Implementing a real-time electronic audit and feedback intervention in primary care

We developed and evaluated the Safety Medication dASHboard (SMASH), which is a web application that shows pharmacists and GPs lists of patients who are potentially at risk from the medications they are prescribed in general practice.

The groups of patients identified by the application are based on a set of evidence-based prescribing safety indicators, agreed by experts, which describe potentially hazardous prescribing situations.

Once identified, the healthcare professional can open the medical record for these patients in their own system to decide how to correct the issue.

SMASH was rolled out in Salford (43 general practices, population size 240,000). A sustained reduction was observed in potentially hazardous prescribing across general practices (28% at 24 weeks and 41% at 12 months). The rate of inadequate blood-test monitoring reduced by 22% at 24 weeks and 24% after 12 months.

SMASH was very well received by users and workload diminished over time as it shifted towards resolving new cases only.

We have worked closely with an Academic Health Science Network (AHSN), Health Innovation Manchester, to scale-up the rollout of SMASH across all 10 Greater Manchester Clinical Commissioning Groups in Greater Manchester (446 general practices, 2.8 million population).

Working with a company called Graphnet, the dashboard has been embedded in the Greater Manchester Care Record, creating a real-time electronic audit and feedback medication safety surveillance system.

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