SMASH! The Salford Medication Safety Dashboard. Richard Williams. NIHR Greater Manchester Patient Safety Translational Research Centre

Transcription

1 NIHR Greater Manchester Patient Safety Translational Research Centre SMASH! The Salford Medication Safety Dashboard Richard Williams This presentation summarises independent research funded by the NIHR Greater Manchester PSTRC. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

2 SMASH The Salford MedicAtion Safety dashboard From the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre Finds patients at risk from the medication they are prescribed Displays the results of medication safety indicators to GPs and CCG pharmacists Greater Manchester Patient Safety Translational Research Centre

3 Indicators SMASH displays the results of indicators An indicator defines a group of patients at risk from a specific medication Examples Prescription of warfarin without an up to date INR Prescription of NSAID to patients with chronic renal failure Prescription of Digoxin to patients with a history of heart failure Prescription of a benzodiazepine or Z drug for 21 days, in a patient aged >65 years, who is not receiving benzodiazepines or Z drugs on a long-term basis Prescription of oral or transdermal oestrogen without a progestogen in a woman with an intact uterus Bupropion prescribed to a patient with epilepsy Greater Manchester Patient Safety Translational Research Centre

4 Standing on the shoulders PINCER 1 Set of indicators Pharmacist led audit and feedback Reduction of prescribing errors cost effective SMASH Uses PINCER indicators Retains pharmacist Adds dashboard 1. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Avery, Anthony J et al. The Lancet, Volume 379, Issue 9823, Greater Manchester Patient Safety Translational Research Centre

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11 SMASH intervention 44 (of 45) practices recruited from Salford Pharmacist visits practice All dashboard interaction logged (non-alphanumeric key strokes, mouse hovers and clicks) 12 months follow up for each practice Greater Manchester Patient Safety Translational Research Centre

12 SMASH intervention Quantitative evaluation Do at risk patient numbers reduce? Is it sustained? How are improvements to numbers of at risk patients related to: Total use and frequency of use of the dashboard Specific area usage User s role Qualitative evaluation Why do people use/not use the dashboard? What do they find useful? Greater Manchester Patient Safety Translational Research Centre

13 SMASH results (so far) Statistically and clinically significant results Practices recruited prior to January 2017 (n=31) At risk patients reduced from 1433 to 771. A mean reduction of 21.4 patients per practice Significant (p=0.0006) when compared with the mean reduction of 3.7 patients per practice recruited after January 2017 (n=14). Early indications of sustained usage Well received by users "it s very user friendly miles more efficient quick and easy within an hour you could have made quite an impact Greater Manchester Patient Safety Translational Research Centre

14 Patients at risk by indicator

15 Sessions per user per day

16 Session duration

17 Usage hours

18 Daily views

19 Weekly views by indicator

20 Greater Manchester Patient Safety Translational Research Centre Future of S a l f o r d M e d i c S a f e t y d a s H b o a r d A t i o n P a t i e n t S M A S H

21 A partnership between The NIHR Greater Manchester Patient Safety Translational Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust

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23 CDS vs A&F Clinical Decision Support (CDS) Alerts, reminders, pop-ups, workflows, some dashboards At point of care Good for prevention, but only works for patients that are seen, and prone to alert fatigue Audit and Feedback (A&F) Reports, some dashboards, often aggregated data, sometimes individual patient data Retrospective view Good for reviews and changing practice, but not as immediate as CDS Greater Manchester Patient Safety Translational Research Centre

24 Architecture Greater Manchester Patient Safety Translational Research Centre

25 Data structure Patient ID Sex Year of birth LSOA Ethnicity GP Records Patient ID Code Date Text Value Unit Source 1 M 1982 E White British P F 1978 E Black British P A. 14/03/2018 DBP 90 mmhg P /03/2018 SBP 150 mmhg P bx22. 14/03/2018 ACEI 25mg 28 Take 1 in am P87001 Greater Manchester Patient Safety Translational Research Centre

26 Patient Safety Centre 2 NIHR Greater Manchester Patient Safety Translational Research Centre Primary and transitional care 5 year programme grant ( 6.7M) August 2017 July 2022 A partnership between Salford Royal Foundation Trust (SRFT) and the University of Manchester Greater Manchester Patient Safety Translational Research Centre