Drug Information Center: School of Pharmacy and Health Professions, Creighton University Medical Center

You should arrive at 10 am on the first morning of clerkship. You will need your laptop, lab coat and name tag. The first day will consist of orientation to the clerkship, computer set up, and a literature searching refresher course.

The first 2-3 afternoons of this rotation will involve a training class in conjunction with the library reference staff. This takes place from 330pm until 5pm. This is a very helpful class to re-familiarize you with searching the literature.

Drug information questions come in at all times, so be prepared to start answering questions on the first day.

What we do and do NOT do <Back to top>

We do…

Take questions from health professionals primarily regarding drugs and drug therapy.
Receive requests primarily from phone calls, but also through email and fax.
Receive questions on a very broad range of topics including dietary supplements, lab test monitoring, disease management, manufacturer information, etc.
Provide support to CUMC P&T committee.
Assist P4 students on clerkship, provided the preceptor is involved.

We do NOT…

Take calls from the general public.
Work on assignments for pharmacy or other health professions students. If a student asks you to help with a project, contact your preceptor before doing so.
Serve as an article retrieval or copy service. If callers just want a copy of an article, refer them to the library reference desk. If it is a faculty member asking, talk to one of the DI preceptors.

Hours of Operation & Rules of the Center <Back to top>

The Center is open every business day Monday thru Friday from 830 am to 430 pm.

Although the start time is 10 am on the first day, everyday thereafter the start time will be at 830 am.

Dress: professional dress (minimum of business casual) is required.
Visitors: Visitors are permitted, but be courteous to your fellow classmates. If you are going to have an extended conversation with a visitor, please go outside the Center.
Food and drink: Permitted within reason.

Contact information <Back to top>

Voice: 280-5100 or 280-5101

Toll-Free: 800-561-3728

Fax: 280-5149

Primary Preceptors

HSL Rotation <Back to top>

Philip Gregory, PharmD, Coordinator, Drug Information Residency

Office: 280-5118

Pager: 978-0081

Zara Risoldi Cochrane, PharmD, Drug Information Specialist
Office: 280-5161

Pager: 978-0149

Amy Wilson, PharmD, Director, Center for Drug Information & Evidence-Based Practice

Office: 280-3269

Pager: 978-157

CUMC Rotation

Anne Bruckner, BS, PharmD, Drug Information Specialist

Office: 280-5158

Pager: 978-1223

All preceptors will be involved in evaluating your rotation experience.

Syllabus & Grading <Back to top>

To review the syllabus and grading, click here.

Student Responsibilities <Back to top>

Your primary responsibility while on drug information clerkship is answering drug information questions. Answering these questions should come before any other projects or assignments. Therefore, if you have any pending question to answer, please complete that question before working on a project.

In addition to questions, you will have various projects as described in this manual.

You are expected to approach this work with a professional attitude and make every attempt to produce high-quality work. Everything done in the Center will be used on a professional level. Remember that there is a patient on the other end of everything you do.

As a courtesy to your colleagues, please be on time. If the phone rings, answer it. Do not wait for your colleagues to answer it for you.

The Center is sometimes very busy. Other times it can be slow. If it is slow and you are caught up on your assignments, be professional and ask your colleague if you can help them out. Alternatively, ask a preceptor if there are any other projects you can help out with.

Playing computer games, reading leisure books, chit-chatting, inappropriate web surfing, or otherwise wasting time is unprofessional and should be avoided.

We encourage you and expect you to make the most of your experience while you are here.

Getting set up <Back to top>

You will need to set up your laptop to print and to get access to the Drug Information Question Database. We will help you set this up on the first. Here are some instructions to get started:

Installing the printer:

Left click on start, select run, in the box type \\spahpprint , click OK, it will search and then show a list of printers, select the DICsavin2522 and double click on it, once the printer has been installed set it as the default.

Accessing the Drug Information Database:

All consultation requests and responses must be documented in the Drug Information Database. Get detailed instructions on using this database.

Introduction to receiving & answering questions <Back to top>

We receive questions most often by phone, but also by email and fax.

How to answer the phone

“Creighton Drug Information Service, this is xxxxxxx” or something similar. Please always state your name so the caller knows who they are talking to.

When you receive a question

· Make sure you get adequate background information in order to determine the ultimate question. If you don’t get the background information initially, you might have to call the requester back to clarify.

· Fill out the information request form and immediately enter into the database.

· Think about and write down your search methodology.

· Consult with the preceptor to let them know you have received a new question BEFORE starting to research your question.

Before you answer a question

· Discuss your response with the preceptor. The preceptor must “sign off” on your response before you give ANY answer. This applies even to simple tablet identification questions. Failure to check with the preceptor BEFORE responding to any question is grounds for failure of this rotation.

· EVERYTHING must be documented in your response in the DI database. We need to know all of the background of the question (even if you think it is unimportant), where you looked (even if you didn't find anything there), and details of your proposed response, whether it is to be written or discussed verbally.

Written Responses to Questions (i.e., Formal Response)

· All written responses must be in the proper memo format. Question examples are available in the DI database for your review (see links below)

See memo template

See sample responses: Minimal complexity, Moderate complexity, High complexity

· All responses must be properly formatted including an introduction, methodology, results, and conclusion. All responses must be written clearly, concisely, and appropriately to answer the question. This means good grammar, no misspellings, etc. Do not ask your preceptor to review a document that you have not already thoroughly proofed and corrected for spelling and grammar.

· All responses must be properly referenced using the reference format from the literature evaluation course (i.e., AMA style).

See quick reference guide to referencing

· If you have any questions, ask a preceptor BEFORE your start.

Document your responses

· All responses, written and verbal must be documented in the Drug Information Database. This must occur before the question is sent out. All responses must be documented using the standard format described in the template (intro, methodology, results, conclusion, recommendations). This must be done for both written and verbal responses.

Emails

· Any email communications with users of the DI service, must be courteous and in written in a letter-like format. This means that you address the email (e.g., start with Dr. Abc) and signed (e.g., Sincerely, Ed Pharmacist, PharmD Candidate).

· All emails should have a subject line include.

Phone Calls/Fax

· A special code is needed to make long-distance phone calls. Just ask the preceptor to enter the code when you need to make a long-distance call.

· Personal calls using the phones or fax in the DIC are not permitted. You can take personal calls on your own cell phone, just be courteous to your fellow classmates.

Confidentiality

The questions you receive are considered confidential. Do not share with others outside of the drug information clerkship. This is private information to be shared only between you, the caller, and the preceptor.

Lawyers and Media

Occasionally we get calls from lawyers or media or other people wanting quotes or research for legal cases, etc. In the event that you receive a call like this, find your preceptor or take a message and the preceptor will call the person back.

Monographs & Class Reviews for P&T <Back to top>

Students may be involved in developing a monograph or class review for the CUMC or Childrens Hospital P&T Committee.

Monographs and class reviews follow a similar format, but monographs only cover one drug in a class. Class reviews compare and contrast all drugs in a class.

This format may be modified for specific reasons. Ask your preceptor before making any formatting changes.

Students completing a monograph or class review may present their monograph or class review at the P&T committee. Your preceptor will let you know the day and time.

See Appendix 1 for a sample monograph and class review from CUMC.

Drug Use Evaluations

During the rotation, all students will be responsible for assisting in data collection for an ongoing quality project at CUMC. This Drug Use Evaluation (DUE) will allow practitioners responsible for quality initiatives at the hosptial to review data and make evidence-based decisions about policy and procedures. During the first week of the rotation, you will receive background information on the project you will be involved with, as well as technical training for data searching and retrieval. Appendix 2 below contains examples of DUE data and results. <Back to top>

Drug Info Lunch Date Presentations <Back to top>

All students on the HSL Drug Information Rotation will have the opportunity to present one of their drug information consultations at a "Drug Info Lunch Date" session. These sessions occur on Tuesdays during weeks 4 and 5 of the rotation.

Your topic for presentation will be selected during the first 2-weeks of the rotation. You and your preceptor will work together to select an appropriate topic. Topics considered appropriate for presentation should be interesting, timely, and practical.

If you get a consultation request that you think fits these criteria, alert your preceptor. Topics must be selected by the end of the second week of your rotation.

Your presentation will be prepared using PowerPoint slides. Each presentation will be no longer than 15 minutes long. It should focus on the most pertinent and practical information. Each presentation should follow the general format of a consultation response including introduction, methodology, results, and conclusion. Like your consultation request, the ultimate goal is to give practitioners information that they can use.

You will work with your preceptor to finalize the slides for your presentation.

Journal Club <Back to top>

Each student on drug information rotation will present a journal club article.

For an example of how to conduct a good journal club presentation, watch this video. (**Note: pay attention to what is said rather than what is shown on the screen. We have changed the format of journal club since this video was taken).

Purpose

There are at least three goals of journal club during this clerkship:

Keep up-to-date with current literature on drug therapy.
Gain experience in literature evaluation.
Practice presentation skills

Responsibilities of the Presenter

· Select an appropriate journal article to review (see below)

o Provide a copy of your article to each student and faculty member at least one week before your presentation day.

· Critically evaluate your article. Use this evaluation tool to help identify strengths, weaknesses, and limitations of the study.

· Summarize your evaluation of the article in written form (see example below). Distribute this document the day of your presentation.

· Present your article and your critical evaluation orally during your selected time. Focus on providing practical information and putting the article into context.

· DO NOT read your hand out as your presentation.

· Your presentation should last no longer than 15 minutes.

· Discuss the article with your colleagues.

Responsibilities of the Participants

· Review the article selected by the presenter ahead of time. Come prepared to discuss.

· Listen to the evaluation of the presenter.

· Ask relevant questions.

· Discuss your evaluation of the article with your colleagues.

Criteria for Choosing your Article

· Current – preferably something within the last 3-6 months; nothing older than 12 months.

· Relevant – choose articles most relevant to our profession (i.e., drug therapy). Avoid articles that focus on diagnostics or disease state epidemiology, etc. Ask yourself: “Will this study impact or change my practice in any way?” If the answer is ‘yes’ then you have a good article.

· Try to pick a topic you think participants will find interesting and important to them. This makes the whole process much more fun.

Journal Club Presentation Format <Back to top>

Citation: Enter the journal article citation

Question: State the research question or hypothesis of the study. What is the question the authors intended to answer by conducting the study?

Background/Introduction: In this section explain the background of the issue the study is trying to address. Explain why it is important to us and why we need to know about this topic. If you have difficulty explaining why it is important you may need to reevaluate whether you've selected an appropriate article.

Study Overview: In this section give an overview of the study. Focus on key information about study design and methodology, and results. Remember, make your presentation practical. When you discuss results make sure you include pertinent, practical information about the treatment effect. This include providing relative risk, absolute risk, and number needed to treat when applicable.

Discussion: In this section, discuss the meaning of the study. Describe what you think this study tells us and what questions you think this study does not answer. Describe limitations and explain how the the limitation affects our interpretation of the findings. Finally, and most importantly, put the study into context. Tell us how the study fits into the big picture. Does it change our practice? If so, explain how. Without understanding the context of findings from new studies, we cannot apply the findings.

Newsletter <Back to top>

Each student will be responsible for creating a newsletter article during the rotation. Students will work together to publish an electronic newsletter, based on our established template, containing all the articles. Topics for newsletter articles will be determined the preceptor. Newsletter articles should be focused for a professional audience, and must be fully referenced. Following a peer-review process, the newsletter will be distributed electronically to local, regional and national practitioners. Click here for examples.

Appendix 1. Monograph & Class Review Instructions and Examples <Back to top>

Monograph template, click here

Sample monographs: Micafungin, Daptomycin

Appendix 2. DUE instructions and examples <Back to top>

To see a sample of DUE criteria/Data collection sheet, click here.

To see a sample of a completed DUE, click here.

Appendix 3: Select Tertiary Resources <Back to top>

ADVERSE REACTIONS AND SIDE EFFECTS

Major References

Meyler's Side Effects of Drugs

American Hospital Formulary Service (AHFS) Drug Information

Facts and Comparisons

Martindale's Extra Pharmacopoeia

Physician's Desk Reference (PDR)

Textbook of Adverse Drug Reactions (Davies)

U.S. Pharmacopeial Dispensing Information (USP-DI)

Drugdex

AMA Drug Evaluation

Product labeling

Handbook of Poisoning

Clinical Toxicology of Commercial Products

Drug Effects in Hospitalized Patients (Miller and Greenblatt)

FDA Drug Bulletin

For Antibiotics

The Use of Antibiotics

Minor References

The Pharmacological Basis of Therapeutics (Goodman and Gilman)

Secondary References

Clin Alert

International Pharmaceutical Abstracts (IPA)

Index Medicus/Medline

Poisindex

AVAILABILITY

Major References

U.S. Availability

American Drug Index Manufacturer

Facts and Comparisons PharmIndex

Drug Topics Redbook PDR

Blue Book Physician’s Generex

Drugdex USAN and USP Dictionary

Foreign Availability

Martindale's Extra Pharmacopoeia

Index Nominum

Drugs Available Abroad

Foreign Equivalents of PDR

Minor References

Handbook of Nonprescription Drugs

Medical Letter

Facts and Comparisons Newsletter

Pharmacists Letter

CHEMICAL PROPERTIES

Major References

Merck Index

AHFS Drug Information

Martindale's Extra Pharmacopoeia

Remington's Pharmaceutical Sciences

USP-National Formulary

COST INFORMATION

Major References

Drug Topics Redbook

Blue Book

Manufacturers and wholesalers

Physician's Generix

Minor References

Facts and Comparisons

Medical Letter

DOSING AND ADMINISTRATION

Major References

AHFS Drug Information

AMA Drug Evaluations

PDR

Facts and Comparisons

USP-DI

Martindale's Extra Pharmacopoeia

Drugdex

For Pediatrics

Harriett Lane Handbook

Textbook of Pediatrics (Nelson)

Pediatric Therapy (Shirkey)

Pediatric Dosage Handbook (Taketoma, Hodding, Kraus)

For Renal Patients/Hemodialysis

Bennett's Nomogram

For Geriatrics

Geriatric Dosage Handbook (Semla, Beizer, Higbee)

DRUG INTERACTIONS

Major References

Hansten's Drug Interactions

Evaluations of Drug Interactions (Shinn)

Drug Interactions Facts

Minor References

AHFS Drug Information

Meyler's Side Effects of Drugs

Facts and Comparisons

Drugdex

AMA Drug Evaluations

Note: Also consider additive pharmacologic properties or additive toxicities. May need to use pharmacology, chemistry, stability, or adverse effects references too!

DRUG IDENTIFICATION

Major References

American Drug Index

Facts and Comparisons

Drugdex

Ident-A-Drug

Poisindex

Martindale's Extra Pharmacopoeia

USAN and USP Dictionary

Merck Index

PDR

Drug Topics Redbook

Blue Book

By Imprint Code

Identidex

PDR

Pictures

PDR

USP-DI

PDR Identification Kit

IMMUNIZATION INFORMATION

Major References

Report on the Committee on Infectious Diseases

Morbidity and Mortality Weekly Report (MMWR)

CDC-Health Information for International Travel

AHFS Drug Information

Guide for Adult Immunization (ACP)

INVESTIGATIONAL DRUGS

Major References

Martindale's Extra Pharmacopoeia

Drugdex

NCI Investigational Drugs: Pharmaceutical Data

PharmIndex

Medical Subject Headings--Suppl Chemical Records

NDA Pipeline

Orphan Drugs

Drugdex

Facts and Comparisons

Treatment IND

Facts and Comparisons

AHFS Drug Information

Secondary References

Unlisted Drugs

IPA

Iowa Drug Information Service (IDIS)

Periodicals

Phase III Trials

"Pink Sheet" FDC Reports

LABORATORY INFORMATION

Major References

Interpretation of Diagnostic Tests (Wallach)

Diagnostics

Clinical Interpretation of Laboratory Tests (Wiomann)

Clinical Diagnosis by Laboratory Methods

Clinical Laboratory Medicine (Ravel)

For Lab/Drug Interactions

Effects of Drugs on Clinical Laboratory Tests (Young)

Hansten's Drug Interactions

AMA Drug Evaluations

AHFS Drug Information

For Antibiotics

Use of Antibiotics in Laboratory Medicine (Lorian)

LAWS AND REGULATIONS

Major References

State and Federal Law

State Pharmacy Practice Act

State Board of Pharmacy Regulations

Pharmacy Law Digest

Code of Federal Regulations

Pharmacy Law Texts

Federal Register

MANUFACTURER'S ADDRESSES AND PHONE NUMBERS

Major References

PDR

Facts and Comparisons

Poisindex

Clinical Toxicology of Commercial Products

Martindale's Extra Pharmacopoeia

Minor References

American Drug Index (addresses only)

NATURAL PRODUCTS

Major References

Integrative Medicine Access

Martindale's Extra Pharmacopoeia

Natural Medicines Comprehensive Database

PDR for Herbal Medicines

Poisindex

Professional's Handbook of Complementary and Alternative Medicine

Review of Natural Products

PATIENT INFORMATION

Major References

USP-DI Volume II: Advice for the Patient

Patient Drug Facts

PHARMACOKINETICS

Major References

Applied Pharmacokinetics (Evans, Schentag, Jusko)

Drugdex

AHFS Drug Information

Basic Clinical Pharmacokinetics (Winters)

Applied Clinical Pharmacokinetics (Mungall)

USP DI Volume III

Minor References

Goodman and Gilman

PDR

Handbook of Clinical Drug Data

Martindale's Extra Pharmacopoeia

PHARMACOLOGY

Major References

Goodman and Gilman

Clinical Pharmacology (Melmon and Morrelli)

AHFS Drug Information

Minor References

PDR

POISONING/TOXICOLOGY

Major References

Poisindex

Clinical Toxicology of Commercial Products

Clinical Management of Poisoning and Drug Overdose (Haddad, Winchester)

Handbook of Poisoning (Dreisbach)

Poisoning-Toxicology-Symptoms-Treatments

Montana Poison Control Center 1-800-525-5042

Minor References

AHFS Drug Information

PREGNANCY AND LACTATION

Major References

Drugs in Pregnancy and Lactation (Briggs)

AHFS Drug Information

USP-DI

PDR

Pediatrics 1989;84:924-36

Handbook of Clinical Drug Data

Drugdex

Drug Therapy in Obstetrics and Gynecology (Rayburn)

Drugs and Human Lactation (PN Bennett and WHO Working Group)

Clinical Aspects of Teratogenicity of Drugs (Nishimura, Tanimura)

STABILITY/INCOMPATIBILITY

Major References

Handbook on Injectable Drugs (Trissels)

Guide to Parenteral Admixtures (also called Kings or Cutter Manual)

AHFS Drug Information

Drugdex

Manufacturer

Secondary References

IPA

THERAPEUTIC USE OF DRUGS

Major Medical References

Practical Care for the Ambulatory Patient (Stultz, et al)

Manual of Medical Therapeutics (Washington Manual)

Textbook of Medicine (Cecil)

Harrison's Principles of Internal Medicine

Harvey's The Principles and Practice of Medicine

Current Therapy (Conn)

Merck Manual of Diagnosis and Therapy (Berkow)

The Pathologic Basis of Disease (Robbins)

Pharmacy Therapeutic Texts

Applied Therapeutics for Clinical Pharmacists (Koda-Kimble)

Clinical Pharmacy and Therapeutics (Herfindel, et al)

Pharmacotherapy. A Pathophysiological Approach (DiPiro)

AHFS Drug Information

Martindale's Extra Pharmacopoeia

AMA Drug Evaluations

Drugdex

Handbook of Nonprescription Drugs

For Antibiotics or Infectious Disease

The Use of Antibiotics

A Practical Approach to Infectious Diseases (Reese RE, Betts RF)

Guide to Antimicrobial Therapy (Sanford)

Appendix 4: AHFS on Excel

Students will help with the AHFS classification review process required by JCAHO @ CUMC.