A highly innovative new digital health application, developed in partnership with Waracle, is set to revolutionise the way in which drugs are prescribed to relieve pain for patients nearing the end of their lives. The mobile app is currently being trialled by doctors at a palliative care unit in the Borders and has the potential to optimise drug dosages to ensure that patients receive the best level of care possible.
Historically, in situations when medication needs to be altered or adapted, doctors would perform dosage calculations using a ‘table of equivalence’ to ensure maximum pain relief. From a medical perspective, these conversions are often very complex to perform, often in high pressure situations where time and margin for error are highly constrained. The biggest risk factors in making an error related to a patient not receiving enough pain relief medication, or receiving too much which can lead to an overdose.
Safer Prescribing of Opioids Mobile App
Now, with the launch of the Safer Prescribing of Opioids Tool (SPOT), this is all set to change for the better and solve some of these complex challenges. The concept for the mobile app, available on iOS and Android, was developed by Dr Roger Flint, based upon his personal and professional experience as a junior doctor. The mobile app is now being trialled at the Margaret Kerr Unit near Melrose.
The story for Dr Flint began only two weeks after graduating from medical school when covering a night shift. The genesis of the idea for SPOT, or ‘the eureka moment’, occurred when Dr Flint was asked to adapt a patients method of pain relief. “The patient was receiving her pain relief and her food through a tube that went directly into her stomach,” said Dr Flint. “But that tube had been blocked. The nursing staff asked me to shift her from the tube pain relief to an infusion under the skin. “I found it quite challenging to perform that calculation and I asked for some help to validate what I had done. “Unfortunately, my senior doctor was unavailable and so that patient went without pain relief until I could get some additional help.” Clearly not an ideal situation.
SPOT now available for iOS, Android and Web
The Waracle team worked closely with Dr Flint at every stage of the project, with the core objective being to ensure other doctors would have a robust means of validating their calculations. Waracle’s job was to translate Dr Flint’s concept into a fully realised mobile app that worked across multiple platforms including iOS, Android and web. “I developed SPOT to ensure that no other prescriber would ever be put in that position again,” he said. “If I’d had SPOT at that time I could have confidently performed the calculation, double checked it independently and that patient would have received her pain relief on time.”
Dr Annabel Howell from NHS Borders said she envisaged the app dramatically enhancing doctors confidence when prescribing opioids, leading to optimised levels of pain relief for sufferers. “You are not using it as the only way of performing the calculation, you are doing it yourself first but it is a great way to validate assumptions,” Dr Howell said. “In the past I have always done that by performing the calculation one way and then doing it a different way and checking I come up with the correct amount. “If there is another member of staff available then we will ask them to do it but there isn’t always someone there so it is really helpful.” Against a backdrop of cost cutting initiatives, increasingly end-of-life care occurs in the patients home, supported by out-of-hours doctors and nursing staff.
Dr Scott Jamieson, based in Dundee, delivers out-of-hours coverage across Angus and is often called to see end-of-life patients who have not been directly in his care. Dr Jamieson has also been busy using the SPOT mobile app. “Increasingly, we are managing more and more complex medication regimes in the community,” he said.”I fully acknowledge the distress that I am going into and I am trying to support that. “I want to ensure that I am confident when I am performing my conversions.”
Niki Barile, Waracle’s Digital Health Project Manager worked closely with Dr Flint throughout the entire project development lifecycle: “Working on anything in digital health is naturally quite personal and often very emotional, we can all relate in some way. This was absolutely the case working on SPOT at Waracle. Though it’s a simple concept around changing how to calculate the prescription of opioids, we all know through either personal experience or the news that this ‘so called’ simple task becomes incredibly challenging when you think of the condition of the patients, the environment along with other time pressures. It was therefore imperative for us to make the process easier, faster and give the doctors confidence in these really difficult situations. Top of our mind was to make sure we streamlined the tasks, making best use of modern usability techniques and procedures, with all the checks and balances built in. We’re so proud to see SPOT go from strength to strength.” Niki continues to work with Dr Flint as the project evolves.
What’s next for SPOT?
The future for Dr Flint and the SPOT mobile app looks very bright. The app is now set to be trialled across a number of health boards and the next stage of the journey will involve exploring other areas within healthcare which could utilise similar processes to optimise care for patients.