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Eur J Clin Pharmacol (2009) 65:10071012 DOI 10.1007/s00228-009-0669-9
PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Interpretation of clinical guidelines for poisoned patients: positive and negative effects of standard phrasesused in TOXBASE
W. S. Waring & S. H. McDonald & A. M. Good &
L. D. Gordon & D. N. Bateman
Received: 30 January 2009 /Accepted: 16 May 2009 /Published online: 11 June 2009 # Springer-Verlag 2009
AbstractIntroduction Electronic information sources are increasingly relied upon for clinical management advice. TOXBASE is a standardised online resource that offers clinical advice on the management of poisoned patients and is the first point of contact between clinicians and the National Poisons Information Service in the United Kingdom. Advice is delivered using a series of standard phrases. The present study examined how healthcare professionals interpret the phrases and studied their impact on clinical decision-making.
Methods A structured prospective written questionnaire was offered to healthcare staff in the Lothian region, and an electronic questionnaire issued to TOXBASE users across the United Kingdom. Participants were asked to respond to a variety of scenarios representing acutely poisoned patients. Clinical management advice was offered via TOXBASE using a variety of standard phrases, and participants were asked to express the likelihood that they would then administer gut decontamination treatment. Results There were 70 respondents to written questionnaires, and 119 respondents to the electronic version. Phrases that included didactic instructions, for example give, contra-indicated, do and perform were associated with strongly positive or strongly negative responses. In contrast, advice that consisted of open phrases such as consider, benefit uncertain, and few data were associated with inconsistent responses.
Conclusion Didactic words and phrases are associated with more consistent interpretation and response than open-ended words and phrases. The choice of words and phrases used in electronic systems can have an independent impact on clinical decision-making and require further consideration.
Keywords Electronic decision support . Guidelines . Poisoning . Overdose . Questionnaire . TOXBASE
Introduction
TOXBASE is an electronic database that contains advice concerning the clinical management of poisoned patients and includes details of approximately 14,000 pharmaceutical products and chemicals [1]. There are entries for special patient groups, for example poisoning in paediatric and pregnant patients, decontamination procedures, explanations of slang terminology, and priority health warnings. TOXBASE is freely accessible to registered healthcare...