SMASH! The Salford medication safety dashboard

Richard Williams,Benjamin Brown,Evangelos Kontopantelis,Richard Keers,Darren M Ashcroft,Anthony J Avery,Mark Jeffries,Wouter T Gude,Colin Davies,Niels Peek

doi:10.14236/jhi.v25i3.1015

Abstract

BackgroundPatient safety is vital to well-functioning health systems. A key component is safe prescribing, particularly in primary care where most medications are prescribed. Previous research has demonstrated that the number...

Highlights

Patient safety has become an integral part of quality management in healthcare systems worldwide
clinical decision support (CDS) systems, such as pop-up alerts, attempt to influence behaviour at the point of care and while some studies have shown benefits,[15] others have shown that clinicians can suffer from ‘alert fatigue’ where poorly targeted alerts lead to their routine dismissal.[16,17] electronic audit and feedback (eA&F) systems, such as dashboards, provide feedback away from the point of care, usually at a population level, to allow for clinicians to review, and potentially change, their practice retrospectively.[18]
SMASH is rendered on the client side with AngularJs,[31] and is served with data via a RESTful API running on NodeJS32 and Express.[33]

Summary

Introduction

Patient safety has become an integral part of quality management in healthcare systems worldwide. While patient safety research has traditionally focused on secondary care,[1,2,3] primary care, as the cornerstone of modern healthcare systems,[4] is increasingly recognised as an area where major improvements in patient safety can be achieved,[5,6] especially due to the large numbers of medications that are prescribed on a daily basis.[7] It has been shown that one in 20 prescriptions in primary care contain errors, and one in 550 contain potentially life threatening errors.[7] One in 25 hospital admissions are the result of prescribing errors in primary care,[8] and adverse drug reactions, of which most are avoidable, cost the NHS an estimated £500 million per year.[9]. IT-based interventions for improving prescribing safety fall broadly into two categories: clinical decision support (CDS) and electronic audit and feedback (eA&F). Previous research has demonstrated that the number of patients exposed to potentially hazardous prescribing can be reduced by interrogating the electronic health record (EHR) database of general practices and providing feedback to general practitioners (GPs) in a pharmacist-led intervention. We aimed to develop and roll out an online dashboard application that delivers this audit and feedback intervention in a continuous fashion.

Objectives

Methods

Results

Conclusion