Safety Informatics lead elected to American College of Medical Informatics

16 Nov

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Safety Informatics lead Niels Peek was recently elected to membership in the American College of Medical Informatics (ACMI). This is a college of elected Fellows who have made significant and sustained contributions to the field of medical informatics. It is the central body for a community of scholars and practitioners who are committed to advancing the informatics field. The membership award was handed out during the annual symposium of the American Medical Informatics Association in San Francisco, 3-7 November 2018.

REVISiTing GPs in training prescribing to improve medication safety

16 Nov

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by Ndeshi Salema

In 2012, the PRACtICe study, funded by the General Medical Council, set out to determine the prevalence and nature of prescribing and monitoring errors in general practices in England. The PRACtICe study found that prescribing errors occur in around one in twenty, or about 5% of the prescriptions. This is important because:

The PRACtICe study also highlighted that, as a group, GPs in training may benefit from further support in prescribing. Further exploratory work took place to identify possible ways to support GPs in training with their prescribing, which resulted in the development of an educational intervention, called REVISiT.

The REVISiT intervention involves:

  • a retrospective review of GPs in training prescribing, which is completed by a pharmacist, followed by
  • individualised feedback on the results of this review in the form of a report, which is discussed in a face-to-face meeting setting.

A small feasibility study of the REVISiT intervention (a retrospective review of approximately 100 prescriptions prescribed by 10 GPs in training) found that 9% of the prescriptions by GPs in training contained an error. The percentage of errors made by GPs in training was much higher than the percentage that was found in the PRACTiCE study, which may be due to the relative inexperience of GPs in training. It also indicated some benefits of the REVISiT intervention in improving the knowledge, skills and attitudes of GPs in training towards prescribing.

Interviews with a variety of stakeholders (healthcare professionals, policymakers, and members of the public) have shown that there is support for REVISiT as an educational intervention that can help improve prescribing, not only for GPs in training but for all types of prescribers. This will enhance the safety of healthcare received by patients.

With funding from the NIHR Greater Manchester PSTRC, the REVISiT intervention is being further developed and tested, in preparation for a trial in the future.

Understanding patient views of online discussion forums to help improve patient safety

16 Nov

close up businesswoman hand holding smartphone touch screen on display for checking work with virtual reality interface for future technology concept

by Sally Giles

A new study exploring patient views on using online discussion forums, to find information relating to side effects from medication, will begin shortly. It is hoped the findings will lead to new ways of improving patient safety.  We know many people with long-term conditions use online discussion forums to share experiences and support. The free-text information from online discussions could provide a valuable source of information about side effects from medication.  However, the experiences of those using online forums varies considerably depending on which long-term condition(s) they may suffer from.

In light of this, it is important to understand the views of different groups of patients in relation to sharing information about medication side effects from online discussion forums.  The plan is to conduct 5 focus groups with patients from 5 of the online communities in Health Unlocked, including patients with lung conditions, thyroid disorders, fibromyalgia, mental health issues and rheumatoid arthritis.  We also have a patient and public involvement (PPI) advisory group. This group consists of 6 members of the public who are part of the five online communities. Their role will be to contribute to the design of the study and its materials, as well as involvement in focus group facilitation and analysis. The PPI group will also play a key part in the dissemination of the findings and development of any future work.

If you would like more information about this study, please contact Sally Giles.

European Conference on Mental Health: discussing care transitions

16 Nov

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by Natasha Tyler

NIHR Greater Manchester PSTRC Research Associate, Natasha Tyler recently presented her work entitled ‘Care Transitions: Patient Distress and Knowledge Sharing’ at the European Conference on Mental Health in Split, Croatia. The conference focused on discussions and collaboration between professionals, researchers and service users in the field of mental health. Natasha was presenting a paper that she is writing alongside Professor Justin Waring and Dr Nicola Wright regarding the distress experienced by those on acute inpatient mental wards during care transitions (when patients are moved from one place to another, or from one healthcare provider to another).

Care transitions are a vulnerable and high-risk stage of most care processes. The recent Healthwatch report found that patients often leave hospital too early or without appropriate levels of ongoing support. The quality and safety of care transitions depends on the involvement and coordination of multiple professionals working within and across multiple care settings. Research consistently shows that patients are often unprepared for the self-management role that occurs in the succeeding care setting, they receive inconsistent advice concerning illness management, and are frequently unable to contact the relevant healthcare professional with access to their care plan.

For people with acute mental health problems, the transition into and out of the hospital can be especially complicated, whereby issues of psychological distress or anxiety require particular consideration. The paper presented used data from focus groups that included 52 participants of different professions (doctors, ward nurses, community healthcare professionals) and service users. It found that service users felt particularly distressed regarding unplanned or unsupported discharge. Professionals also experienced stress as they felt unable to pay appropriate attention to preparing service users for care transitions, because they are overstretched and felt it outside their comfort zone. This was characterised by one poignant quote that was tweeted by interested academics attending the presentation ‘we have had a couple of incidents when we’ve had to discharge people to the pavement’.

Whilst at the conference, Natasha networked with a number of academics, she was particularly interested in research conducted in Finland using Assertive Community Treatment, an intensive and highly integrated approach for community mental health service delivery. The presentation was entitled ‘No more revolving door’; which is of particular relevance to mental health care transitions, whereby the metaphor ‘revolving door’ is used to describe an endless cycle of admission and discharge from inpatient acute services. The Finnish research reported a slight improvement in patient outcomes as a result of the service. This was relevant as Natasha is currently conducting a review of discharge interventions in acute metal health services in order to identify the most important outcomes to measure. When she asked the presenter how he chose the outcomes, he explained these were just the outcomes he felt most relevant. This supports the rationale for the necessity to develop a standardised set of core outcomes, which would reduce inconsistency in outcome reporting; which is the next phase of Natasha’s research.