Learning Objectives
After completing this application-based continuing education activity, pharmacists will be able to
- Recognize key elements of a drug information request
- Describe a typical process for researching drug information requests
- Prioritize information in the final written response
- Identify the best language to use based on the inquiring party’s needs
After completing this application-based continuing education activity, pharmacy technicians will be able to
- Identify questions that are within the pharmacy technician’s scope of practice
- Recognize tools and resources to use when attempting to answer a drug information question
- Complete the steps to completing a drug information request that is within the pharmacy technician’s scope of practice
Release Date: September 15, 2023
Expiration Date: September 15, 2026
Course Fee
Pharmacists: $7
Pharmacy Technicians: $4
There is no funding for this CE.
ACPE UANs
Pharmacist: 0009-0000-23-035-H01-P
Pharmacy Technician: 0009-0000-23-035-H01-T
Session Codes
Pharmacist: 23YC35-PXK63
Pharmacy Technician: 23YC35-KPX44
Accreditation Hours
2.0 hours of CE
Accreditation Statements
The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Statements of credit for the online activity ACPE UAN 0009-0000-23-035-H01-P/T will be awarded when the post test and evaluation have been completed and passed with a 70% or better. Your CE credits will be uploaded to your CPE monitor profile within 2 weeks of completion of the program. |
Disclosure of Discussions of Off-label and Investigational Drug Use
The material presented here does not necessarily reflect the views of The University of Connecticut School of Pharmacy or its co-sponsor affiliates. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.
Faculty
Sumoda Achar
PharmD and MBA Candidate 2024
UConn School of Pharmacy
Storrs, CT
Shelly Evia
PharmD Candidate 2024
UConn School of Pharmacy
Storrs, CT
Stefanie Nigro, PharmD, BCACP, CDCES
Associate Clinical Professor
UConn School of Pharmacy
Storrs, CT
Jeannette Y. Wick, RPh, MBA
Director Office of Pharmacy Professional Development
UConn School of Pharmacy
Storrs, CT
Faculty Disclosure
In accordance with the Accreditation Council for Pharmacy Education (ACPE) Criteria for Quality and Interpretive Guidelines, The University of Connecticut School of Pharmacy requires that faculty disclose any relationship that the faculty may have with commercial entities whose products or services may be mentioned in the activity.
Samoda Achar, Shelly Evia, Jeannette Wick, and Stefanie Nigro do not have any relationships with ineligible companies.
ABSTRACT
Pharmacists and pharmacy technicians often field questions from patients or other healthcare providers. Pharmacists may be more accustomed to answering questions than pharmacy technicians are, but that doesn't mean that pharmacy technicians can't answer appropriate questions. Pharmacy staff members should know their scope of practice and be willing and able to answer questions that fall within the scope of practice. Using an organized approach can help pharmacy staff members answer questions efficiently and effectively. Documentation is also an important aspect of drug information questions, as is saving the information in case it is needed later.
CONTENT
Content
INTRODUCTION
A drug information (DI) request is a medication-related question posed by any interested party, but usually a healthcare professional or a patient. As the healthcare team’s drug expert, one of a pharmacist’s main duties is answering these queries effectively and providing an answer that is appropriate for the inquirer’s level of expertise. Pharmacy technicians and pharmacy interns also answer some drug information questions (see TECH TALK SIDEBAR). This continuing education activity outlines various drug information questions that pharmacy staff field most often and describes a methodical approach to ensure pharmacy staff answer requests effectively and accurately.1
TECH TALK SIDEBAR: Questions within the Pharmacy Technician’s Scope of Practice?2,3
Pharmacy technicians and interns can answer general questions that are within the bounds of their education and training. That vague statement requires some interpretation. If the answer is common knowledge (not specialized pharmaceutical knowledge), technicians can answer. In addition to working with supervising pharmacists to interpret the statement, pharmacy technicians and interns need to know state law governing their scope of practice.
Pharmacy technicians and interns are often the first point of contact for customers who want over-the-counter (OTC) medications. Technicians can answer general questions about ingredients if the information is on the label. Some examples include
- Does this product contain acetaminophen? What brands of acetaminophen do you stock?
- Where are the medicines for pain?
- Is there a less expensive generic or store brand for this product?
- Do you have any [insert name of prescription medication] in stock?
- Do I need to refrigerate this liquid antibiotic?
- What does “analgesic” mean?
- What does “sustained release” mean?
- Is this prescription for a controlled substance?
- Why can’t I refill this prescription today?
Pharmacy technicians and interns can also convey information from the pharmacist but should be careful. A PRO TIP is that if technicians or interns don’t understand what the pharmacist says, they should ask the pharmacist to make the information clearer. And if the answer is long or complicated, they should write it down and recite it back to the pharmacist before transmitting it to the person with the question.
Helping customers find specific medications or classes of medications is within the technician’s scope of practice. When patients have questions about their medications, doses, and how best to administer them, technicians may hesitate to answer. If the information is clearly printed on the prescription label, on the auxiliary labels, or contained in an FDA-approved Medication Guide, the technician or intern can answer.
Technicians and interns need to work with the supervising pharmacist to determine if they can answer other questions. When in doubt, technicians should consult with or refer the question to the pharmacist. Technicians and interns must refer questions about potential adverse effects, administration problems, possible alternative medications, and clinical issues to the pharmacist. Before referring the patient, they can collect some baseline information. They cannot counsel or give advice, even if the medication is OTC.
Depending on the practice setting, the nature and complexity of DI requests can vary. Being able to answer DI requests is every pharmacy employee’s responsibility (although the type of information varies and at a certain level, the response is the pharmacist’s primary responsibility). Having an organized approach to answering DI questions is highly relevant when working within the community and hospital settings.4
Pharmacy employees who work primarily within a community setting can expect to receive DI requests from patients and from practitioners. These requests can range from asking about drug storage requirements (which a technician can usually answer) to consequences of taking an OTC medication in combination with prescription drugs, to requests regarding the safety of a medication for an uncommon or off-label indication. Pharmacists who work in hospital settings can expect to receive most DI requests from colleagues within the care team. For instance, a DI request could come from a prescriber asking about medication absorption and distribution in a patient with comorbid conditions, or from a nurse asking if a medication can be crushed. Pharmacists who work in industry settings, however, may receive medication information requests that vary greatly from those received in clinical settings.4
All DI requests require referencing reliable materials and sometimes, various internal policy or research documents. While DI requests are diverse, they all require similar analysis of sources and communication to provide a quality answer. Because pharmacy employees at different levels of responsibility can answer DI questions, this continuing education activity will call the person asking the question the requestor and the person finding the answer the respondent.
SCREENING THE REQUEST
One of the most confounding situations in the pharmacy occurs when someone asks a question, the respondent spends times finding an answer, and then the requestor says, “Oh, that’s not what I needed to know!” Sometimes, requestors don’t really know how to ask questions effectively. This is a problem that all customer service fields encounter, and answering DI requests is both a clinical function and a customer service. It’s why when you call many customer service lines, the customer service representative will say, “OK, what I hear you asking is….” and then rephrase the question.5
To answer DI requests effectively, the respondent must thoroughly understand the question.5 Very specific questions tend to be easily answerable, while others are more general or vague. In both instances, respondents need to ensure they understand the question. They can rephrase the question in their own words and say, “Let me make sure I understand. Do you mean….”, or they can use open ended questions (questions that cannot be answered with a yes or a no) to ask the requestor to provide more information. This avoids answering a question that wasn’t asked or intended or was poorly formulated.
Often, requestors don’t know how to ask a question that will provide the information they need. The hallmark of this type of question is that the requestor may use jargon inappropriately or words that don’t seem to make sense. Respondents can say, “Excuse me, I’m not sure I understood entirely. Can you rephrase the question?” or “Pardon me, but I didn’t quite understand the question. Can you tell me a little more about what you want to know and why?” That final word—WHY—provides the impetus for the requestor to provide necessary information.
Once the question has coalesced and both parties agree on its intent, the respondent can solicit important details from the requester and, if applicable, the patient, before delving into a search. At this point, the respondent needs to spend time actively listening to the requestor’s explanations.
This can be difficult if the requestor is long-winded, difficult to understand, or cognitively impaired, so it requires patience. Here’s a PRO TIP for listening: it’s called the traffic-light-rule.6 During the first 30 seconds (which seems like a short period of time, but is actually relatively long), the requestor’s “talking light” is green. Pharmacy staff should let them talk. In the next 30 seconds, the requestor’s light is yellow: pharmacy staff probably have enough information and should make note of comments or questions. After one minute, the requestor’s talking light is red: pharmacy staff should be comfortable stopping the requestor politely or asking questions.6
Before continuing, review the following DI requests. How would you proceed? Later in this activity, we’ll provide a description of the ideal process.
Pharmacist DI request #1: TN, 35-year-old obese female (BMI = 32.4 kg/m2) with uncontrolled type 2 diabetes will start on an atypical antipsychotic today to manage schizophrenia. TN’s psychiatric nurse practitioner (NP) calls with questions about drug selection. The NP mentions that TN’s drug formulary lists aripiprazole, haloperidol, olanzapine, and quetiapine as tier 1 preferred options. The NP wants your opinion as to which atypical antipsychotic may be most appropriate to prescribe for TN. What do you suggest?
Pharmacist DI Request #2: You work at a tertiary care internal medicine center. MS, an 80-year-old female, was recently admitted to the medicine floor. She had fallen when she was trying to use the restroom at her nursing home and presented to the emergency department with a wrist fracture. She suffers from insomnia and other comorbidities. Her medication list includes lisinopril 20 mg daily, metformin 500 mg twice daily, rosuvastatin 20 mg daily, and lorazepam 0.5 mg PRN anxiety and sleep. The nursing home staff states that MS received more doses of lorazepam in recent weeks. The medical resident believes that the increased lorazepam use could have contributed to the fall and wants to know if trazodone would be a safer replacement for MS’s insomnia. How do you respond?
Technician DI Request #1: I left this medication in my bathroom for four days, and then I noticed it says, “Keep in the refrigerator.” My house is cold, and the bottle didn’t feel warm. Is this still good, and if it isn’t, what should I do?
Technician DI Request #2: My child is having trouble swallowing her medication and refuses to take it. Are there any easier ways I could give it to her?
Identify Critical Information
Although it may seem counterintuitive, beginning with the end in mind is critical and the person gathering information must determine the requestor’s preferred response format. This means asking how the requester wants to receive the response. The respondent will need to adjust the answer according to the requestor’s preferences. Some requestors will want to wait for an answer. If the information is to be communicated through email or an electronic medical record, respondents may use their organization’s required format (a SOAP note or similar formats; see Table 1), but formats used in medical records may not be the most efficient approach in person or over phone. In person or on the phone, respondents need to use a more conversational tone. Furthermore, the respondent will need to determine the requestor’s level of medical competency and tailor the response accordingly. If the requestor is a patient, it is more appropriate to use simple language than if a provider asked the same or similar question. Respondents will have to evaluate these factors critically to provide a sound and comprehensive answer.7
Table 1. Formats for Communicating Critical Information8,9
Communication Format | Parts of the format | Uses |
SOAP | S: Subjective information
This section includes descriptive information about a patient’s symptoms, feelings and experiences.
O: Objective information This section includes pertinent lab values, imaging, or diagnostic tests.
A: Assessment In this section the subjective and objective information are taken into consideration to make an assessment regarding the patient's disease states.
P: Plan/ Follow Up This section outlines a detailed plan regarding the patient's treatment and the follow-up and monitoring required. |
This format is a widely-used written format in healthcare. It helps organize pertinent patient information and efficiently present an answer. This format is especially useful when the respondent must consider multiple pieces of information. |
ISBAR | I: Introduction
Introduction of the pharmacist and the respondent, and the pharmacist’s role and location.
S: Situation What are the current events regarding the patient?
B: Background What has happened in the past with the patient?
A: Assessment Identify the problem at hand and make assessments regarding the patient's disease state.
R: Recommendation Outline the next steps and your plan. |
This format is beneficial for verbal communication. It helps the presenter explain the problem at hand and the solution in a time efficient way. |
TITRS | T: Title
Introduction of who you are and your purpose in helping the patient.
I: Introduction Present the patient and the problems that the patient needs help with.
T: Text State subjective and objective information that is necessary to support any recommendations.
R: Recommendation Outline the treatment plan in a clear, complete, and concise manner.
S: Signature Include name, title, and phone number. |
This format is beneficial when a brief and concise formal consult is needed to communicate a progress note towards a medical team. |
Assess the Urgency of the Response
While it is critical to provide an appropriate response for the question, doing so in a timely manner is just as critical. Asking the requestor is the simplest way to determine the expected response time. However, many times the requestor isn’t present or cannot be reached, and it is up to the respondent to determine which questions require immediate responses and which may not. Clinically critical topics include
- Medication safety: does the DI request ask if a certain therapy could cause or have caused harm to the patient?
- Time sensitivity of the treatment: how important is timeliness to the treatment and disease progression?
- How much of a concern is the problem to the requestor: does it seem that the requestor needs an immediate response?
Sometimes, respondents don’t know the answer to the question immediately.10,11 Pharmacy staff will never be able to answer every question, but they can handle every question gracefully and provide a complete, accurate answer within a reasonable time. When they don’t know the whole answer, they should answer what they can immediately and tell the respondent that they need to do a little more research to answer the remainder. A PRO TIP is to tell the requestor when to expect an answer (and to be sure to follow through).10-12
Obtain Sufficient Background Information
In simple words, this step is about getting to know the patient or problem or establishing a strong understanding of the patient’s relevant characteristics by obtaining background information. Since some patients have low health literacy, obtaining this information can be a challenge. However, narrowing the search to only include relevant information and filtering unnecessary information can make the process more efficient. This could be achieved by7
- Asking targeted questions to patients. For example, instead of asking patients if they take their medication regularly (a closed-ended question that can be answered with yes or no), asking when they last took their medications provides a more precise answer.
- Identifying avenues that can provide accurate information. For example, instead of asking patients what other medications they take, checking the local profile and/or contacting their community or specialty pharmacist to receive a medication list can be more accurate.
- Reviewing any available records like medical charts or dispensing records.
Identify Extraneous Information
Obtaining complete information is important but ensuring that the information is pertinent to the question being asked is just as important.
Many times, DI requests are in-depth and require researching two or more sources before arriving at an answer. While conducting this search, ensure that the sources are relevant to the problem at hand. For example, if a study suggests that a medication is contraindicated in a patient, determine if the patient’s characteristics are similar to the study’s population. Furthermore, extraneous information could come from data gathering as well. For example, a patient may have multiple diseases, but they may not all impact the problem at hand. Making this distinction is important to provide a thorough and accurate answer.7
Answers to Pause and Ponder
Pharmacist DI request #1: Haloperidol is not an atypical antipsychotic; therefore, it would be eliminated immediately and the remaining atypical antipsychotics would be reviewed as outlined below:
Screen Request | Pertinent patient information: past medical conditions (uncontrolled diabetes, schizophrenia). Medications on tier 1 of patient's formulary: quetiapine, olanzapine, haloperidol, aripiprazole. |
Reformulate Request | This is a therapeutics drug information request because the provider is looking for the best medication to treat the patient's schizophrenia without adding any contraindications to the patient's current medication list or concomitant medical conditions. |
Formulate Response | The provider made the request in writing, so a written response is most appropriate. The SBAR format would succinctly and effectively convey the message. First, we conducted a Google search and a tertiary source search (PubMed) including the pertinent patient information and request. Our search read "effects of antipsychotics on obesity and diabetes." Through this, we determined that some antipsychotics lead to changes in metabolic activity. Because the patient has diabetes that is exacerbated by weight gain, the best choice is an antipsychotic that does not have a significant effect on the metabolism. After conducting a more thorough primary source search on the metabolic effects of antipsychotics, we found that the best drug would be aripiprazole. Additionally, monitoring the BMI and efficacy would be appropriate. |
Assess Understanding | Provide the response in a professional and timely manner. Document the request to display accountability and in case there is a similar question in the future. Follow up with the requestor to access the outcomes and ensure that there are no lingering questions or concerns. |
Pharmacist DI request #2: Off-label use of low-dose (25 to 100 mg) trazodone, a decades-old antidepressant with drowsiness as a side effect, is common.13 In fact, off-label usage for insomnia has surpassed its use for depression.14 The American Academy of Sleep Medicine does not recommend trazodone because of limited supporting data. A 2018 Cochrane review found equivocal evidence supporting its short-term use for insomnia, but little data on long‐term safety and efficacy exists.15 The Beers Criteria doesn’t highlight trazodone as a potentially inappropriate medication in older adults, not because of evidence demonstrating safety, but because of lack of studies demonstrating harm. However, a retrospective cohort study found low-dose trazodone was no safer with respect to fall-related injury risk than benzodiazepines among 15,582 nursing home residents aged 66 years and older. Future studies need to confirm trazodone’s safety with respect to other risks such as dependence, withdrawal, and cognitive impairment.16
Technician DI request #1:
It would depend on the medication. Some medications, like amoxicillin, are refrigerated to preserve the taste while most others, such as insulin, are refrigerated to preserve the compound. The technician should ask what medication the patient is referring to and then look up the specific storage requirements for that medication. Some places where this information is available include Drugs.com (https://www.drugs.com/medical-answers/drugs-that-require-cold-storage-166784/) and (https://www.iehp.org/en/members/helpful-information-and-resources?target=emergency-safety). If the medication is not listed in these resources or the medication’s stability has possibly been compromised (such as exposure to extreme heat), the technician should consult the pharmacist.
Technician DI request #2:
It would vary depending on the medication. Some medications have specific coating that needs to stay intact to ensure proper drug delivery, and such medications should not be crushed. Other medications do not have such restrictions and can be crushed, split in half, sprinkled in foods like applesauce, or have a liquid formulation that can be considered as an alternative with a doctor’s approval. The technicians should ask, “What medication is your child taking so that I can look it up?” Information regarding which medications can be crushed can be found in the following website https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2014/Aug/Meds-That-Should-Not-Be-Crushed-7309. If the medication or the specific dosage form is not available on the list, the technician should ask the pharmacist to review the medication.
Recognize when to ask for additional support or information. While drug information requests can be challenging, involving other healthcare professionals to hear about their experiences with similar clinical situations can offer a new perspective. Some benefits of consulting with experts include formulating a patient-specific answer to the question whereas a study may be irrelevant. When the request requires analysis beyond the scope of a drug information search, it is appropriate to reach out to a professional. While this may take additional time, arriving at the correct answer is more important than to harm the patient unknowingly. And a PRO TIP is that if reaching out will mean you cannot answer the question in the time frame promised, contact the requestor and say you need more time and why.
REFORMULATING THE REQUEST
To ensure the core request is clear, the respondent will need to ask many questions, especially if requesters don’t know what question they need to ask. Before starting to research the answer, respondents need to gather information needed from the requestor. In addition, it’s prudent to identify resources the requestor has already consulted (and their reliability in case information needs to be corrected).
Categorize the Request
Requests can be based on complex patient specific cases, for educational purposes, or geared towards a decision-making process in medication therapy for a specific patient demographic. To fully optimize patient care and provide evidence-based recommendations, it is helpful to ask specific questions and consider all factors pertinent to the specific DI request. Categorizing the request can help stay on track, address all concerns, and point the respondent to the appropriate resources. Table 2 lists common categories and the questions that can clarify the request.
Table 2. Common DI Categories and Related Questions1
DI Category | Related Questions |
Allergy/Cross-reactivity
|
Does the patient have any documented allergies?
What caused or is suspected to have caused the allergic reaction? When did the patient take the medication, and when did the reaction occur? What type of allergic reaction occurred? Is this a class or drug specific effect? |
Alternative, or Complementary Medicine
|
Where did the patient obtain the medication?
Why is the requestor taking or interested in taking the medication? What other medications or treatments are available? |
ADR/Safety
|
What are the possible side effects?
What monitoring parameters need to be considered? |
Compatibility (Y-site, syringe, IV)
|
What solution will medication be used in?
If applicable, how will the medications be administered? |
Dosage/Route/Administration
|
What is the route of administration?
What is the recommended therapeutic dose for pediatrics, adults, and geriatrics? How should the medication be taken (with/without food, with water, etc) |
Drug Identification
|
What was the source of the medication (e.g., domestic or foreign)?
What is the generic and brand name? Where did the medication come from? |
Ingredients/Stability
|
What physical conditions exist? (Temperature, light protectant, storage duration, diluents)
Are there IV admixture compatibility/non-admixture stability data available? |
Interactions
|
What are the possible interactions between:
● Drug-drug ● Drug-food ● Drug-lab ● Drug allergy |
Kinetics
|
What is the onset/half-life/duration?
What are the serum levels? Is dialysis a consideration? What is the medication’s bioavailability? |
Pharmacoeconomics
|
Are there other competitors on the market?
Are there cheaper alternatives with the same therapeutic effects? What is the AWP pricing? |
Pharmaceutics
|
What is the drug route of administration and drug dosage?
What patient factors will affect the drug? Age, weight, gender, organ function, current medications |
Pharmacology | What factors will affect drug metabolism and bioavailability? |
Pregnancy/Lactation | What health conditions does the mother have?
What medications is the mother currently taking? What is the current trimester? How long has the mother been taking the medication or expected to take this medication? Will the drug be present in breast milk? How will the drug affect the infant? What is the infant's age? What health conditions do the mother and infant have? Was the infant a full term or premature delivery? |
Vaccinations
|
Is the vaccination appropriate for the patient?
What are some side effects to monitor? When should the patient get the vaccination? |
Therapeutics
|
What is the desired effect?
Is the goal cure or prophylaxis? What previous medications and doses has the patient used? Is this medication being used for an FDA approved or off-label use? |
Toxicity
|
What are possible sequelae?
What management strategies are available? |
Abbreviations: ADR = adverse drug reaction; AWP = Average Wholesale Price; FDA = Food Drug Administration; IV = Intravenous
Finding Reliable Sources
Being able to locate sources efficiently and correctly for a DI request is very important. Three main types of sources are available: primary, secondary, and tertiary.
- A primary source is any original research found in journals. Examples of primary sources are trial results found in the New England Journal of Medicine (NEJM) or similar journals in which researchers use a trial design to answer a specific question. (Note that NEJM and similar journals also publish secondary source materials, too.) This is the strongest Limitations of using this evidence include lack of access to journals that require paid subscriptions and lack of good search skills to find relevant papers.
- Secondary sources analyze, interpret, present, or restate information from primary sources. Textbooks, books and review articles, commentaries, guidelines, and Medline are examples of secondary sources.
- Tertiary sources compile information from other sources and organize it. Lexicomp , Micromedex, and DynaMed are common tertiary sources for DI requests as they use information from Food and Drug Administration-approved complete prescribing information (package inserts) and clinical studies. One limitation to be aware of is these sources are not updated rapidly therefore the information could be old and outdated.
Determine the Best Source
When evaluating DI requests, in most cases the best course of action is to start with tertiary sources, such as textbooks or DI databases, when possible.1 These platforms provide a starting point and often suggest a basic idea for the answer. For many DI requests such as dosage, half-life, or adverse effects, the tertiary resource may provide a sound answer. Requests asking to compare two medications’ efficacy or assess the appropriateness of an uncommon or off-label medication use may require further research. Databases that identify off-label use include Micromedex. In such cases, a primary source is the best resource. References sections of databases like DynaMed and Micromedex can be a great start for finding appropriate primary sources. Using search engines such as MEDLINE, PubMed or Google Scholar (scholargoogle.com) can provide access to relevant primary literature as well.1 Reviewing two to three sources is good practice for most drug information requests. Respondents must determine the relevance of the studies by evaluating if the trial size was large enough to be statistically reliable, if its findings were clinically significant, and if the patient population is similar to the patient.
Use General Search Engines Appropriately
Using general search engines like Google, and Microsoft Edge can be an acceptable starting point for a search. A metasearch engine is usually better. A metasearch engine is a platform that aggregates the results from multiple search engines and organizes them based on their relevance. Examples of metasearch engines include Dogpile, ixquick, and Metacrawler which aggregate information from sources like Google and Yahoo as well as videos posted on various platforms.
Researchers must consider the following factors when determining a source’s credibility17:
- Is the information’s original source listed and reliable?
- Does the funding for the site come from a sound source such as a university (.edu), an established patient advocacy organization or a professional society (.org), or a government-funded organization (.gov)?
- How is the information presented and how is it supported?
- Who wrote the article on the webpage? Is the author a credible healthcare provider or a journalist writing about a medical topic?
- Is the information updated and verifiable with other sources?
Table 3 matches types of information and reliable sources to find information.
Table 3. Finding Reliable Sources for Drug Information Requests
Type of Request | Source | |
Alternative or Complementary medicine | Natural Medicine Comprehensive Database | |
ADR/Safety | Lexicomp*, UpToDate*, Micromedex*, Package Inserts | |
Compatibility | FDA-approved prescribing information, Trissel’s Stability of Compounded Formulations* | |
Dosage/Route/Administration | Complete prescribing information, Lexicomp*, Micromedex*, etc. | |
Drug Identification | Lexicomp* (Drug I.D) Drugs.com, WebMD Pill identifier, RxResouce.org (pill identification tool) | |
Ingredients/Stability | Complete prescribing information, Lexicomp* | |
Interactions
|
CYP | Complete prescribing information, Lexicomp* |
HIV | HIV Drug Interactions
Clinicalinfo Drug Database |
|
Kinetics | Complete prescribing information, Lexicomp* | |
Pharmacoeconomics | Studies published in pharmacoeconomics journals | |
Pharmaceutics | PubMed* and primary sources | |
Pharmacology | Lexicomp*, Micromedex* and could require further research with primary sources | |
Pregnancy/Lactation | LactMed | |
Regulatory | The Pharmacy Practice Act, Pharmacist's Manual | |
Therapeutics | Dynamed*, UpToDate*, DiPiro’s textbook | |
Toxicity | MSDS, PubChem, Micromedex* | |
Vaccinations | CDC vaccine and immunization schedule, Lexicomp | |
Veterinary Information | Plumb’s Veterinary Drug Handbook |
*=sources requiring a subscription or payment
Abbreviations: ADR = Adverse Drug Reactions; CDC = Center for Disease Control and Prevention; CYP = Cytochrome P450; FDA = Food and Drug Administration; MSDS = Material Safety Data Sheet; HIV = Human immunodeficiency virus
Another relevant option that many healthcare professionals are considering for answering drug information requests is artificial intelligence (AI) platforms such as ChatGPT. While these seem to be able to provide responses that are based on data and research, the issue that users run into is the AI is not able to approach/appraise situations critically. While AI can provide information that may be or seem accurate, it is cannot assess the data that it uses to ensure that it is relevant to the situation or specific patient. Additionally, AI doesn’t cite its sources, meaning that it can be difficult to assess the appropriateness of the source. Last, it is important to realize that AI has sometimes provided wrong answers that could lead to patient harm and therefore need to be checked against reliable sources.
Figure 2 summarizes a typical drug information process.
Figure 2. The Drug Information Process
FORMULATE THE RESPONSE
Verbal responses tend to be easier for most people than written responses, but respondents should document every request. One simple rule should guide the response: Use principles of clear communication. Clear communication reduces risks of misinterpretation and increases the requestor’s understanding. It optimizes patient care. Clear, concise sentences that are short (fewer than 25 to 32 words) and straightforward create an ideal response.18 It is best to be comprehensive with adequate information and complete sentences that leave no confusion. Each statement should have a clear purpose with no extraneous information or unnecessary words. Respondents must paraphrase important information from accumulated data taken from reliable sources, while avoiding copying and pasting from other outside sources. The response must focus on the audience (the requestor) and the requestor’s background, remembering that different types of professionals have different education and focus.18
Organize and Evaluate Information
Organizing information makes research and presentation straightforward and simple for the audience to understand quickly. Templates are available to help keep information organized and formulated, but they have advantages and disadvantages.
- Pros: Templates provide consistency that makes it easier for requesters to follow. (Saving your responses to DI requests is a PRO TIP, discussed in the SIDEBAR) Templates also provide an idea about how the completed presentation will look and reduce the time associated with creating the response. Some organizations provide templates for their employees. Lacking an approved template, respondents can find customizable templates from their workplace or university. Example templates found in the appendices show how useful templates can be. Templates can act as checklists to remember what should be included in a drug information response.
- Cons: Many templates limit the amount of allowable customization or text, and respondents must be knowledgeable about editing templates. Templates may also limit the approach to the topic and limit the information to standard or predictable fields; this is a problem when the question is unique or unusual. It is important to understand that templates are guides in answering requests and are not restrictions.
Templates that can be used while answering drug information questions have different strengths and limitations. The choice of template can be dependent on the pharmacist’s preference as well as the type of drug information request. We reviewed the templates in the addendum and assessed their utility. Take a minute to look at them. How do your assessments compare to ours?
Template 1 located in Appendix 1:
Pros: Extensive prompts for what should be included in a drug information response. This format is very detailed which could be useful for less experienced users.
Cons: Could be too detailed to be used for a wide range of requests. It lacks space, so users will have to use it against a document that they have already created.
Template 2 located in Appendix 2:
Pros: This format displays the drug information request topic quickly, organizes patient information and the response, and includes references to use for evidence-based literature support. It is broad enough to be used for multiple types of requests. It could be especially helpful for pharmacists who receive a wide variety of requests as it allows them to focus and tailor responses appropriately.
Cons: Insufficient prompts or guidance responders, making it more suitable for experienced pharmacy staff. This would too broad for beginners or pharmacy students because it does not outline various aspects of drug information responses.
SIDEBAR: Saving FAQs for Future Use: The FAQ File19,20
Pharmacy staff often notice that they receive the same or similar questions repeatedly. Each time a requestor asks the question, the respondent must answer again. When employees in the pharmacy discuss questions they receive, they may find that although each of them has only answered a specific question once or twice, collectively they are answering the same question often. A frequently asked question (FAQ) file has numerous advantages. It can
- Save time for everyone including the requestor
- Standardize the answer so that it is consistent each time staff answer the specific question
- Provide the answer in clear language
- Create an answer that technicians and students can give to requestors without asking the pharmacist to intervene
- Refer requestors to web sites or documents for additional information
To develop a reliable FAQ file, pharmacy staff should take several steps:
- Identify the questions that are asked frequently.
- Develop a simple format for all FAQs. Usually, the actual question appears at the top of the documents, with the answer below.
- Start small and ask one employee to draft the FAQ.
- Have two or three people review the FAQ, including a pharmacist and at least one or two support personnel. Encourage reviewers to provide constructive criticism. If the FAQ usually comes from a colleague or patient, involve colleagues and patients in the review.
- A good process for reviewing FAQs is to ask a reviewer to read to a certain point and then stop. The project coordinator should ask, “Can you tell me in your own words what you just read?” If the reviewer explains and the information is incorrect, the project coordinator should not correct the reviewer; rather, the project coordinator should make a note that the section needs work and why.
- The project reviewer should ask additional, open-ended questions including
- What’s your general reaction to this draft FAQ?
- What did you like about this draft FAQ?
- What did you dislike about this draft FAQ?
- Is anything in this draft FAQ confusing?
- What would you do if you got this document?
- What do you think the writer was trying to do with this document?
- And here’s a PRO TIP: Often, people will not answer directly because they do not want to appear uneducated or picky. A way to circumvent this issue is to ask, “Thinking of other people you know who might get this document…”
- What about the document might work well for them?
- What about the document might cause them problems?
- Once the FAQ completes the process and is ready for “prime time,” save it in a format that cannot be edited (i.e. a PDF that is locked for editing) and upload it to a shared file or drive where all employees can access the document and print or clip it to an email when needed.
Finally, drugs and drug information change over time. Organizations that use FAQ files must schedule routine review (at least annually and more often if necessary) to ensure that the content in FAQ files remains current and correct.
Proofing and Editing Drafts
Proofing and editing written drafts entails first fact-checking the narrative and the sources used, and then reviewing the text to ensure it is clear and professional. The respondent must re-assess and re-evaluate each source and the information gathered. Asking other healthcare professionals who have expertise to contribute to or proofread the draft is smart. Collaborating with colleagues can be beneficial, especially in healthcare. The recent emphasis on interdisciplinary approaches reminds us that healthcare professionals from multiple backgrounds need to collaborate and exchange information more often than not. Colleagues can also help confirm or modify any information, while also giving feedback to learn how to better future drug information requests.
Once the data is confirmed as accurate, the last step is to double check for spelling and grammar errors and ensure the response is clear and concise. A skilled pharmacy technician is often an exceptional collaborator in this step.
Document, Document, Document
Documentation is helpful when pharmacy employees have to refer back to that specific topic on a similar drug information question or when colleagues have a similar request in the future. Documenting the response will aid as a reference point and could help clinicians in the future make decisions regarding patient care.21 Documentation will also display accountability and the respondent’s value to the organization and the interdisciplinary team. Many healthcare organizations have policies and procedures for documenting DI requests, and all staff should follow them if they exist.
ASSESS REQUESTOR’S UNDERSTANDING AND SATISFACTION
Following up after responding to a DI request is a professional action. The respondent should follow up with the requestor in a timely manner and assess the outcomes. If the requestor is not completely satisfied, the respondent can adjust the answer and recommendations appropriately.7 Follow-up will also reveal if the requestor has implemented the recommendation (and if it worked), provide feedback for potential modifications in future DI requests, and show professionalism and dedication to patient care. A PRO TIP is to document the follow-up and outcomes.
CONCLUSION
Pharmacy teams have serious responsibilities related to DI requests, which can cover a broad spectrum of topics and specialties. Pharmacists, pharmacy technicians, and pharmacy students should use a methodical approach, followed by documentation. As the ever-changing landscape of healthcare, medicine, and technology continues to advance, the providing drug information will remain an integral part of the pharmacist’s responsibilities.
Table 4 provides additional resources.
Table 4. Additional Resources
Systematic Approach to Answering Drug Information Requests
This resource helps characterize the various types of drug information requests |
https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/preceptor-toolkit/sicp-busy-day-systematic-approach-answering-drug-info-requests.ashx?la=en&hash=7C8B36648FAB999DE761D3AE37BFE48A847B8551 |
7 Tips on Improving Communication in Your Pharmacy
This resource provides guidance on how best to speak with patients |
https://www.pbahealth.com/elements/7-tips-on-improving-communication-in-your-pharmacy/ |
Formulating an Effective Response: A Structured Approach
This resource provides strategies to answer formulated drug information requests. |
https://accesspharmacy.mhmedical.com/content.aspx?bookid=2275§ionid=177197497 : |
ASHP Guidelines on the Pharmacist’s Role in Providing Drug Information
This resource provides suggestions on how to answer a formulated drug information request. |
https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacists-role-providing-drug-information.pdf |
How To Evaluate Health Information on the Internet: Questions and Answers
This resource provides approaches on how to find credible sources to answer drug information requests. |
https://ods.od.nih.gov/HealthInformation/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx |
Templates:
Requirements checklist for drug information Response1 - UBC Blogs. Accessed July 3, 2023. https://blogs.ubc.ca/oeetoolbox/files/2019/01/Requirements-Checklist-for-Drug-Information-Response.pdf.
Drug Information Request and Response Form.; 2017. Accessed July 3, 2023.
https://blogs.ubc.ca/oeetoolbox/files/2019/01/DIR-Example.pdf
PHRM Handbook. Accessed July 3, 2023.
Pharmacist Post Test (for viewing only)
Pharmacy: Motivation to be the Best Drug Information Station
Pharmacists Post-test
After completing this education activity, pharmacists will be able to
1) Recognize key elements of a drug information request
2) Describe a typical process for researching drug information requests
3) Prioritize information in the final written response
4) Identify the best language to use based on the inquiring party’s needs
1. Which of the following describes a good practice in answering complicated drug information requests?
A. Reviewing at least two sources when looking for answers
B. Using a couple of metasearch engines (e.g., Dogplie)
C. Using tertiary sources (e.g., Micromedex, Lexicomp)
2. A patient approaches the community pharmacy counter asking about experiencing GI upset when taking his daily medications. His medications include metformin, prednisone and lisinopril. Which of the following is an appropriate targeted question to obtain key information?
A. Are you taking your medications at the correct times?
B. How are you taking your medications?
C. Are you taking your medications with food?
3. Which of the following are elements of screening a response to correctly identify the key elements in a drug information request?
A. Setting aside extraneous information to focus on pertinent information
B. Relying solely on the patient’s recollection of medical information
C. Asking closed-ended questions to extract targeted information
4. Which of the following correctly identifies the process of answering a drug information request?
A. Screen request for pertinent information, reformulate request, formulate response, assess understanding
B. Assess understanding, reformulate request, screen request for pertinent information, formulate response
C. Formulate response, reformulate request, access understanding, screen request for pertinent information
5. A doctor asks how many hours prior to dialysis medication X should be administered to ensure an optimal response. Which category would the question fall under?
A. ADR inquiry
B. Therapeutics
C. Kinetics
6. If asked a question about the dosing for atorvastatin for a 40-year-old patient recently diagnosed with dyslipidemia, which of the following sources would be the most appropriate place to look for the answer?
A. Natural medicine comprehensive database
B. LactMed
C. Lexicomp
7. Which of the following correctly pairs the appropriate language and the type of requestor who is asking for information?
A. Patient: “Possible adverse events include gastrointestinal upset and an increase frequency of bowel movements.”
B. Provider: “The patient may have a tummy ache and have to go to the bathroom to poop a lot.”
C. Nurse: “Patients who take this medication may develop some side effects including nausea and diarrhea”
8. Which of the following statements identifies the purpose of the “assess understanding” step
A. To gauge requestors’ satisfaction and determine if they implemented the recommendation or need further assistance
B. To test the requesters health literacy and attempt to match the language you use to the language they understand
C. To provide new information to requestors so that they have multiple options in case the first answer didn’t resolve their problem
9. You have been tasked with creating a general drug information template. Which of the following are important aspects to include in your template
A. Prior medical history; lab values; current medications
B. Patient’s education; reference authors; siblings’ ages
C. Patient’s age, financial status, current medications
10. A patient approaches the pharmacy stating that she left a refrigerated medication on her front porch for more than 24 hours. She asks if it is still safe to use the medication. Which of the following is the most efficient way to answer?
A. Google the name of the drug and look for a patient or nurse blog site
B. Look at the package insert for the medication in the pharmacy database
C. Find two the primary sources for the stability in various temperatures
Pharmacy Technician Post Test (for viewing only)
Pharmacy: Motivation to be the Best Drug Information Station
Pharmacy Technician Post-test
After completing this education activity, pharmacy technician’s will be able to
1) Identify questions that are within the pharmacy technician’s scope of practice
2) Recognize tools and resources to use when attempting to answer a drug information question
3) Complete the steps to completing a drug information request that is within the pharmacy technician’s scope of practice
1. Which of the following questions would require counseling from a licensed pharmacist?
A. Do I store this liquid antibiotic at room temperature or refrigerate it?
B. Is there a less expensive generic or store brand for this product?
C. What other medications should I avoid taking with this prescription?
2. A patient approaches the community pharmacy counter asking about experiencing GI upset when taking his daily medications. His medications include metformin, prednisone, and lisinopril. Which of the following is an appropriate targeted question to obtain key information?
A. Are you taking your medications at the correct times?
B. How are you taking your medications?
C. Are you taking your medications with food?
3. When can pharmacy technicians answer questions and help customers find specific medications or classes of medications while staying within their scope of practice?
A. If information is clearly printed on the prescription label, on auxiliary labels, or in an FDA-approved Medication Guide.
B. If the supervising pharmacist is busy and will not have time to help a customer for at least 15 minutes to an hour.
C. When the technician does not like the specific customer and would like to see the customer leave as soon as possible
4. Which of the following correctly identifies the process of answering a drug information request?
A. Screen request for pertinent information, reformulate request, formulate response, assess understanding
B. Assess understanding, reformulate request, screen request for pertinent information response, formulate response
C. Formulate response, reformulate request, access understanding, screen request for pertinent information
5. A 58-year-old woman comes to the pharmacy counter and tells you she received her Shingrix vaccine two weeks ago and does not remember when she needs to come back for her next Shingrix dose. Where would a pharmacy technician be able to find information about vaccine scheduling to answer the patient’s question?
A. Trissel’s Stability Compendium
B. LactMed and lexicomp
C. CDC Vaccine and Immunization Schedule
6. According to the traffic-light-rule, what should the pharmacy staff member do after one minute of listening?
A. Pharmacy staff should let patients continue to talk because it’s unlikely they have disclosed enough information.
B. Pharmacy staff probably has enough information and should make note of comments or questions.
C. Pharmacy staff should be comfortable stopping the requestor politely or asking additional questions.
7. A mother is picking up her son’s antibiotic prescription and asks if there is a specific way that her son should take the medication. Where would you find this information about the route of administration for antibiotics?
a) PubMed
b) Pharmacists Manual
c) Lexicomp
8. Which of the following statements identifies the purpose of the “assess understanding” step
A. To gauge requestors’ satisfaction and determine if they implemented the recommendation or need further assistance
B. To test the requesters health literacy and attempt to match the language you use to the language they understand
C. To provide new information to requestors so that they have multiple options in case the first answer didn’t resolve their problem
9. You have been tasked with creating a general drug information template. Which of the following are important aspects to include in your template
A. Prior medical history; lab values; current medications
B. Patient’s education; reference authors; siblings’ ages
C. Patient’s age, financial status, current medications
10. A patient approaches the pharmacy stating that she left a refrigerated medication on her front porch for more than 24 hours. She asks if it is still safe to use the medication. Which of the following is most efficient way to answer?
A. Google the name of the drug and look for a patient or nurse blog site
B. Look at the package insert for the medication in the pharmacy database
C. Find two the primary sources for the stability in various temperatures
References
Full List of References
References
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