Scaling a local Safety Medication Dashboard programme in Greater Manchester

The Safety Medication Dashboard (SMASH) is an IT system, created by the University of Manchester, designed to prevent hazardous prescribing. It runs patient record data against evidence-based harm indicators, such as acute kidney injury or gastrointestinal bleeds (originally the PINCER set), highlighting where reviews are required.

After a pilot in Salford, patients at risk of harm from hazardous prescribing dropped by 40% in 12 months, and when the Greater Manchester Care Record (GMCR) launched, an opportunity arose for Health Innovation Manchester to redevelop SMASH within GMCR BI architecture, broadening the user base to 2.8 million people and creating a prototype process for widespread medication safety initiatives.

User feedback

According to the BMJ, 237 million medication errors are made every year in England, costing the NHS £98 million and 1,700 lives annually. 54% of errors occur during administration, 1 in 5 during prescribing (21%), and 16% during dispensing.

Following the successful rollout of the Safety Medication Dashboard (SMASH) IT system in Salford between 2015 and 2018, Health Innovation Manchester and the University of Manchester teamed up to integrate an evolved SMASH into the GM Care Record (GMCR), scaling the innovation across the whole of Greater Manchester.

By developing SMASH within the GMCR, primary care staff across 411 practices now have access to a standardised, easy to use medication safety tool which allows them to easily review medications across a cohort and make informed, proactive clinical decisions based on the data.

The improved filtering options on the new SMASH dashboard allows comparison, evaluation, and identification of patients at practice, PCN, locality and ICB level, supporting both population and individual health. This helps identify and rectify any unwarranted variation in medical prescribing errors, promoting equality of care for everyone in Greater Manchester.

After a period of testing, the new dashboard officially launched across Greater Manchester in April 2023.

The SMASH dashboard was originally designed by the team at the University of Manchester with extensive public and patient engagement, utilising Health Innovation Manchester’s Patient Participation Group. Academics and researchers in Manchester worked with clinicians in Salford and Stockport, involving the Greater Manchester Medicines Safety Group for governance. It was a collaborative effort across the region, incorporating design, clinical and technical support from different organisations.

Clinical impact

SMASH currently has an active user base of 471 clinical users, who accessed the dashboard 3,160 times in 2023.

A survey of SMASH users in January 2024 found that 65% of prescribers agree or strongly agree that patients are less at risk of unnecessary appointment or hospital admissions from unsafe prescribing by using the SMASH dashboard. A further 65% of prescribers also agree or strongly agree that patients are safer using medicines in their practice due to the SMASH dashboard.

Patient impact

Since going live with the GMCR-embedded SMASH dashboard in April 2023, there was a further 7% reduction in patients at risk of harm to the end of the year.

Economic impact

By bringing product development of SMASH ‘in house’, updates to the annual indicator prioritisation and other amendments are made centrally for the benefit of all, and there is a reduced IG clearance which saves a huge amount of time.  As the GMCR data is securely held in the cloud, on-premises servers are no longer required. Annual programme costs for practices reduced from £22k to £15k, providing a saving of £7k a year, which means that primary care staff are accessing the full benefits of GMCR data at a much-reduced annual cost.