P01S05: Pneumonia (drug interaction)
Bottom line: Information on pneumonia was used to justify the management
of the patient (Levaquin). It contributed to avoid an inappropriate treatment
(Doxycycline).
Level 1 outcome (situational relevance): On June 11, 2008, P01 did a search at work, by themselves, and after
an encounter with a patient. They retrieved one information hit about drug
interactions. The reported search objectives were: to address a clinical
question, to share the information with a patient, to exchange information with
other health professionals, and to plan, manage, coordinate, delegate or
monitor tasks with other health professionals. She's a patient that has dementia, and I was seeing
her in a house call for one of the doctors here that was away, and the
patient's level of consciousness and her mental functioning had declined
suddenly, even though she had dementia, so they want me to go in and see her,
and she was on a number of medications. And it turned out that I thought she
had pneumonia, so I wanted to treat her for pneumonia. And she was 94 years
old. [
] I wanted to put her on Levaquin [or Doxycycline]. [
] The clinical
question was just: does anything that she's on interact with the new medication
I want to give her? [
] There must have been about 10 medications that she was
on [
]. There was a caregiver who was taking care of her in her home. She
doesn't take her medication herself. So I was just teaching her [the caregiver]
that that was the drug that we were going to give her for the 10 days. [
] I
also had to make sure that the medication she was on coincided with what we
had. [
] [And her] physician had come back the next day, I just kind of shared
with him that this is what I did with the patient. [
] [And] I was planning on
a follow-up. According to P01, e-Therapeutics+ was
the only source for information, and the retrieved information was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive
cognitive impact (see table). Regarding practice improvement, P01 stated: It's very
helpful to know what drugs interact with what other drugs, and it also helps me
remember for future reference, which drugs. [
] So I'm slowly getting to know
so I won't have to look them up every time. And to understand why they
interact, not just yeah they interact.
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): Drug
interactions tab levofloxacin, doxycycline,
Aricept, Risperidone etc. extract on Levaquin (P01S05H01)
Level 3 outcome
(information use): Information on Levaquin was retrieved for
a patient, and used to justify the management of the patient since P01
hesitated between two antibiotics (information used as presented in
e-Therapeutics+). I ended up giving her
Levaquin because it [e-Therapeutics+] showed that it was the least one to
interact [
]. There was some reason I could not give her Doxycycline [
]. I [used
e-Therapeutics+] to justify [the treatment] meaning that I was saying this
[Levaquin] is what I'm going to use, and here is the evidence that says that
it's appropriate to use this one.
Level 4 outcome (patient health): Regarding patient health, P01 reported that the information
contributed to avoid an inappropriate treatment. I just wanted to get the right drug, so
that I wasn't using something that was not appropriate for her or one that
might be harmful. [
] I wanted to make sure it was an acceptable drug, didn't
have any side effects for this lady or cause her to even decline further. [
] I
just wanted to make sure it that it was going to fix her pneumonia, and that
I'm not just finding one thats acceptable but is not going to treat her
pneumonia.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information Manage patient care |
Practice improved Learned something Confirmed Reassured |
Justify choice |
Avoid |