By Ken Saunders, PharmD

IN 1999, FREMONT AREA MEDICAL CENTER, A 262-BED COMMUNITY HOSPITAL in Fremont, Nebraska, implemented the Epocrates Rx Pro drug and formulary reference. We chose the product primarily for its versatility. With three software package options—free, advanced, and premium—we were able to select the Epocrates offering that suited our needs. We can also take advantage of free features such as Epocrates MedTools and Epocrates MobileCME.

Furthermore, because our pharmacists can access the Epocrates products from handheld devices, the program’s tools are easy to use when making rounds with physicians, which we do every day. We no longer have to carry four or five pocket-sized reference books; instead, we just keep our handhelds in the front pockets of our lab coats.

The reference is updated up to three times a day, so our staff has the latest information at their fingertips. To download the latest information to our handhelds, we simply connect our device to the Internet and a message on the handheld informs us when the update is complete.

The program also notifies us about pertinent alerts, such as the Vioxx recall. If one of these “DocAlerts” is of interest, we can opt to receive more information and articles via e-mail. When I come across a particularly interesting DocAlert, I will print it and post it on our pharmacy bulletin board for everyone to read.

There are several other features of the Epocrates product that we find very helpful in treating our patients. For instance, the different silos of information are crossreferenced; I can click a drug name listed in the infectious-disease treatment guide (which outlines effective therapies for a variety of diseases), and then view the drug’s complete monograph.

Another helpful program feature to use while on rounds and when evaluating patients’ labs is the Epocrates Lab program. Fremont’s clinical pharmacists use Epocrates Lab on a daily basis to help interpret lab results and make proper diagnoses.

In addition, many of the product’s features provide an added measure of safety. For example, the built-in dosing calculator helps us ensure our accuracy when determining drug therapies for pediatric patients, as well as other patients with specific dosing needs. In addition, the software’s IV-compatibility checker helps us to identify IV medications that need to be run on separate lines due to incompatibility.

Information on alternative medications and herbal products is also available, alerting us to instances in which there is a risk for an adverse reaction. In fact, using Epocrates Rx Pro’s MultiCheck feature, I can cross-reference multiple drugs and products to find out if a patient is at risk for an interaction, such as a possible increase in blood pressure or metabolism, and if so, we bring the matter to the attention of the physician.

Epocrates also has a product that can be downloaded onto a stationary PC, making it easier for nurses and physicians who are working after pharmacy hours to access drug and formulary information. The PC-based program, RxOnline, also provides color images of drugs, increasing the ease with which we can identify a patient’s home medications.

Cost data for prescribed drugs is also available on Epocrates. This feature covers scenarios for both uninsured and insured patients. The program lists the copays for about 130 health plans, and with that information, we are able to discuss post-discharge medication costs with our patients. In fact, the most common question patients ask us during discharge rounds is, “How much is this drug going to cost?” This feature allows us to inform the patient, and consequently, prevents “sticker shock” when the patient ultimately fills their prescriptions. Furthermore, if a particular prescription is out of a patient’s financial reach, I can use Epocrates to find a therapeutically equivalent medication at a lower cost, and call the doctor to make the change in the prescription.

The Epocrates reference also supplies phone numbers of various drug manufacturers, allowing me to easily call the manufacturers to explore prescription-assistance programs for our patients when needed. All in all, Epocrates Rx Pro is a great patient-service tool during our pharmacists’ discharge counseling sessions.
There are many benefits to the helpful tools embedded in Epocrates’ product. But above all, we value its ability to keep us up-to-date and well informed as we care for our patients.

Prior to assuming his current post as pharmacy clinical coordinator at Fremont Area Medical Center, Ken Saunders, PharmD, served as clinical pharmacist at the University of Nebraska Medical Center.