Push technology in the pharmacy: clinical decision support helps the pharmacy department of a South Carolina medical center automate monitoring of medication effectiveness - Medication management: case history

Health Management Technology, Jan, 2003 by David Amsden

Specific Results for Year 2000

# of alerts generated by the system:    36,640
# of patients with monitoring alerts:   14,740
# of interventions from these alerts:    5,776

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It's Saturday night in an urban emergency department (ED). Two young men bring in their friend, a young woman, who is unconscious. "She's been messing with Georgia Home Boy," they tell the admitting nurse, and leave. It's a potential life-and-death situation, but what's the medical issue? A sexual assault? A fight?

MICROMEDEX has recently improved POISINDEX, its toxicity database, so a quick check of a hand-held device reveals that "Georgia Home Boy" is a slang term for Gamma Hydroxybutyric Acid, or GHB, an illegal drug that induces a sense of euphoria and intoxication. The drug is sometimes mixed with alcohol to intensify its effects, which can result in respiratory depression and coma. The ED staff can now take proper steps to treat the young woman.

This addition to POISINDEX provides a searchable database of more than 4,000 slang street drug terms to allow doctors to quickly determine what a patient has taken when they don't know the real name of the drug. There are more than 70 identified slang terms for amphetamines, and more than 130 common street names for crack cocaine, all available from a laptop computer or hand-held device.

Many of these slang terms are regional in nature, so even a seasoned emergency physician from one part of the country may not be familiar with phrases used in another area.

To develop and maintain the database, company researchers surveyed practitioners nationwide, researched and verified the survey results, and organized the resulting data into a searchable database. The company sampled from all areas of the country to ensure that as many regional slang variations as possible would be included. Also, clinicians are surveyed regularly to ensure that new street drugs and terms are consistently updated.

By looking up the slang term, clinicians can find not only what has been taken, but also quickly get symptoms, likely uses (e.g., if the drug is usually taken with alcohol, etc.) and best practice treatments.

"In an emergency situation, seconds count. This information would not be as useful for professionals if it were a book kept in a specific room of an ED," says Dr. Rich Klasco, chief medical officer at MICROMEDEX. "By making the information available at the point of care with minimal disruption to workflow, this tool that can make a difference in patients' lives."

David Amsden, Pharm.D., B.C.N.S.P., is a pharmacy manager of Palmetto Health Richland, Richland, SC.