Stephen Hughes is an Antimicrobial Consultant Pharmacist and Trust lead for the antimicrobial stewardship service at the Chelsea & Westminster NHS Trust. In this blog, Stephen shares how his interests in improving prescribing in the face of antimicrobial resistance and digital transformation combine, and how we must balance pragmatism with our ambitious ideas when implementing new technological solutions in the NHS.
Doing more with less is necessary
Antimicrobial resistance is a global health emergency that threatens to jeopardise progress in modern medicine. Here, germs like bacterial and fungi have developed the ability to evade the medications designed to kill them. Infections such as pneumonia or urinary tract infection are becoming more difficult to treat as a result.
Our treatments such as antimicrobials (or antibiotics) have revolutionised our management of infections. Yet with increasing antimicrobial resistance these treatments are becoming less and less effective. For many patients, this means more severe infections, spending longer in hospital and ultimately higher rates of complications including death. With one in ten patients visiting the emergency department and nearly one in two patients admitted requiring antimicrobials, many will be affected.
With high volumes of patients treated everyday for infection and increasing limited treatment options, we must do more with less. Patients treated with antimicrobials need follow-up monitoring on discharge as a safety-net to recognise early signs of treatment failure and ensure timely intervention. It is no longer acceptable to discharge patients with no follow-up and hope they recover. Instead, we need patient-reported outcome measures (PROMs) for real-time feedback and monitoring of infection response for our patients. Here, early signs of treatment failure can be recognised and more importantly acted upon to provide timely corrective treatment.
Introducing a digital solution for patient feedback
To meet the complexity and scale of this problem, we need to utilise digital solutions to support our patients. Simple, intuitive technology that both provides patients and their carers with relative information about their infection and treatment and also enables patients to self-triage themselves for early signs of infection complications is needed. Patients with potential signs of treatment failure or worsening infection can alert the responsible clinicians of these symptoms in real-time and prompt an escalation of treatment. This helps to mitigate some of the major complications of antimicrobial resistance and protects our patients post-discharge.
Patients are increasingly using more technology as part of their healthcare. Ideally, any new digital solution should adapt a currently available technology. We want to limit duplicating apps or online portals between the patient and NHS, so using an established solution is preferred. ‘Patient Knows Best’ (PKB), ‘My clinical Outcomes’ and ‘DrDoctor’ are all used by different clinical specialities within the organisation and ideally should be adapted for this purpose to simplify the process for patients and the Trust. Yet few of these technologies meet all of the requirements for this infection-related safety net. Thus, I must decide to sacrifice content and utility of the technology and use a currently available app or push ahead with a bespoke build. The former would simplify the process and limit unnecessary waste within the NHS, the latter would enable be to adapt the software to the problem in hand.
Difficulties pursuing a bespoke build, including concerns around safe data transfer from NHS to each patient, necessitated a revision of currently available systems. Testing a proof-of-concept with the available technologies (e.g. DrDoctor) may be a more useful first step, determining if the patients will use the system as expected and if the feedback can be provided in real-time. If we have initial success, this can be followed up with a bid for more funds and exploring a bespoke build or even adapting the current platform with our experiences to date.
Often the ambition with these projects is to build from scratch a novel, bespoke and new digital solution. Yet, in the current space where there is an abundance of new technologies currently available, using and adapting established systems may be more efficient. I hope this pragmatic first step will test this proof-of-concept whilst I collect the initial findings. If it works, and if it is as useful as I hope, I will then move to the next step of adding the additional functionality to the digital solution. A journey of a thousand miles begins with a single (simple) step.
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