what it contained. The pharmacist found that Ultracet was not listed in any of the available drug reference texts. When he checked Micromedex, the program threw him a curve and immediately brought up a different drug with a very similar name, "Ultracef," which
is the former name for DURICEF (cefadroxil), a cephalosporin antibiotic. These look-alike trademarks and others that are so remarkably alike can lead quickly to confusion and errors.

Because the pharmacist could not find Ultracet in Micromedex or other drug reference texts, he told the lab staff that the patient must have meant that he was taking "Ultracef." Since antibiotics exclude patients from donating platelets, the patient was told he was not eligible at this time. Since he had taken time off from work for this altruistic purpose, he persisted. He maintained that his medication was not an antibiotic, but the lab would not agree to do the procedure. The patient then contacted the pharmacist directly to insist that he look at the Ortho McNeil web site for information about Ultracet. The pharmacist did not have Internet access and had never considered using this up-to-date resource to seek out drug-related information. When he contacted the company through other means, "Ultracet" was properly identified and the patient was able to donate platelets.

SAFE PRACTICE RECOMMENDATIONS: In many hospitals, senior managers may be reluctant to allow Internet access to staff because they are concerned about staff visits to web sites that are not related to work. For information, they assume that textbooks and computerized drug information programs will be able to meet all needs. As the above example shows, this clearly is not the case. For example, during the analysis of error reports and other medication safety-related issues, much of the research performed by ISMP staff requires access to drug and health device manufacturer web sites to obtain information on their new products. We also have found that investigation into unapproved uses of drugs, special medical procedures, and many other hard-to-find topics, is much more effective and efficient when using information found through an Internet search.

In addition to its value as an education and communication tool, staff can access reliable sites (e.g., ISMP, ASHP, FDA, USP) for up-to-date information about drug shortages, hazard alerts, error reporting, and other crucial medication safety issues. With the information explosion in healthcare today, clinician access to the Internet has become a necessity, not a luxury. While appropriate controls and monitoring may be needed, no pharmacy or clinical area should be without it. This means that access should not be restricted to managers' offices, which often are closed to clinical staff after hours. In fact, access to the Internet is particularly important in facilities without 24-hour pharmacy services. In the hospital above, the Internet is now available to clinical staff. Also, Micromedex reports that they've corrected the most up-to-date release of the program for this month. A query for Ultracet now correctly presents results for tramadol and acetaminophen.

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