Pathfinder projects were early stage idea testing projects in wound care and opioids aimed at informing the next stages of development.
Two of these projects were carried out by the GM CHC team, on focussing digital technologies in the community as part of wound care for ulcers, and comparative risk of respiratory depression in patients treated with opioids for non-cancer pain. 1) Wound care in community nursing Patients with venous leg ulcers and pressure ulcers often experience long healing times and numerous interactions with healthcare services before their condition improves. The care for these patients takes place in the community and support was given by GM CHC to explore the use of digital technologies for wound care in the community. Research was conducted to assess the implementation of a 3D camera in the community for capturing wound images and recording the data into the electronic patient record. The study showed that there were still a number of technical barriers in the community including integration issues between the camera software and the electronic patient record system and difficulties with internet connectivity whilst in patients’ homes and the community. Practical issues included the extent to which available lighting affected the quality of the photographs and therefore usefulness of the image for clinical care. A consortium is using the insights from the research study to inform future innovation spread and adoption plan as part of supporting digital technologies in the community. 2) Opioids The most serious opioid-related adverse event is respiratory depression, which is potentially fatal. Assessing the comparative risk of respiratory depression in patients treated with opioids for non-cancer pain can support improved care pathways and ultimately contribute to reduction of unintentional overdoses.
In the UK, opioid-related deaths have been increasing over the last few decades, it is of particular concern that the majority of deaths are unintentional. Opioids are also associated with serious side effects, the most serious being respiratory depression that usually precedes death.
Respiratory depression is not captured in primary care records and often not coded in electronic patient records (EPR), therefore minimal data exist regarding comparative safety.
GM CHC worked with Salford Royal Foundation Trust (SRFT), a Global Digital Exemplar site to measure Opioid ‘exposure’ using electronic prescribing data, with accurate information on not just if an opioid was prescribed by the physician but whether it was administered to the patient.
A standardised governance process for accessing data from EHRs was established. . Data on 33,341 opioid users admitted to hospital between 2014-2017 were accessed, analysed with extension of existing methods for processing medication data from EPRs, and examined for medication safety outcomes.
The study showed that electronic vital signs that are measured in every patient as part of routine clinical care can be used to measure respiratory depression whilst on an opioid. Additional information collected in the EPR such as assessment of the patient’s pre-hospital status, allowed better control for confounding by indication, giving a clearer picture of causal associations.