Impact case study database

Franklin’s research has had wide-ranging national and international impact on medication safety, including quality improvement projects, policy and educational practice.

Using feedback to reduce prescribing errors.

In 2013, Franklin led a quality improvement project at Imperial College Healthcare NHS Trust (ICHT) to develop, implement and evaluate a trifold approach to providing feedback to hospital prescribers [ S1]. Based on her earlier research [ R3], this comprised providing name stamps for junior doctors who were encouraged to stamp/write their name clearly when prescribing, introducing principles of effective feedback to support pharmacists providing feedback on prescribers’ individual errors, and fortnightly ‘prescribing tip’ emails that addressed a common and/or serious error. Evaluation demonstrated an increase in medication orders for which junior doctors stated their name (from 10% to 50%) as well as significant improvement in pharmacists’ perceptions of the overall effectiveness of feedback provision (p=0.03) [ S1]. [TEXT REDACTED FOR PUBLICATION, S2].

This initial project suggested that wider rollout could bring widespread improvement to error rates. A toolkit was developed, describing how to introduce the Prescribing Improvement Model (PIM) to help reduce prescribing errors made by Foundation Year 1 hospital doctors. This comprised practical guidance derived from Franklin’s research [ R3] as previously described, plus an accompanying video [ S3]. Data on prescribing errors collected by seven participating hospitals, including the Royal Marsden and London North West University Healthcare NHS Trust, suggested a statistically significant reduction in prescribing errors from 11% to 9% (p=0.003), a relative reduction of 18% [ S4]. Testimonials indicated that this work has had “a significant impact on improving patient safety”, has been incorporated into junior doctor training, and has resulted in amendment of clinical pharmacy guidelines, as well as being used as a model for learning at the London North West University Healthcare NHS Trust [ S5].

Avoiding reliance on ‘smart’ pumps to reduce errors in intravenous infusions.

Franklin and colleagues’ research [ R4] raised key questions that challenged the prevailing view that ‘smart’ infusion pumps are the solution for intravenous medication errors. In January 2019, Franklin was asked to participate in a UK Parliamentary round table event, ‘Meeting the Medication Error Challenge’, with NHS England, the Care Quality Commission and the Medicines and Healthcare Products Regulatory Agency, to consider the role of smart pumps. At this event, she advised that these pumps were not a panacea, that the evidence for their benefits was not yet clear and that local evaluation is essential [ S6]. Supporting this stance, Franklin’s research was also used by the Healthcare Safety Investigation Branch (HSIB, responsible for conducting independent investigations of patient safety concerns in NHS-funded care across England) in their investigation of the procurement, usability and adoption of ‘smart’ infusion pumps [ S7]. A testimonial from HSIB clearly links [ R4] to the development of key recommendations in the report, stating: [TEXT REDACTED FOR PUBLICATION, S7].

Improving inpatient experience through self-administration.

Franklin’s research [ R6] has informed the revision of policies on self-administration of medication and associated patient-facing materials (including patient leaflet ‘ Keeping and administering your medicines in hospital’) to encourage this type of practice [ S8]. Building upon Franklin’s findings, a quality improvement project at Imperial College Healthcare NHS Trust demonstrated an increase in self-administration from 41% (64/155) to 66% (78/118) of patients [ S9]. In 2019, the NHS Specialist Pharmacy Services repository of good practice for all English NHS organisations also cited this work for increasing the availability of self-administration as well as raising professionals’ awareness of patients’ ability to self-administer [ S10].

Influence on medical practice.

Franklin has been the lead author on the 2020 revision of the World Health Organization’s (WHO) Multi Professional Patient Safety Curriculum Guide to form a separate Inter-Professional Medication Safety Curriculum Guide [ S11]. The current version is widely used to guide undergraduate and post-qualification training of healthcare professionals around the world, particularly in lower and middle income settings, and is available in ten languages. The revised WHO guide refers to Franklin’s work in making recommendations around giving feedback on errors, supporting patient and carer involvement in medication safety, and the need to be aware of the unintended consequences of technologies. As an example in practice, and in addition to the implementation of the Prescribing Improvement Model (PIM) within Imperial College Healthcare NHS Trust, PIM has formed the basis of teaching at Imperial College London Medical School [ S12], where it was noted the importance of “real life examples of mistakes …they capture the attention of the students who want to avoid mistakes”. PIM has also been adopted as far away as Taranaki District Health Board Hospitals in New Zealand [ S12] as an ‘alternative electronic method’ to specifically target areas of best practice that can be further optimised [ S12], and received positive feedback from prescribers who found the PIM’s specific examples of prescribing best practice to be concise and educational.