Beyond the labelling: Expert medication resources are essential for safe and effective patient care

As clinicians, we know that the field of medicine is a constantly evolving landscape, with new research emerging daily that enhances our understanding of diseases and expands the arsenal of drugs available to treat them. For those on the front lines of patient care, this becomes even more challenging. Balancing the need for safe and effective treatment with the unique circumstances of individual patients and the limitations of existing resources is an issue that clinicians are dealing with around the world. Jordan Fulcher explores these challenges and provides some solutions.

The foundation of safe prescribing: Licensing and labelling
The foundation of safe prescribing lies in the licensing and labelling of medications. These regulations ensure that medications are rigorously tested and proven effective for their intended uses. However, the focus of this information is often on the broad strokes of regulatory approval, leaving out the finer details and nuances that are cru­cial for clinical decision-making. Regula­tory approval and labelling primarily fo­cus on approved uses, dosages, and safety warnings, which may not capture the dy­namic nature of medical research. Emerg­ing evidence on a drug’s effectiveness for off-label uses remains largely absent. Ad­ditionally, the latest prescribing strategies developed through real-world clinical ex­perience may not be reflected in these doc­uments, leaving clinicians out of the loop on potentially life-saving advancements.

The limitations of current resources for clinicians
National formularies, which are common­ly relied upon by clinicians for prescrib­ing information, frequently draw heavily from these licensing documents. While they provide essential general information about a medication, they fall short in sev­eral key areas.

• Limited scope of information: The information available in formularies and labels often adheres to a one-size-fits-all ap­proach. Labels cater to a broad audience, offering a simplified version of a drug’s in­teraction with the human body. However, each patient is unique. Factors such as age, weight, existing health conditions, and ge­netic makeup can significantly impact how a drug behaves within an individual. Limit­ed information can lead to dosage miscalcu­lations, increasing the risk of a medication being, at best, ineffective. At worse, it could cause adverse reactions and patient harm.
• Lack of depth and breadth. Manu­facturer labelling often prioritises brevity, omitting detailed information on a drug’s mechanism of action, potential side effects at different dosages, or how the drug in­teracts with specific foods or supplements. This lack of depth hinders a clinician’s abil­ity to fully understand a medication’s intri­cacies. Without a thorough understanding of how a drug works, potential side effects may be difficult to anticipate or manage. Similarly, omitting details on the severity and prevalence of adverse reactions at vari­ous dosages makes it harder to discuss po­tential downsides with patients and make truly informed decisions together.
• Drug interactions and adverse reac­tions: A medication prescribed for one con­dition might interact poorly with another drug or supplement a patient is taking for a different indication, leading to reduced ef­fectiveness or serious health complications. Whilst labelling and formularies often provide concise lists of interactions, there is a lack of actionable recommendations. Limited information on potential interac­tions makes it challenging for clinicians to identify these risks and manage them, po­tentially jeopardizing patient safety.
  
  These limitations highlight a clear need: The current resources available to clinicians are insufficient for navigating the complexi­ties of modern medicine. A high-quality, evidence-based solution ^[1] is needed to em­power clinicians to diagnose effectively, pre­scribe medications with greater precision, and ultimately deliver superior patient care.

The impact of comprehensive resources on patient care
More comprehensive resources that seam­lessly integrate the latest research findings, such as UpToDate® Lexidrug™ ^[2] drug reference solution and Medi-Span® ^[3] em­bedded drug data, enable clinicians to stay informed about the most recent, evidence-based prescribing strategies. Providing patient-specific guidance ^[4], considering a patient’s medical history, potential drug in­teractions, and even down to their genetic variations ^[5]. This level of personalised information would significantly reduce the risk of adverse reactions and optimize treatment effectiveness. Providing clini­cians access to detailed information allows them to identify and anticipate potential side effects and manage them proactively.

A trusted solution partner backed by trusted evidence and a rigorous editorial review process ^[6] will not only highlights potential issues with prescriptions and treatments but will also provide clinicians with a clear action plan on how to manage these situations. One clinical resource that covers all stages of the medication process – from diagnosing, to prescribing, to admin­istration and onto monitoring and manage­ment – aligns clinicians and clinical teams, providing all with the consistent access to the information that they need, at the right time, and allowing them to find guidance specific to the patient that they are treating.

Streamlining medication prescribing, administration, and monitoring
How could a more personalised medica­tion decision support solution work for you and your clinical teams in the real world?

Step 1: prescribing
Let’s consider the following clinical situa­tion: An elderly patient with a background of epilepsy has been diagnosed with hos­pital-acquired aspiration pneumonia. The usual local hospital guidelines recommend meropenem for this indication, but how do we adjust this for our specific patient at the prescribing stage? Firstly, we consider:

• Do they have any renal impairment ^[7] associated with their advanced age?
• Is their infection susceptible to me­ropenem, and how would we test for that?
• What medicines are they taking for their epilepsy that could interact with the treatment?

In this case, the labelling states that the use of meropenem with valproic acid and its derivatives are not recommended, but no practical information is provided to the clinician on how this should be managed in practice. What alternatives can be given?

Step 2: verification
Once a prescribing decision has been safely made, the pharmacist has additional considerations prior to verification.

• How should the treatment be monitored?
• When should this be reviewed?
• How do we step the patient down?

Step 3: administration
Even when the medication is verified and ready to be administered, the nursing team will have additional questions that need to be answered to ensure safe administration.

• What infusion options do I have for this treatment?
• Can I safely administer this IV medica­tion ^[8] alongside the others prescribed for my patient, or will I need to set up a new line?
• Is there any administration associated reactions that I need to be aware of?

Without a trusted solution, these vari­ous clinicians can end up working from disparate resources, with varying degrees of accuracy. Resources such as UpToDate®, UpToDate Lexidrug, and Medi-Span align the highest-quality evidence with patient management recommenda­tions. All members of the care team have access to the answers that they need, in one place.

The role of trusted resources in medication management
The current information provided by la-belling and national formularies is not enough for modern medicine. The limita­tions of existing resources force clinicians to balance adhering to regulations with providing the best possible care for their patients. A more comprehensive solution that integrates the latest research, offers patient-specific guidance, and provides in-depth drug information is essential. Em­powering clinicians with such a tool would not only streamline the prescribing process but also lead to safer, more effective, and ultimately better patient care.

• Learn more about Wolters Kluwer medication decision support solutions: www.wolterskluwer.com/en/solutions/uptodate/drug-decision-support.

References:

1. www.wolterskluwer.com/en/solutions/uptodate/drug-decision-support
2. www.wolterskluwer.com/en/solutions/uptodate/enterprise/lexidrug
3. www.wolterskluwer.com/en/solutions/medi-span/medi-span-around-the-world
4. www.wolterskluwer.com/en/expert-insights/why-its-important-to-adjust-drug-dosing-for-patient-specific-factors
5. www.wolterskluwer.com/en/expert-insights/pharmacogenomics-balancing-optimism-challenges
6. www.wolterskluwer.com/en/solutions/uptodate/about/editorial-process
7. www.wolterskluwer.com/en/expert-insights/optimizing-renal-dosing-to-improve-patient-outcomes
8. www.wolterskluwer.com/en/expert-insights/iv-compatibility-challenges-best-practices-and-the-route-ahead