How the SMASH web app can reduce hazardous prescribing and help patients
SMASH is a web application that shows pharmacists and GPs lists of patients that are potentially at risk from the medications they are prescribed.
The groups of patients that the application flags up are based on a previous study called PINCER. PINCER created a set of 'prescribing safety indicators', agreed by consensus among experts, which described potentially hazardous prescribing.
These indicators are run through patients' electronic health records in general practices to identify patients potentially at risk of hazardous prescribing.
One example would be patients who have a history of internal bleeding being prescribed medications such as aspirin, which could increase the risk of further internal bleeds without other treatments being prescribed to protect against this.
Once identified, the healthcare professional can open the medical record for at-risk patients in their own electronic health record system to decide on a possible course of action.
Richard Williams, Software Engineer at the Greater Manchester PSTRC, says: "We've managed to get people in all eligible practices in Salford (43 out of 44) using the dashboard.
"Although we haven't finished analysing the data, it would seem that as well as reducing the numbers of at risk patients, we've also seen this reduction sustained, suggesting that we have changed work practices, rather than simply fire-fighting."
The dashboard was designed, developed and implemented with funding from the Greater Manchester PSTRC. The centre's Safety Informatics theme and Medication Safety theme were responsible for its initial concept right through to the rollout of the intervention in practices across Salford.
The 2017 BCS: Chartered Institute for IT's prestigious John Perry award was this year awarded to Richard Williams for his outstanding contribution to primary care computing through the development and rollout of the SMASH dashboard.
The future of SMASH
The next phase of the PSTRC will see the dashboard rolled out across Greater Manchester and beyond, in conjunction with Connected Health Cities, as part of a framework called Advanced analytics in primary care: Provision of actionable information for quality improvement, otherwise known as ACTION. This will involve a large increase in the number and type of indicators presented.
One pharmacist who has been involved in the project says: "The main benefit of SMASH is how quick and easy it is to access these patients that are at risk. Running similar searches on the GP clinical system is a nightmare."
Richard Williams adds: "[SMASH]…reduces duplication of effort across multiple pharmacists, meaning they have more time for resolving problems, which in turn increases their reach and impact.
"Patients receive a higher standard of medication safety monitoring on their behalf and have corrective action taken more quickly."
- Akbarov A, Kontopantelis E, Sperrin M, Stocks SJ, Williams R, Rodgers S, Avery A, Buchan I, Ashcroft DM. Primary care medication safety surveillance with integrated primary and secondary care electronic health records: A cross-sectional study. Drug Safety 2015: 38: 671-682.
- Stocks SJ, Kontopantelis E, Akbarov A, Rodgers S, Avery AJ, Ashcroft DM. Examining variations in prescribing safety in UK general practice: cross-sectional study using the Clinical Practice Research Datalink. British Medical Journal 2015; 351: h5501.
- Williams R, Keers R, Gude WT, Jeffries M, Davies C, Brown B, Kontopantelis E, Avery AJ, Ashcroft DM, Peek N. SMASH! The Salford Medication Safety Dashboard. J Innov Health Inform. 2018;25(3):183–193.