P16S02: Adverse effect of an anticoagulant

Bottom line: Information on an adverse reaction of an anticoagulant was used to better understand a specific issue regarding a patient (metallic taste associated with Warfarin medication). It contributed to increase patient knowledge, and to avoid an inappropriate procedure (e.g. switch to another drug) or unnecessary health care visit (e.g. referral to another MD).

Level 1 outcome (situational relevance): On December 13, 2008, P16 did a search at work, by themselves, and after an encounter with a patient. They retrieved two information hits about Metallic taste of Warfarin. The reported search objectives were: to address a clinical question, to share information with a patient, and to exchange information with other health professionals. “The patient [a man between fifty and sixty years old] had recently started on Warfarin and had been experiencing a metallic taste, and was wondering whether or not it could be related to the Warfarin. […] So I kind of looked into it and said that we’d get back to him. […]The doctor wanted to know the answer […] as well.” According to P16, e-Therapeutics+ was the only source for information, and the found information was relevant.

Level 2 outcome (cognitive impact): The second hit was associated with a report of positive cognitive impact (see table). Regarding practice improvement and learning, P16 stated: “I identified an adverse reaction. I was able to identify a side effect that we hadn’t seen before [the metallic taste]. […][Now] when we first see a patient to start on anticoagulation, we can provide that information up front to them.”

Retrieved information hits:

1) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Warfarin – Warfarin sodium – Coumadin – Precautions (P16S02H01)

2) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Warfarin – Warfarin sodium – Coumadin – Adverse effects (P16S02H02)

Level 3 outcome (information use): Information on Metallic taste & Warfarin therapy was retrieved, and used to better understand a specific issue regarding a patient (information used as presented in e-Therapeutics+). “[I wanted to understand why] the patient was experiencing the metallic taste in his mouth.”

Level 4 outcome (patient health): Regarding patient health, P16 reported that the information contributed to increase patient knowledge, and to avoid inappropriate procedure. “[...] When I saw the patient in the following session I was able to pass on the information to the patient so that he was aware of the cause of the metallic taste.” […] We [P16 and the doctor] were able to explain that the effect was related to his treatment. [...] We were able to narrow down what could have caused it, and then sort of avoid further exploration of the issue.”

Levels of outcome of information-seeking

Situational relevance	Positive cognitive impact	Information use	Patient health
Address a clinical question Share information Exchange information	Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured	Understand issue	Avoid Patient knowledge

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