Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis

Pharmacist-led Safety Medication dASHboard (SMASH) implemented in 43 general practices (n=235,595) in Salford reduced rates of potentially hazardous prescribing and inadequate blood-test monitoring, which was sustained over 12 months for prescribing but not for monitoring.

SPS commentary:

SMASH comprised training of clinical pharmacists to deliver the intervention, a webbased dashboard providing actionable, patient-level feedback, and pharmacists reviewing individual at-risk patients, and initiating remedial actions or advising GPs on doing so.

At baseline, 95% of practices had rates of potentially hazardous prescribing (composite of 10 indicators) between 0.88% and 6.19%. After introduction of SMASH:

  • Prevalence of potentially hazardous prescribing reduced by 27.9% (95% CI 20.3-36.8%, p<0.001) at 24 weeks and by 40.7% (29.1-54.2%, p<0.001) at 12 months
  • Rate of inadequate blood-test monitoring (composite of 2 indicators) reduced by 22.0% (0.2-50.7%, p=0.046) at 24 weeks; change at 12 months (23.5%) was no longer significant (−4.5- 61.6%, p =0.127).

After 12 months, 95% of practices had rates of potentially hazardous prescribing between 0.74% and 3.02%.

PLOS Medicine