What are we trying to do?
Researchers at the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC) have created SMASH, a pharmacist-led digital intervention that improves patient safety when prescribing medication in general practice. Trained pharmacists working in general practice use the SMASH dashboard to identify patients who are exposed to potentially harmful prescribing. For example, patients with a history of internal bleeding may be prescribed medications such as aspirin which could increase the risk of further internal bleeds without prescribing other treatments to protect them. SMASH identifies this and warns the practice-based pharmacists, who can then decide on a possible course of action together with GPs and other practice staff. The dashboard updates every night allowing near real-time feedback on any medication changes made.
SMASH was trialled in Salford with impressive results; in addition to substantially reducing the numbers of at-risk patients, the reduction was sustained after 12 months. This success led to the decision to roll out SMASH across all 10 localities in Greater Manchester.
This roll out is being led by Health Innovation Manchester, in partnership with the NIHR GM PSTRC but it is far from straightforward as there are numerous technical, legal and governance challenges which need to be overcome.
Why is this important?
Medication errors leading to adverse drug events are a major healthcare problem, and one that has been acknowledged recently by the third WHO Global Patient Safety Challenge. A study of English general practices identified errors in 5% of medicine prescriptions. In most cases the consequences of such errors will be negligible because the medications that are prescribed carry very low risk, but the sheer volume of prescribing (over one billion prescription items supplied in the community in England each year) means that avoidable deaths in primary care due to medication errors are seven times more likely than in hospitals. Improving the safety of drug prescribing in primary care has therefore been recognised a priority by the NHS.
How are we doing it?
We will focus on identifying and solving implementation barriers within different localities and capturing the effects on serious harm outcomes. Specifically, we will answer the following research questions:
- How is SMASH scaled-up and spread across Greater Manchester?
- What organisation infrastructure and support is needed to implement and sustain the SMASH across different localities?
- What are the factors which, in the opinion of local stakeholders, contribute to or detract from the spread and scale-up of SMASH?
- What are the effects of the GM-wide roll-out of SMASH on the safety of drug prescribing in primary care? What are the effects on associated adverse events such as kidney failure, life-threatening bleeds, and asthma exacerbations?
This will involve a mixed methods approach.
- Qualitatively - we are undertaking non-participant observations, interviews and focus groups with staff responsible for the delivery and implementation of SMASH, along with a document analysis
- Quantitatively - We are looking at electronic health records from general practices and hospitals to assess whether the introduction of SMASH has led to a reduction of potentially hazardous medication prescriptions and associated adverse events.
Who are we working with?
- Health Innovation Manchester
- NIHR Greater Manchester Patient Safety Translational Research Centre
- Greater Manchester Health and Social Care Partnership
- Graphnet Health
For further information please contact Rebecca McShane (Programme Manager)