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Pharmacist-led audit/feedback intervention improves medication safety

Stephen Padilla
20 Oct 2020

The pharmacist-led Safety Medication dASHboard (SMASH) intervention has resulted in reduced rates of potentially hazardous prescribing and inadequate blood-test monitoring in general practices during the first 24 weeks after initiation, a study has shown. The reduction is sustained at 12 months for prescribing but not for monitoring.

“There were substantial differences in rates of potentially hazardous prescribing between practices prior to the intervention, and there was a marked reduction in the variation between practices over the 12-month follow-up period,” the researchers said.

SMASH was implemented in 43 general practices covering a population of 235,595 people in Salford, UK, and included the following components: training of clinical pharmacists to deliver the intervention; a web-based dashboard providing actionable, patient-level feedback; and pharmacists reviewing individual at-risk patients and initiating remedial actions or advising general practitioners on doing so.

The intervention was initiated between 18 April 2016 and 26 September 2017. The researchers used an interrupted time series analysis of rates (prevalence) of potentially hazardous prescribing and inadequate blood-test monitoring to compare observed postintervention rates to extrapolations from a 24-month preintervention trend.

A total of 47,413 (mean age, 60 years; 48.7 percent males) individuals were registered to participating practices and had one or more risk factors for being exposed to hazardous prescribing or inadequate blood-test monitoring at the start of the intervention.

Ninety-five percent of practices at baseline had rates of potentially hazardous prescribing (composite of 10 indicators) between 0.88 percent and 6.19 percent. The prevalence of potentially hazardous prescribing decreased by 27.9 percent (95 percent confidence interval [CI], 20.3–36.8 percent; p<0.001) and by 40.7 percent (95 percent CI, 29.1–54.2 percent; p<0.001) at 24 weeks and at 12 months after intervention initiation, respectively. [PLoS Med 2020;17:e1003286]

For inadequate blood-test monitoring (composite of two indicators), the rate reduction was 22.0 percent (95 percent CI, 0.2–50.7 percent; p=0.046) at 24 weeks and nonsignificant at 12 months (23.5 percent, 95 percent CI, –4.5 to 61.6 percent; p=0.127).

The rates of potentially hazardous prescribing stood between 0.74 percent and 3.02 percent for 95 percent of practices after 12 months.

Previous studies showed how general practice-based pharmacists improved integrated patient care and how they could deliver clinical interventions efficiently and in high volume. [Int J Pharm Pract 2018;26:501-506; Res Social Adm Pharm 2018;14:228-240]

“Our study demonstrates how these pharmacists can also play a key role in sustainably improving medication safety in general practice and reducing variation in potentially hazardous prescribing between practices,” the researchers said.

“However, for this to be effective, it is imperative to have an underpinning ‘learning health systems’ capability for continuous data-driven self-study that promotes change and improvement,” they added. [Yearb Med Inform 2017;26:16-23]

Such capability requires a digital infrastructure for continuous, patient-level feedback that allows practitioners to identify high-risk patients, access educational materials, and compare rates of high-risk prescribing and monitoring both between practices and within their practice over time, according to the researchers.

The current study was limited by the nonrandomization of practices, leading to potential unmeasured confounding of the findings, they noted.

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