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Garfield S, Etkind M, Franklin BD. Using patient and carer perspectives to improve medication safety at transitions of care. BMJ Qual Saf 2024; 33:149-151. [PMID: 38124229 DOI: 10.1136/bmjqs-2023-016801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | | | - Bryony Dean Franklin
- UCL School of Pharmacy, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
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Han JED, Liu X, Bunce C, Douiri A, Vale L, Blandford A, Lawrenson J, Hussain R, Grimaldi G, Learoyd AE, Kernohan A, Dinah C, Minos E, Sim D, Aslam T, Patel PJ, Denniston AK, Keane PA, Balaskas K. Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study-HERMES study report 1-study protocol. BMJ Open 2022; 12:e055845. [PMID: 35105593 PMCID: PMC8808461 DOI: 10.1136/bmjopen-2021-055845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recent years have witnessed an upsurge of demand in eye care services in the UK. With a large proportion of patients referred to Hospital Eye Services (HES) for diagnostics and disease management, the referral process results in unnecessary referrals from erroneous diagnoses and delays in access to appropriate treatment. A potential solution is a teleophthalmology digital referral pathway linking community optometry and HES. METHODS AND ANALYSIS The HERMES study (Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: a cluster randomised superiority trial with a linked diagnostic accuracy study) is a cluster randomised clinical trial for evaluating the effectiveness of a teleophthalmology referral pathway between community optometry and HES for retinal diseases. Nested within HERMES is a diagnostic accuracy study, which assesses the accuracy of an artificial intelligence (AI) decision support system (DSS) for automated diagnosis and referral recommendation. A postimplementation, observational substudy, a within-trial economic evaluation and discrete choice experiment will assess the feasibility of implementation of both digital technologies within a real-life setting. Patients with a suspicion of retinal disease, undergoing eye examination and optical coherence tomography (OCT) scans, will be recruited across 24 optometry practices in the UK. Optometry practices will be randomised to standard care or teleophthalmology. The primary outcome is the proportion of false-positive referrals (unnecessary HES visits) in the current referral pathway compared with the teleophthalmology referral pathway. OCT scans will be interpreted by the AI DSS, which provides a diagnosis and referral decision and the primary outcome for the AI diagnostic study is diagnostic accuracy of the referral decision made by the Moorfields-DeepMind AI system. Secondary outcomes relate to inappropriate referral rate, cost-effectiveness analyses and human-computer interaction (HCI) analyses. ETHICS AND DISSEMINATION Ethical approval was obtained from the London-Bromley Research Ethics Committee (REC 20/LO/1299). Findings will be reported through academic journals in ophthalmology, health services research and HCI. TRIAL REGISTRATION NUMBER ISRCTN18106677 (protocol V.1.1).
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Affiliation(s)
- Ji Eun Diana Han
- University of Birmingham Institute of Inflammation and Ageing, Birmingham, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Catey Bunce
- RM CTU, Royal Marsden Hospital NHS Trust, London, UK
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - John Lawrenson
- Dvision of Optometry and Visual Science, City University of London, London, UK
| | - Rima Hussain
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gabriela Grimaldi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Annastazia E Learoyd
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Christiana Dinah
- Ophthalmology, London North West Healthcare NHS Trust, Harrow, UK
| | - Evangelos Minos
- North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Dawn Sim
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Pearse A Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Grimes TC, Garfield S, Kelly D, Cahill J, Cromie S, Wheeler C, Franklin BD. Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol. BMJ Open 2020; 10:e044441. [PMID: 33234663 PMCID: PMC7688439 DOI: 10.1136/bmjopen-2020-044441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences. METHODS AND ANALYSIS This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to 'cocoon'/'shield' and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient's/carer's perspective. ETHICS AND DISSEMINATION This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.
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Affiliation(s)
- Tamasine C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Sara Garfield
- UCL School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Joan Cahill
- Centre for Innovative Human Systems (CIHS), School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sam Cromie
- Centre for Innovative Human Systems (CIHS), School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Carly Wheeler
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Bryony Dean Franklin
- UCL School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
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Blandford A, Furniss D, Galal-Edeen GH, Chumbley G, Wei L, Mayer A, Franklin BD. Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Intravenous (IV) medication administration has traditionally been regarded to be error-prone with high potential for harm. A recent US multisite study revealed surprisingly few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.
Objectives
To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation in errors, discrepancies and practices, including the contribution of smart pumps.
Design
Phase 1 comprised an observational point-prevalence study of IV infusions, with debrief interviews and focus groups. Observers compared each infusion against the medication order and local policy. Deviations were classified as either errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs, and analytically in supplementary analyses. Phase 2 comprised in-depth observational studies at five of the participating sites to better understand causes of error and how safety is maintained. Workshops were held with key stakeholder groups, including health professionals and policy-makers, the public and industry.
Setting
Sixteen English NHS hospital trusts.
Results
Point-prevalence data were collected from 1326 patients and 2008 infusions. In total, 240 errors were observed in 231 infusions and 1489 discrepancies were observed in 1065 infusions. Twenty-three errors (1.1% of all infusions) were considered potentially harmful; one might have resulted in short-term patient harm had it not been intercepted, but none was judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of deviations varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or to respond to patient need. Smart pumps, as currently implemented, had little effect. Staff had developed practices to manage efficiency and safety pragmatically by working around systemic challenges.
Limitations
Local observers may have assessed errors differently across sites, although steps were taken to minimise differences through observer training, debriefs, and review and cleaning of data. Each in-depth study involved a single researcher, and these were limited in scale and scope.
Conclusions
Errors and discrepancies are common in everyday infusion administration but most have low potential for patient harm. Findings are best understood by viewing IV infusion administration as a complex adaptive system. Better understanding of performance variability to strategically manage risk may be more helpful for improving patient safety than striving to eliminate all deviations.
Future work
There is potential value in reviewing policy around IV infusion administration to reduce unnecessary variability, manage staff workload and engage patients, while retaining the principle that policy has to be fit for purpose, contextualised to the particular ward situation and treatment protocol, and sensitive to the risks of different medications. Further work on understanding infusion administration as a complex adaptive system might deliver new insights into managing patient safety.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann Blandford
- UCL Interaction Centre, University College London, London, UK
- UCL Institute of Healthcare Engineering, University College London, London, UK
| | - Dominic Furniss
- UCL Interaction Centre, University College London, London, UK
- UCL Institute of Healthcare Engineering, University College London, London, UK
| | - Galal H Galal-Edeen
- UCL Interaction Centre, University College London, London, UK
- UCL Institute of Healthcare Engineering, University College London, London, UK
- Department of Information Systems, Faculty of Computers and Information, Cairo University, Cairo, Egypt
| | - Gill Chumbley
- Pain Management Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Li Wei
- UCL Institute of Healthcare Engineering, University College London, London, UK
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Astrid Mayer
- UCL Institute of Healthcare Engineering, University College London, London, UK
- Royal Free London NHS Trust and UCL Medical School, University College London, London, UK
| | - Bryony Dean Franklin
- UCL Institute of Healthcare Engineering, University College London, London, UK
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
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Wheeler C, Furniss D, Galal-Edeen GH, Blandford A, Franklin BD. Patients' Perspectives on the Quality and Safety of Intravenous Infusions: A Qualitative Study. J Patient Exp 2019; 7:380-385. [PMID: 32821798 PMCID: PMC7410139 DOI: 10.1177/2374373519843921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The administration of medication or fluids via the intravenous route is a common intervention for many hospital inpatients. However, little research has explored the safety and quality of intravenous therapy from the patient's perspective, despite the role of the patient in patient safety receiving increased attention in recent years. Objective To explore patients' perspectives on the perceived quality and safety of intravenous infusions and identify implications for practice. Method Qualitative semistructured interviews were conducted with 35 hospital patients receiving intravenous infusions in critical care, oncology day care, general medicine, and general surgery areas within 4 National Health Service hospitals in England. Data were analyzed thematically. Results Four underlying and interlinked themes were identified: knowledge about intravenous infusions, challenges associated with receiving intravenous infusions, the role of health-care professionals, and patients' attitudes toward receiving infusions. Conclusions Patients were generally satisfied with receiving infusions; however, factors that contributed to decreased feelings of quality and safety were identified, suggesting areas for intervention. Issues to do with infusion pump alarms, reduced mobility, cannulation, and personal preferences for information, if given more attention, may improve patients' experiences of receiving intravenous infusions.
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Affiliation(s)
- Carly Wheeler
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Galal H Galal-Edeen
- UCL Interaction Centre, London, United Kingdom.,Faculty of Computers and Information, Cairo University, Giza, Egypt
| | | | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom.,Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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