P23S05: Gastro-Oesophageal Reflux Disease
Bottom line: Information on Gastro-Oesophageal
Reflux Disease (GERD)
was used to justify the management of a patient (decrease the dose of
domperidone). It contributed to return of the symptoms (negative short-term
outcome), which led to re-increasing the drug dose (no long-term outcomes).
Level 1 outcome (situational relevance): On May 4, 2009,
P23 did a search at work, with a colleague (nurse), and after an encounter with
a patient. They retrieved one information hit about domperidone. The reported search objective was: to address a clinical
question. “He [the hospitalized patient, a 1-year old boy], had multiple
malformations and one of them [was causing] gastro-oesophageal
reflux. He was treated with domperidone 4 times a day before each meal because
he was vomiting a lot. [...] That was my first
day during the rotation, I didn’t know the patient before. The nurse
mentioned to me that the dose the patient is taking is higher than the maximum
acceptable dose. So I did a search, because I wasn’t aware of the dose [in children]. I realized that indeed the dose he was taking was
higher, a bit higher than normal. […] My question was
what is the maximum recommended dose of domperidone in children?” According to P23,
e-Therapeutics+ was the only source for information, and the found information
was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive
cognitive impact (see table). Regarding practice improvement and learning, P23 stated: “There was
information that I didn’t know before [maximum
recommended dose in children]. […][It will
improve my practice as] I will use the recommended dose of domperidone in children.”
Retrieved information hit:
1) e-Therapeutics+
(CIRT): eCPS Tab – Domperidone – CPhA Monograph
– Dosage and administration – Recommended
dose and dosage adjustment – Maximum
recommended dose is 2.4 mg/kg/day (P23S05H01)
Level 3 outcome
(information use): Information on domperidone was retrieved, and used to justify the management of a patient
(information used as presented in e-Therapeutics+). “The patient had not been vomiting for the last week. I decided to
decrease the dose to the maximum acceptable dose. I think he was taking before
7.5 mg 4 times a day, so I decreased it to 5. [...] In this particular patient,
the purpose of the search was to find what was the recommended dose to treat
the patient, to make sure that we control the vomiting without having any side
effects of giving too much medication.”
Level 4 outcome (patient health): Regarding
patient health, P23 reported that the use of the found information contributed
to return of the symptoms (negative short-term outcome), which led to re-increasing
the drug dose (no long-term outcomes). “[Later
on the baby] started to vomit again so we had to increase the dose again above the
maximum acceptable dose. [...] [Since
then] I think he was fine. I mean, for the last 2-3 days uh, there was no
vomiting.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Practice improved Learned something Motivated to learn |
Justify choice |
No outcome |