P03S06: Benzodiazepines (sedation for a test)
Bottom line: Information on benzodiazepines was used to maintain the management of the patient (sedation in
preparation for a test). There were no information-related patient health
outcomes.
Level 1 outcome (situational relevance): On December 16, 2008, P03 did a search at work, with a nurse educator,
and before an encounter with a patient. They retrieved two information hits
about Versed and impaired cognition. The reported search objectives were: to address a clinical question, to
share the information with a patient or caregiver, to exchange information with
other health professionals, and to plan, manage, coordinate, delegate or
monitor tasks with other health professionals. “[The patient was a] woman [in her] early fifties. […]
We were going to be sending this patient for a test, for scope, for which she
needed to be sedated with Midazolam. And she wasn’t diagnosed with Alzheimer’s
but she is having some cognitive changes. She likely will soon be diagnosed so
I just wanted to make sure that there was no contraindication for her having
the sedation, or if it was going to extend the life of the drug or anything
like that. […] I wanted to be able to tell the patient that it was safe to have
the sedation or to warn them that the side effects may be prolonged or whatever
the case may be. So I just wanted to have a better understanding to share with
the patient. […] The nurse educator was also working with this patient and had
other patients that are similar, so I wanted to make sure that she was aware of
the plan.” According to P03,
the information from e-Therapeutics+ was more relevant than the information
from another paper-based resource (The Merck
Manual of Geriatrics). “[I
found] nothing specifically to talk about Midazolam [in the other resource].”
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive cognitive impact (see table). Regarding practice
improvement, P03 stated: “I gained knowledge in this area where I wasn’t confident in my
knowledge. […] I would know how to better prepare patients for tests that have
some risk of cognitive impairment, if they can be using these drugs. […] I was
not sure [and I learned something] (regarding P03S06H01).”
Retrieved information hit(s):
1) e-Therapeutics+ (CIRT): e-CPS tab – Versed – Midazolam HCL -
Benzodiazepines (CPhA monograph) – Contraindications,
warnings and precaution (P03S06H01).
2) e-Therapeutics+ (CIRT): e-CPS tab – Versed – Midazolam HCL –
Benzodiazepines (CPhA monograph) – Table 3: Benzodiazepines –
drug interactions (P03S06H02).
Level 3 outcome
(information use): Information on Versed and Alzheimer’s was retrieved, and used to
maintain (be more certain about) the management of the patient (information used
as presented in e-Therapeutics+). “I later met with
the patient and proceeded to tell them about the test they were going to have
[endoscopy] and the information related to the drug that they would get for the
test. […] The plan was for the patient to go ahead with the test. I was checking
to make sure that it was safe to do so (regarding both hits).”
Level 4 outcome (patient health): Without this information, P03’s management of the patient would have
been the same. There were no clear relationships between the use of
information and expected patient health outcomes.
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 Motivated to learn |
Be more certain |
No outcome |