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Innovative IT system that prevents prescription errors wins prestigious national prize

5 Dec

Richard Williams_John Perry award_CROPPED

Richard Williams, a Senior Software Engineer at The University of Manchester, based in the NIHR Greater Manchester Patient Safety Translational Centre (Greater Manchester PSTRC) and Centre for Health Informatics, has been awarded the respected John Perry Prize by BCS: The Chartered Institute for IT.

Announced at a glitzy ceremony in early October, the prize recognises Richard’s outstanding contribution to Primary Care Computing.  Having been awarded annually since 1985 it is one of the IT industry’s most respected accolades, acknowledging innovation and excellence in computer science.

The Prize along with £500 cash was awarded in recognition of Richard’s work developing and disseminating the Smart Medication Safety Dashboard (SMASH).  This potentially life-saving piece of software, which was developed with support from the Greater Manchester PSTRC and Health eResearch Centre (HeRC), was created to improve patient safety by reducing the number of prescription errors.  Such errors occur in 5% of prescriptions according to a recent study of English general practices with one in 550 considered to be life-threatening.

Richard’s work involved the development of an algorithm that trawls GPs’ patient databases in search of high-risk – and possibly dangerous – prescription and/or disease combinations. Once identified, these prescriptions are flagged up to a relevant pharmacist who is able to investigate, question and where appropriate refer prescriptions back to the GP for review.

The high-risk combinations that SMASH could identify might, for example include a patient receiving a complex blend of high-strength medications that need to be carefully managed or someone who has been receiving an un-checked repeat prescription for a long time.

Alongside the digital infrastructure required to develop and implement SMASH, Richard also created an easy-to-view front-end platform.  This allows pharmacists to clearly and quickly identify any risks without the need for complex and time-consuming analysis.

SMASH is now being used by 43 active practices across Greater Manchester. Richard created SMASH by building upon previous work conducted at The University of Nottingham. The team are in the process of analysing the impact, but preliminary results look good. As of January 2017 the number of patients at risk in practices using the dashboard had reduced by 50% – a mean reduction of 21 patients per practice.

Richard was named the overall winner of the prize in the face of tough competition and now joins a respected list of previous recipients including Kate Warriner and Dr Amir Hannan.  Speaking about the prize, Richard said:

“John Perry was pioneering in the field of primary care computing and for his work on developing the first clinical coding terminology for GPs. It’s a great honour to be associated with him, and is particularly relevant as my current research is around how researchers build, reuse and share sets of clinical codes.”

The Smart Medication Safety Dashboard (SMASH) was funded by the NIHR Greater Manchester Patient Safety Translational Research Centre and delivered by the Health eResearch Centre.  Find out more information about the development of the dashboard on the SMASH page of the PSTRC website.

Safety Informatics: Using every opportunity to learn

11 Sep

by Niels Peek, Research Lead for Safety Informatics theme

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As our world is quickly becoming more connected, a transformative potential emerges to make it safer. Digital technologies are now commonplace within the NHS and in our daily lives, producing rich data on all aspects of health.

For instance, my smartphone captures my whereabouts through its GPS sensor and thus knows that I’m currently in China. It also measures my physical activity by counting my daily steps. The electronic health record maintained by my GP describes all interactions that I’ve had with primary care, including symptoms, observations, measurements, test results, prescriptions, and referrals. Hospital records capture rich data on diseases (e.g. through high-resolution images) and provide detailed accounts of any hospital care that I have received.

Connecting these data sources can help us gain a deep understanding of patient safety issues and the factors that can increase risk. Not only can they tell us that an adverse event has happened (e.g. someone was admitted to A&E) but they can also help us to trace back the chain of events leading up to this (e.g. a trip abroad; followed by a period of staying at home, not feeling well; a GP visit).

Advanced analytical methods such as Artificial Intelligence can subsequently facilitate early assessments of risk, and support patients and clinicians in preventing adverse events. This structured, system-level approach is also known as a learning healthcare system: an integrated healthcare system which harnesses the power of data and analytics to learn from every opportunity, and feed the knowledge of “what works best” back to patients, clinicians, public, health professionals and other stakeholders to create rapid cycles of continuous improvement.

The Safety Informatics theme within the NIHR Greater Manchester PSTRC will utilise the learning healthcare system approach to understand real-world contexts in which safety issues arise and what is required to take corrective actions. We will build on the established “ACTION” infrastructure to provide real-time feedback to primary care clinicians in Greater Manchester which is already used to improve medication safety, support long-term conditions management, and facilitate antibiotic stewardship.Specific projects will focus on:

  • reducing diagnostic errors
  • enabling automated monitoring of late treatment effects in cancer survivors
  • prevention of pulmonary complications after surgery
  • more timely and accurate computer-assisted monitoring of lab test results by both    patients and clinicians.

Patient Safety: the way forward

8 Aug

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

University campus

Seventy five percent of patient safety research is focused on hospitals. Less is known about patient safety outside hospitals, yet 85% of NHS contacts happen in these settings, mostly in general practice and in pharmacies. The scale of primary care in England is huge. There are 340 million general practice consultations annually, with 2% involving a patient safety incident, which means 6.8 million times each year where a patient is potentially at risk of harm. There are one billion prescriptions issued per year outside of hospitals, with 4.9% having an error – 49 million every year. And 20% of patients discharged from hospital will report an adverse event, which could lead to costly readmission to hospital. On 1 August 2012, the Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC) started, funded by the National Institute for Health Research (NIHR).  Our PSTRC has been a groundbreaking centre as it was the first patient safety centre to focus on primary care (general practice, community pharmacies etc.) as well as the interfaces with hospital care. The focus on primary care was intentional and needed.

We have achieved many improvements in primary care safety over the last 5 years. For example, we have developed a “Safer Prescribing” e-learning course for GPs, which has reduced prescribing errors.  We have developed a Medication Safety Dashboard as a “missed opportunity detector” that has resulted in fewer patients being at risk of potentially hazardous prescribing. We have used mobile technology such as smartphone apps to deliver safer healthcare. As an example, ClinTouch monitors symptom change in people with serious mental illness. We have worked in partnership with patients, GPs and pharmacists to create a Patient Safety Guide for general practice.

I am a health services researcher who has focused on the quality and safety of primary care for 25 years. Over that time there have been many advances in improving quality and safety but equally people are living longer, often with several health conditions requiring care from many different sources, in a world that becomes ever more complex with new digital technologies and “intelligent healthcare communities”. Most research and advances in patient safety are typically found within single care settings, such as the emergency department. Less attention has been paid to safety between (transitional) community providers and hospital care settings. Delayed diagnosis, incomplete patient information and medication errors are examples of problems, which may occur both within settings and across an interface. That is why we shall focus on primary care but also on transitional care settings in our second period of 5-years of funding from the National Institute for Health Research (NIHR), which started on 1 August 2017.

Over the next 5 years, our research will focus on:

  • Safety Informatics – developing technologies and behaviours that create safer care systems and to prevent diagnostic errors – working with the Health e-Research Centre
  • Medication Safety –developing safety management systems to ensure safer prescribing and treatment and to prevent medication errors
  • Safer Care Systems and Transitions – a new theme, to make care safer for patients moving between care settings
  • Safety in Marginalised Groups – a new theme – to enable patients and carers to take control of their care. There will be a key focus on patients and carers as well as mental health, working with the Centre for Mental Health and Safety

Service responsibility and patient responsibility for patient safety go hand-in-hand. They are equal. A member of the public seeking healthcare as a patient for themselves or a loved-one deserves the safest and best quality care possible. That is the duty of healthcare providers and professionals. Avoiding errors, or identifying and correcting them, is a high priority. Equally, patients can do much to keep themselves safer in terms of accessing care appropriately, taking medications as prescribed, self-managing a healthy lifestyle with sensible eating and drinking as well as exercising etc. This is the responsibility of each member of the public. It is a shared responsibility that requires co-design and partnership working, which underpins everything we do.

A key aspect of our work, and something which I think is crucial to the PSTRC, is capacity building and training people to be able to conduct and apply research. This includes recruiting PhD students, helping a group of pharmacists to work together on research projects in their own pharmacies, and training researchers as well as members of the public and patients. Healthcare isn’t just about a medical procedure or treatment option, it is about people, both those who deliver the care and those who receive it or work in partnership together. The PSTRC aims to be an interactive research centre working with healthcare professionals, the NHS, local authorities, industry and patients, carers and members of the public to make healthcare safer.

Much is happening in Greater Manchester that gives us opportunities to make a real difference. We will work across Greater Manchester’s newly-integrated Health and Social Care Partnership which serves 3 million people. The Connected Health Cities programme across the north of England will help us get our research implemented. We will continue to work in partnership with colleagues at the University of Nottingham, especially in the research on safer transitions and medication safety. We look forward to new collaborations with colleagues at the Christie NHS Foundation Trust and Central Manchester NHS Foundation Trust. There is much we can do using new digital technologies and behavioural interventions to improve safety and healthcare for the benefit of patients.

I want to thank everyone who has been involved with the PSTRC over the last 5 years. I look forward to working with everyone in the new PSTRC to continue our exciting, innovative and important research. The PSTRC has many outstanding and world-leading researchers and an excellent core staff. There is much to do but we will continue to build the capacity to make care safer.

The PSTRC has a strong involvement and engagement agenda working alongside members of the public and patients as well as healthcare professionals. If you would like to find out more about our research and how you can get involved then please email Zarina Saeed at zarina.saeed@manchester.ac.uk .