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Pharmacist's Role in Providing Drug Information

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Pharmacist's Role in Providing Drug Information Medication Therapy and Patient Care: Specific Practice Areas–Guidelines 471 ASHP Guidelines on the Pharmacist’s Role in Providing Drug Information Background and Rationale pharmacist should have the skills to perform the following DI activities2,3: The provision of drug information (DI) is among the fun- damental professional responsibilities of all pharmacists. 1. Providing DI to patients, caregivers, and health care Recent practice trends, including increased provision of professionals. medication therapy management services and efforts to 2. Creating and maintaining currency of a variety of print obtain provider status, have placed pharmacists in increas- and online educational resources for patients (e.g., tip ingly complex patient-care roles and necessitated a higher sheets, pamphlets) and health care professionals (e.g., level of competence by all pharmacists in meeting DI needs. in-service documents, newsletters) on topics such as Drug information may be patient specific, academic (for optimal medication use, general health, or select clini- educational purposes), or population based (to aid in the cal questions. decision-making process for evaluating medication use for 3. Educating health care professionals on safe and effec- groups of patients). The goal of providing carefully evalu- tive medication-use policies and processes, including ated, evidence-based recommendations to support specific development of resources to communicate this infor- medication-use practices is to enhance the quality of patient mation. care, improve patient outcomes, and ensure the prudent use 4. Leading or participating in continuing education ser- of resources. The primary focus of these guidelines is to de- vices for health care professionals. scribe contemporary DI activities, including the application 5. Precepting and educating pharmacy students and resi- of a systematic approach, appropriate documentation meth- dents. ods, and use of high-quality DI resources. This information 6. Participating in quality improvement research projects is intended to assist pharmacists in providing optimal DI ser- and drug cost analyses. vices in a variety of practice settings, including hospitals and 7. Contributing to the biomedical literature and providing health systems, outpatient care centers, managed care envi- peer review for other contributors. ronments, medical communication departments, and univer- sity or academic-based drug information centers. Some of Some activities may be more appropriate for pharmacists the activities described in these guidelines are the subjects with additional expertise and training in DI, such as those of other American Society of Health-System Pharmacists who have completed a postgraduate year two (PGY2) drug (ASHP) policy and guidance documents, which should be information residency. Drug information specialists often referred to for additional information. Pharmacists providing perform DI activities that overlap with other pharmacists DI should use professional judgment in assessing ASHP’s and health care professionals. However, as a result of their policy and guidance documents and in adapting them to advanced training and experience, DI specialists may be meet their health care organizations’ and patients’ needs and able to more efficiently retrieve, evaluate, and disseminate circumstances. information in order to develop evidence-based recommen- dations and assist in patient care decisions.2 Many DI spe- Drug Information Activities cialists are also involved in medication-safety activities and collaborate with experts in informatics. These activities are highlighted in other ASHP statements.4,5 Specific activities To be an effective provider of DI, the pharmacist must ex- of the DI specialist may include some or all of the follow- ercise excellent oral and written communication skills and ing2,6-11: be able to 1. Providing information when there is not sufficient time 1. Anticipate and evaluate the DI needs of patients and for other health care professionals to appropriately re- health care professionals. search the DI question, when there is a knowledge gap, 2. Obtain appropriate and complete background or when the question requires more thorough research. information as described under the section Systematic 2. Establishing and maintaining a formulary based on sci- Approach for Responding to Drug Information entific evidence of efficacy and safety, pharmacoeco- Requests. nomics, and institution-specific factors. 3. Use a systematic approach to address DI needs by effectively searching, retrieving, and critically 3. Coordinating programs to support population-based evaluating the literature (i.e., assessment of study medication practices that maximize patient outcomes design, statistics, bias, limitations, applicability). (e.g., development of pharmacotherapeutic guidelines, 4. Appropriately synthesize, communicate, document, medication-use evaluation criteria, and therapeutic in- and apply pertinent information to the patient care terchange protocols). situation.1,2 4. Developing and participating in efforts to prevent medication errors and adverse drug events, includ- A variety of DI activities may be performed by pharmacists, ing surveillance, ensuring institutional compli- depending on the particular practice setting and need. Every ance to Risk Evaluation and Mitigation Strategies 472 Medication Therapy and Patient Care: Specific Practice Areas–Guidelines (REMS), and leading reporting and analysis programs ing a response.1,13 The importance of gathering pertinent pa- (e.g., MedWatch). tient data and understanding the context of a question prior 5. Monitoring and assessing the clinical significance of to answering a DI request is described in the literature.14-16 medication safety alerts communicated by the FDA, drug Of note, a full systematic approach may not be practical for manufacturers, and other sources. all requests, especially for urgent clinical needs in the di- 6. Performing health outcome and comparative effec- rect patient care setting. In addition, consideration should tiveness analyses. be given to the ethical and legal aspects of responding to DI 7. Coordinating investigational drug services, including requests, including patient privacy concerns.1 participating on institutional review boards (IRBs), A systematic approach may be outlined as follows.1,13 evaluating protocols, and providing DI to patients, caregivers, and health care professionals. 1. Identify the requestor. In order to obtain complete in- 8. Managing drug shortages, including identify- formation and develop a response with the appropriate ing alternative treatments, developing proto- perspective, consider the health literacy and profes- cols for restrictive use, and addressing formulary sional background of the requestor. concerns. 2. Define the true question and information need. 9. Developing clinical decision support tools such as or- Identify the true question and information needed by der sets, dosing protocols, and order-entry alerts. asking probing questions of the requestor. For exam- 10. Maintaining DI and medication-use policy-related in- ple, “Why is the question being asked?” and “Does tranet resources. the question pertain to a specific patient?” may help 11. Precepting or providing advanced DI education and reveal important details of the true question.1 This training to interprofessional and pharmacy students kind of information helps in optimizing the search and residents. process and assessing the appropriate time frame of 12. Coordinating selection and purchase of pharmacy and response need. institution-wide DI resources. 3. Obtain complete background information. Obtain 13. Participating in various fee-for-service projects (e.g., more complete background information, including formulary support, database development, training examining the medical record for patient data, if ap- programs) for clients. plicable, to individualize the response to meet the re- 14. Planning and delivering academic detailing programs. questor’s need. 4. Categorize the question. Classify requests as patient- Although the above activities may be best suited for phar- specific or academic and by type of question (e.g., macists with advanced DI training, many institutions lack product availability, adverse drug event, compatibility, a formal DI specialist. Therefore, other pharmacists may compounding/formulation, dosage/administration, drug be involved in more in-depth DI activities, depending on interaction [drug-drug, drug-disease, drug-laboratory], their level of expertise. For example, preparing drug mono- drug product identification, pharmacokinetics, thera- graphs for pharmacy and therapeutics committees was once peutic use/efficacy [FDA approved vs. unlabeled indi- considered almost exclusively the responsibility of the DI cations], safety in pregnancy/nursing toxicity/poison- specialist. As pharmacy practice has evolved, the expertise ing) to aid in tailoring the search strategy and selecting and knowledge of all pharmacy practitioners have been inte- resources. grated into this process. 5. Perform a systematic search. Perform a systematic Today, depending on the institution, pharmacists search of appropriate tertiary, secondary, and primary without specialized DI training may prepare monographs, resources, including electronic resources, as necessary. assist in the design of medication-use evaluation criteria, 6. Analyze the information. Evaluate, interpret, and com- participate in medication monitoring activities,
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