P01S09: Anti-diarrheal drug
Bottom line: Information on an anti-diarrheal drug for Crohn’s disease was used to maintain the management of a
patient (narcotic prescription). There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On October 27, 2008, P01 did a search at work, by themselves, and
after an encounter with a patient. They retrieved one information hit about
Lomotil (antidiarrheal drug). The reported search
objectives were to address a clinical question, and to look up something they
forgot. “[The patient] was a woman, […]
about sixty to sixty five, […] who had come in for prescription refills and she
was a new patient of mine. […] She has Crohn’s
disease and she’s been on Lomotil for a while so I gave her a prescription
refill for everything except for the Lomotil because I told her: “I am pretty
sure that that’s a narcotic and I can’t prescribe it [RNPs cannot prescribe
narcotics], but I’ll have to get back to you”. […] The patient had left, and I told that she’d have to come
pick up the prescription later. […] I was
going to write the prescription for the patient on a regular prescription pad
for the doctor to co-sign. […] I was looking for the name of the drug that was in Lomotil. […] I
was certain it was a narcotic and I just wanted to verify that before I went
ahead and put it on a prescription pad for her.” According to P01, the information from e-Therapeutics+ was in
agreement with and equally relevant as the information from another health
professional (a doctor colleague). “I knew it was a
narcotic but I also thought it might have been on a triplicate prescription,
which is a special type of narcotic, I talked to the doctor and told him that
this patient needed Lomotil he had said it’s a triplicate. I had to fill in a
triplicate for that prescription.”
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice improvement, P01 stated: “[In the
e-CPS,] the
“n” with the circle just meant it was a narcotic, and I couldn’t prescribe it. It just
makes it quicker to know which drugs are narcotics so that I don’t have to keep
searching them up. I was searching them, looking them up all the time.”
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab – Lomotil –
introduction section (P01S09H01).
Level 3 outcome
(information use): Information on Lomotil was retrieved for a patient, and used to better
understand a specific issue with respect to the management of a patient, and to maintain (be more certain about) the
management of this patient (information used as presented in e-Therapeutics+).
“I got
the prescription…the triplicate prescription from the physician and he filled
it out. He advised me that it was triplicate, and then I called to patient to
let her know she could come and pick up. She only had three days to pick up or
the triplicate becomes invalid, and so she had picked up.”
Level 4 outcome (patient health): Regarding patient
health, P01 did not associate the information with any health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten |
Practice improved Learned something Reminded something Confirmed Reassured |
Be more certain Understand issue |
No outcome |