Aim: We sought to assess the accuracy of different search terms to identify individuals with active seasonal allergic rhinitis (SAR) in general practice.Methods: A reference search strategy was developed to identify patients with active SAR. This was applied through inspection of electronic health records of patients aged 15-45 years in a 10% random sample of a general practice database. Searches used Read codes and medication relating to SAR. Sensitivity, specificity, and positive and negative predictive values were calculated.Results: Using the reference search strategy, 54/1092 (4.9%) of 15-45 year-old patients had current SAR. Searching for drugs used in nasal allergy had the highest sensitivity (85%) and good specificity (86%). Searching for a recorded history of SAR (H170) in the last two years was more specific (100%) but this approach only had limited sensitivity (17%).Conclusions: Electronic searches can be used to identify patients with current SAR, but the accuracy varies widely. Larger numbers of sufferers can be identified using broader search parameters, but with increasing numbers of false positives. In contrast, more focused search strategies give a smaller yield needing less cleaning of data to identify true positives, but there is an associated increase in the number of false negatives.

BackgroundOpioid conversion is complex and currently performed manually using tables of approximate equivalence, often in high pressure clinical situations. Apps that offer opioid dose conversion are available but there are concerns about their accuracy, reliability, and clinical validation.AimThe study evaluated a novel opioid dose conversion app, The Safer Prescription of Opioids Tool (SPOT), as a clinician decision support (CDS) platform. The secondary objective was to use SPOT to describe patterns of opioid dose conversion in palliative and end-of-life care.MethodThis prospective clinical utility single-centre pilot study followed a mixed methods design. Prescribers completed an initial survey exploring their current opioid prescribing practice. Thereafter prescribers used SPOT for opioid dosage conversions in parallel to their usual clinical practice. Lastly, prescribers evaluated SPOT through a survey and focus group. SPOT was evaluated using clinical data across primary, secondary and tertiary care in palliative care and end of life care settings at a Scottish Health Board in both out-of-hours and in-hours.ResultsSPOT correctly matched the Gold Standard result in 258 of 268 (96.3%) calculations. Users had a statistically significant increase in confidence in prescribing opioids after using SPOT. A majority (62%) of conversions were for cancer pain. Focus group feedback highlighted perceived benefits in Quality Improvement and Safety when using SPOT.ConclusionSPOT is a safe, reliable and validated CDS that has significant potential to reduce harms from opioid dosing errors, particularly in primary care, including rural primary care, and the out-of-hours setting.

Opioid errors are a leading cause of patient harm. Active failures in opioid dose conversion can contribute to error. Conversion is complex and is currently performed manually using tables of approximate equivalence. Apps that offer opioid dose double-checking are available but there are concerns about their accuracy and clinical validation. This study evaluated a novel opioid dose conversion app, The Safer Prescription of Opioids Tool (SPOT), a CE-marked Class I medical device, as a clinician decision support (CDS) platform. This single-centre prospective clinical utility pilot study followed a mixed methods design. Prescribers completed an initial survey exploring their current opioid prescribing practice. Thereafter prescribers used SPOT for opioid dosage conversions in parallel to their usual clinical practice, then evaluated SPOT through a survey and focus group. SPOT matched the Gold Standard result in 258 of 268 (96.3%) calculations. The 10 instances (3.7%) when SPOT did not match were due to a rounding error. Users had a statistically significant increase in confidence in prescribing opioids after using SPOT. Focus group feedback highlighted benefits in Quality Improvement and Safety when using SPOT. SPOT is a safe, reliable and validated CDS that has potential to reduce harms from opioid dosing errors.