The Safer Prescription of Opioids Tool (SPOT®) is the first clinically validated opioid converter in clinical practice. SPOT® has been developed in partnership with the University of Dundee, NHS Tayside, The Digital Health and Care Institute, Scottish Enterprise and Innovate UK. SPOT® is undergoing deployment in NHS Borders.

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The Product

The SPOT platform is a new medical device. A clinician-led, clinically validated, CE-marked clinician decision support tool, SPOT is proven to significantly improve the confidence of opioid prescribing in users and adherence to best practice guidelines [1].

Summary:

SPOT is the only CE-Marked, clinically-validated equianalgesic opioid converter in clinical practice, assessed against the NHS Scotland Quality Assurance Framework for Medical Device Apps, based upon the Scottish Palliative Guidelines, proven to improve adherence to guidelines and confidence in prescribers which is ready for Board-level adoption and is currently undergoing roll-out in an NHS Board. It comes with the mandated software support, updates, indemnity and ongoing clinical appraisal to continue to fulfil the National Quality Assurance Framework.

The SPOT platform allows users to access up to date prescribing information and calculate drug dosages through their smartphones, including iOS and Android.

SPOT is designed to reduce unwarranted variation and primary and secondary harms when pre-scribing opioids whilst supporting warranted variation of choice to align to individual situations, values and side effect profiles.

SPOT was created and trialed in NHS Tayside over a four year period across primary, secondary and tertiary care by a multi-professional interdisciplinary team including independent prescribers, pharmacists, a clinical pharmacologist and director of research, the RCGP Executive Officer (Quality Improvement), the Palliative Medicine Special advisor to the Scottish Government Health & Social care Directorate and the Chief Medical Officer and National Clinical Lead for Palliative and End of Life Care for Health Improvement Scotland.

SPOT enables clinicians to independently and remotely double-check their equianalgesic opioid conversions safely, quickly and conveniently at the patient’s bedside, whilst providing access to nationally adopted best-practice Scottish Palliative Care Guidelines. This helps to reduce and mitigate risk, preventing conversion errors leading to harm and increasing spread of opioid options for each individual to have personalised analgesia approaches implemented.

Following an Innovate UK funded development programme, SPOT is undergoing deployment at scale. It is available in web-app, iOS and Android hybrid-app format.

SPOT has been assessed and meets the standards of the NHS Scotland Quality Assurance Framework for Medical Device Apps.

The need for SPOT is pressing.

The EQUIP study highlighted that 43.8% of prescriptions contained an error 2. All grades of prescriber made errors, and the highest error rate was in Foundation Year 2 doctors3. The causes are multifactorial, but root cause analysis identified common themes, include a lack of knowledge of their prescription, pressure of work, and inadequate knowledge of relevant prescribing rules4.

NHS England conducted a study of admissions due to Adverse Drug Reactions (ADRs) in two large hospitals in Merseyside. Over six months, 1225 ADR related admissions were observed. 72% of these were judged to be avoidable, including medication errors. The median bed stay in these cases was 8 days, accounting for 4% of capacity. The projected cost of such admissions to the NHS was estimated at £466m5.

SPOT aims to revolutionise the way that opioids are prescribed, reducing error, cost to the NHS, and safeguarding patients.

SPOT app in use performing a calculation

Case Studies

Case study image

Julie's Story

As a junior doctor, I know this acutely. Out of hours, two weeks after starting work in my first rotation as an FY1 in General Medicine, I was asked to switch a dying patient on nasogastric opiates to a syringe driver. Her nasogastric route was compromised. It was not a familiar procedure, and I asked for help.

I contacted the registrar, who was busy with acutely unwell patients. Once I found the correct guideline, I manually converted the patient’s nasogastric opioid intake to a subcutaneous syringe driver. This took me a considerable amount of time, and all the while the patient was not receiving her pain relief.

In the end, I did not have the confidence to prescribe the opiates, as I was unsure that I had made the correct conversion using pen and paper. I called the registrar to double-check the dosages.

It was a sobering lesson, and I was determined that no other junior doctor or nurse prescriber should be put in the same position. At that time, I decided to create a program to ensure that junior staff can double-check their opioid calculations.

Meet the Team

Photo of Sir Alfred Cuschieri

Prof. Sir Alfred Cuschieri

Advisor

Alfred Cuschieri is Professor of Surgery at the Scuola Superiore Sant’Anna in Pisa and Chief Scientific Advisor to the Institute of Medical Science and Technology (IMSaT). Previously he was Professor and Head of Department of Surgery and Molecular Oncology at Ninewells Hospital and Medical School, University of Dundee. His research interests include minimal access therapy, endoscopic surgery, technology and micro-robotics, ergonomics, nanotechnology and nanoscience and virtual/augmented reality systems for skills training. Alfred Cuschieri is the European Editor-in-Chief of Surgical Endoscopy and serves on the Editorial Board of 10 other peer review journals.

Photo of Dr Jacob George

Prof. Jacob George

Academic Lead and Director of Research and Development for NHS Tayside

Prof Jacob George, MB ChB, MRCP, MD is Professor of Cardiovascular Medicine and Therapeutics, Hon. Consultant Physician & Clinical Pharmacologist and Chair of the Medicines Advisory Group. He is Director of TASC and recently appointed as an International Expert Member of the Malaysian Scientific Review Panel for Phase I Clinical Trials. Prof George is the Tayside representative of the Scottish Medicines Consortium. To date, Dr George has attracted in excess of £1.2m research funding.

Photo of Dr Deans Buchanan

Dr Deans Buchanan

Consultant in Palliative Medicine and Palliative Care Clinical Lead for NHS Tayside

Dr Deans Buchanan, MB ChB, BSc (Hons), M.D., FRCP. Clinical lead for Palliative care research in NHS Tayside and consultant in Palliative care medicine. He has published widely and the co-director for the Dundee University MPH programme and co-lead of the Macmillan Tayside Palliative and End of Life Care Managed Care Network. Dr Buchanan is the Palliative Medicine Special advisor to the Scottish Government Health & Social care Directorate and the Chief Medical Officer.

Photo of Dr Scott Jamieson

Dr Scott Jamieson

GP Partner
Steering Group Primary Care Lead

Dr Scott Jamieson MBChB MRCGP DRCOG DFSRH DPD. GP Partner in Kirriemuir and OOH GP in Dundee. He represents GPs locally at RCGP Scottish Council and locally sits on Medicines Advisory Group and the Therapeutics Committee. He is the RCGP Scotland Executive Officer for Quality Improvement.

Photo of Joanna Forbes

Joanna Forbes

BSc MSc BN RN Project Manager
and Senior Research Nurse

Joanna has experience in acute, high dependency and intensive care nursing. She has been a member of the nurse team at the Clinical Research Centre since 2008 and the facility’s Project Manager since 2015.

Photo of Dr Roger Flint

Dr Roger Flint

Founder and Medical Doctor

Founder. Doctor Flint Ltd is led by Dr Roger Flint, MB ChB, BSc. (Hons), MSc., a medical doctor with a background in Public Health. His Masters degree involved the interrogation of large general practice data sets and producing novel search strategies. He is currently a General Practice Speciality Trainee in NHS Lothian.

See SPOT in action

References

  • Flint, R.; Buchanan, D.; Jamieson, S.; Cuschieri, A.; Botros, S.; Forbes, J.; George, J. The Safer Prescription of Opioids Tool (SPOT): A Novel Clinical Decision Support Digital Health Platform for Opioid Conversion in Palliative and End of Life Care—A Single-Centre Pilot Study. Int. J. Environ. Res. Public Health 2019, 16, 1926.
  • Seden, K., Kirkham., J., Kennedy, T., Lloyd, M., James, S., McManus, A., Ritchings, A., Simpson, J., Thornton, D., Gill, A., Coleman, C., Thorpe, B., Khoo, S. Health services research - Research: Cross-sectional study of prescribing errors in patients admitted to nine hospitals across North West England BMJ Open 2013;3:1
  • EQUIP final report. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf
  • Tully M, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, Wass V. The causes of and factors associated with prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32:819–836.
  • Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ : British Medical Journal. 2004;329(7456):15-19.

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