Understanding the use of a novel interactive electronic medication safety dashboard inprimary care : a mixed methods study
The safe prescribing and monitoring of medicines is an important aspect of health care provision worldwide. The Salford Medication safety dASHboard (SMASH) intervention provided general practices in Salford (Greater Manchester, UK) with feedback about identified patients exposed to potentially hazardous prescribing and inadequate blood-test monitoring through an online dashboard, and input from practice-based clinical pharmacists trained in root cause analysis. As part of a wider evaluation of the SMASH intervention, we explored how pharmacists and other practice staff used the SMASH dashboard to improve medication safety, how they interacted with the dashboard to identify potential medication safety hazards and their workflow to resolve identified hazards.
We used a mixed-methods study design, which involved synergistic utilisation of quantitative data and qualitative data. We combined the dashboard’s user interaction logs from forty-three general practices participating in the SMASH trial during the first year of receiving the SMASH intervention, and qualitative data from semi-structured interviews with 22 pharmacists and physicians from 18 practices in Salford. We analysed the qualitative interview data using a thematic template analysis approach. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated in a process of synthesizing and weaving of the data.
Practices interacted with the dashboard a median of 12.0 (interquartile range, 5.0-15.2) times per month during the first quarter of use to identify and resolve potential medication safety hazards. This typically started with the hazards they perceived to be most serious or those that were most prevalent. After observing a potential hazard, pharmacists and practice staff worked collaboratively to resolve it sequentially by verifying the dashboard information, reviewing the patient’s clinical records, and by deciding potential changes to the patient’s medicines. Dashboard use transitioned over time, towards regular but less frequent (median of 5.5 [3.5-7.9] times per month) checks to identify and resolve new cases. Practices with a larger number of at-risk patients had more frequent dashboard use. In 24 (56%) practices only pharmacists used the dashboard; in 12 (28%) use by other practice staff increased as pharmacist use declined over time; and in 7 (16%) there was mixed use by both pharmacists and practice staff.
Pharmacists started using the dashboard to identify patients at risk, focusing on the most prevalent safety hazards and highest risk (patients highlighted by more than one indicator) first. They subsequently worked with GPs to resolve these risks on a case-by-case basis. Over time this workload reduced as it shifted towards resolving new incident cases, and in some practices GP staff started to use the dashboard as pharmacist activity reduced. These factors contribute to making SMASH a sustainable intervention after resource-intensive pharmacist activity eased.