Download Limitations of Common Information Sources used by UKMi

Limitations of Common Information Sources used by UKMi
version 6.0, June 2014 – Major changes since last edition in March 2013, picked out in red
This is not a comprehensive guide. It is a list of observations from experienced pharmacists that has been shared to help others appreciate that no
information source is “perfect”.
General Issues
(1) No single source is totally comprehensive or completely up-to-date in all respects and all databases have the potential to have search
function anomalies; use your professional judgement to decide when you need to verify facts in another resource.
(2) Think about synonyms when searching books, databases or websites since cross-referencing is not always reliable
(e.g. “hypericum” vs. “St John’s Wort”; “alopecia” vs. “hair loss”).
(3) In US texts remember that some generic names differ from the UK. There is a UKMi Q&A that addresses this issue:
http://www.medicinesresources.nhs.uk/upload/documents/Evidence/Medicines%20Q%20&%20A/QA62_4USdrugnames.doc
(4) You should expect most books to be at least 1-2 years out-of-date at the point of publication. Even paper texts that are updated on a
regular basis eg Martindale, Stockley and Hale, have online versions that are updated more regularly
(5) A webpage retrieved from a search engine such as Google may be an old version (a ‘cache’ page). For more information see:
www.googleguide.com/cached_pages.html so ‘refresh’ web pages to be sure you get the current version. (If you want to find an old
version of a webpage try www.searchengineshowdown.com/others/archive.shtml )
(6) Some governmental websites can hold several versions of the same document.
(7) UKMi provides guidance to help you decide on the reliability of information on the web:
www.ukmi.nhs.uk/filestore/misc/EffectiveuseoftheInternetforEnquiryAnswering_v1.1Dec.doc
(8) When using any database, including Embase and Medline, be aware that keywords and subheadings may have been chosen by nonmedical personnel and as such may not always be entirely consistent or logical.
(9) Some websites are particularly difficult to search eg MHRA and NICE. For a general search of these sites, use Google Advanced Search
and cut and paste the website address eg www.mhra.gov.uk into the box labelled “Search within a site or domain”. Then enter your search
terms.
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Risks with Specific Sources
Source
Risk Issues
BNF
(1) Wherever possible the web version of the BNF should be used in preference to the printed version as it is updated
monthly (including errors and clarifications). It is recommended to use the bnf.org or Medicines Complete versions.
(2) All users of the BNF should read the section How to use the BNF.
(3) The introductory paragraphs to sections often contain important information which can be missed if users consult
individual monographs only.
(4) Listed side effects may not indicate frequency of occurrence.
(5) Indications/ uses/ unlicensed uses etc sometimes reflect the views/ practice of experts and so may not be evidencebased or the same as in the SPC.
Department of Health website
The site’s search engine does not always function well. It is often better to use Google instead. Use Advanced Search
and cut and paste www.dh.gov.uk into the box labelled “Search within a site or domain”. Then enter your search terms.
DrugDex
(1)
(2)
(3)
(4)
Embase via NHS Evidence (and
OvidSP)
eMC
(1) Years covered are less than for Medline – consider the implications of this when searching for older drugs.
Fridge Database
If you do not find what you are looking for, search using generic name or brand name. Only updated every 2 years –
manufacturing process may have been updated during this time.
Handbook on Injectable Drugs
(”Trissel”)
Gives information mainly on American preparations. Note that formulations may differ between the US and UK and this
can affect compatibility.
This is a US database. Check it reflects UK practice.
Check currency via the “last modified” date after the references list at the end.
Whilst SPCs are held on Drugdex – users are advised that they may not be as up-to-date as those on the eMC.
Be careful of American spellings – if looking down a lot of interacting drugs make sure you check the American
name (e.g. pethidine/meperidine; salbutamol/albuterol etc.. See Q+A (Point 3 of general issues above) for more
examples).
(1) Individual SPCs may not list certain excipients if the medicine contains extremely small (“trace”) amounts. If it is vital
to avoid all exposure to a given excipient it would be wise to ring the manufacturer and check.
(2) Although coverage is continually improving, not all SPCs for generic products are available through the eMC.
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IV Guide on Medusa
A few monographs have not been updated recently. Check with more recent sources if necessary.
Medications in Mothers’ Milk
(“Hale”) 14th edition
(1) Some monographs are based on more complete literature searches than others. Be careful about relying upon as a
sole source.
(2) An on-line subscription to Hale is preferable, since this is updated on an ad-hoc basis in between published editions.
However, when a new paper edition is published, for a short period, this may be the most up-to-date version. There
is a lag time, of around a couple of months, until the on-line version is updated and brought in-line. During this time,
if a Centre has both a print and an on-line version, both copies should be checked. Alternatively, if the information
cannot be clarified elsewhere, one of the specialist breast-feeding centres can be contacted to double check both
versions.
Medline via NHS Evidence
(1) This resource does not include ePub Ahead of Print publications. In order to access these it is necessary to search
PubMed
MHRA website
(1) Do not use the search engine on the MHRA home page to search Drug Safety Update. Go to the Drug Safety
Update homepage (http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate) and use the section function on
the right-hand side. However, be aware that articles are not always appropriately keyworded.
(2) If searching Drug Analysis Prints online check which term the database uses for the side effect in question (e.g.
dysgeusia or ageusia rather than ‘taste disturbance’).
(3) Also remember that the term you are looking for may appear under more than one heading – suggest using ctrl F
function with different possible spellings.
National Travel Health Network
and Centre (NaTHNaC)
(1) This advice is based on that produced by the HPA (now part of Public Health England) and may differ from advice in
other sources (i.e. Travax, Fit for Travel). However, all advice is evidence based. It is advised that one resource only is
used in these circumstances.
Natural Medicines Comprehensive
Database
(1) Some natural medicines have very similar or identical names but contain different ingredients. Check names
carefully.
(2) This is a US database, and European brand names are not always included.
(3) Beware using the ‘interaction checker’ in isolation as this might miss pharmacodynamic interactions as well as drug/
disease interactions.
Palliative Care Formulary 4th
edition
(1) Available in paper and electronic formats. A number of errors have been identified and therefore a number of reprint
versions of the 4th edition are available – later reprint versions will contain fewer errors. Reprint changes to the first
print run have not been widely circulated; however, subsequent errors identified will now be made available via
MI-UK Mailbase and also on their own website. In addition, new and updated monographs are being included in the
electronic format. The electronic format is therefore the most up to date and is the recommended format.
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(2) If the paper format is purchased, ensure you are registered on-line since the syringe driver tables remain free to
access. Also ensure that you have ticked to receive emails and alerts, and you will then be notified of any further
errors identified.
Renal Drug Handbook 3rd edition
(1) Despite some references to published data, some dose recommendations are based upon specialist
experience/practice.
(2) As the doses given may therefore differ from the licensed doses, it is particularly important to check the SPC as well.
(3) The online version is a PDF of the latest edition of the book – if you have access to both a paper copy and the online
copy check the versions are the same as some centres may have an earlier version of the same edition of the book.
In addition updated monographs have not been widely circulated and may not have been included in either the
online or the book version.
Schaefer – Drugs in Pregnancy
and Lactation 2nd edition
(1) This has not been updated recently – it is advised that other more recently updated sources of information on drug
use in pregnancy and lactation are consulted.
Stockley’s Drug Interactions
(1) This is not and was never intended to be a definitive guide to every possible drug interaction so should not be used
as a sole source for “screening” patients’ medications for potential interactions.
Tic-Tac
(1) Sometimes colours are described oddly within the database so, if possible, focus on other characteristics instead/as
well to aid identification where possible.
(2) Avoid using the size function to narrow down your search, as this risks excluding matching products.
(3) Products that have recently been added and for which a sample is awaited will only be found by searching the ‘any
product form’.
Travax
(1) This advice is based on that produced by NHS Scotland and may differ from advice in other sources (i.e. NaTHNac).
However, all advice is evidence based. It is advised that one resource only is used in these circumstances.
UCL Hospitals Injectable Medicines
Administration Guide – 3rd edition
(1) This edition contains a number of errors which were not notified on the publication’s website. These have been
shared via the UKMi network. If any other errors are found, UKMi will circulate them via its network.
(2) The information contained in the guide mainly reflects local practice.
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