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