The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions

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The pitfalls of pragmatic research Pharm-assist
Using PDAs to assist in Pharmacy decisions

• Pip Divall
• Clinical Librarian
• University Hospitals of Leicester NHS Trust

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PDAs in Leicester

• Previously run trials with Foundation Year
  doctors
• Knowledge in the Palm of Your Hand
• Personal Digital Assistants for Foundation
  doctors Handheld knowledge in the clinical
  setting. (Article in preparation)

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Pharm-ASSIST

• Does using a PDA loaded with drug information
  increase the number of interventions made by a
  Pharmacist on the medical wards?

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Primary Outcome

• To assess how often a Pharmacist on the medical
  wards uses a PDA resources to check, alter, or
  amend drug charts for patients and for what
  reasons
• Checking doses / frequency or duration and
  safety.
• Checking guidelines
• Checking appropriateness of treatment for
  patients
• Checking details of unfamiliar diagnoses
• Researching evidence for treatment

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Design

• An evaluative before and after audit to assess a
  PDA reference tool Doctors Companion. There
  will be a 28 day period of data collection
  without the use of the PDAs, followed by a 14 day
  lead-in period to become used to the
  functionality of the resources, and a further 28
  day period in which the resources will be
  evaluated in the Pharmacy department at
  University Hospitals of Leicester NHS Trust.

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Pitfall 1

• Design of data collection tool we worked with
  Pharmacy team to find out what we needed them to
  record to measure our primary outcome
• Issues of whether to record time taken, which
  items most important

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Pitfall 2

• Having the resource ready to use at the end of
  the 28 day data collection period
• BNF 53 publication threw schedules

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Pitfall 3

• Working with an area the library does not usually
  interact with
• Have Assistant Chief Pharmacist on board, Head of
  Medicines Information very busy people!
• Difficult to get in touch with Pharmacists, but
  much easier than doctors!

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Study materials

• Already have a stock of PDAs used in previous
  trials
• Many staff now have PDAs of their own

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Pitfall 4

• Some of the existing PDAs are old run the
  software slowly.
• This may interfere with data collection add
  another barrier to use of software
• Benefit the new SD cards are multiplatform, so
  not limited by hardware

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Additional considerations

• Response rate we have a discrete group who are
  easy to track, yet some baseline data still
  missing
• All data collection tools should be tested
  ready to go!

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Pitfall 5 Too many cooks

• Design by committee can lead to holes in
  methodology
• Someone else was supposed to be doing that
• Clear roles
• Delegation

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Audit or research?

• Whats the difference?
• Is ethical approval necessary?
• Audit and research cannot be distinguished in a
  reliable or valid way.
• Wade, DT, Ethics, audit, and research all shades
  of grey. BMJ  2005330468-471 

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The Outcome

• Watch this space!!