The blind leading the blind: Co-production of medication safety solutions for people with sight impairment in community pharmacy
Authors: Riste L K , Jaye K , Gangani N , Williams R , Embury S M , Lewis P J , Giles S , Ashcroft D M 
Published: November 2023

Abstract

Introduction
Around 237 million medication errors occur each year in England, with an estimated cost of £98 million1. We carried out a scoping review identified that people with sight impairments were a group at high risk of errors (under review).

Aim
To improve medication safety for people with sight impairments by developing an ‘App’ to help them manage medications.

Methods
We attended an initial in-person ‘Tea and Tech’ stakeholder group led by Henshaws Sight Loss charity in Manchester, UK and sought feedback from people with sight impairments about their experiences of medication.
Ethical approval for this study was granted by The University of Manchester Research Ethics Committee (Ref: 2021-11098-18381).
Co-design workshops – Due to the ongoing COVID-19 pandemic, we held two online workshops, minimising the need for travel and face to face meetings2. Workshops were promoted by RNIB amongst their ‘Community Connectors’. Community Pharmacists who were part of our NIHR Greater Manchester Patient Safety Translational Research Centre were also invited to participate to provide their perspective as healthcare professionals. Sessions were co-facilitated by patient safety researchers and researchers acting as notetakers.
The first workshop (June 2021), focussed on the experiences of people with sight impairment around using medication, and potential solutions to these. The second workshop (July 2021), ranked these potential solutions, prioritising ideas for development.

Results
Those attending the Tea and Tech group warned against developing ‘another App’, highlighting problems caused by their sight impairment around installing and using ‘Apps’ generally.
Co-design workshops were attended by six people with sight impairment and six community pharmacists. The difficulties reported included inability to distinguish between medications, to access dosing instructions (on medication labels) and safety information within product information leaflets. The solutions ranked as most important were 1) one to one consultations with pharmacists 2) improving medication packaging and 3) the need for pharmacist training.
Discussions highlighted the lack of a system for pharmacists to reliably identify people with sight impairments.
This led us to develop a pharmacy software system called Find Logo And Give Medication advice (FLAG-Me Vision) which identifies people with sight impairments using existing data within the electronic health record. An on-screen alert (shown as a logo) on the patient medication record, prompts pharmacy staff to offer a one-to-one consultation. Resources available on our website (www.flag-me.org) supports consultations and meets the remit for pharmacist training.
Our prototype software created by Imago Student Software company at The University of Manchester, was tested using dummy NHS records and Hospital Run (open-source software).

Discussion/Conclusion
Market discovery and testing for FLAG-Me Vision has been undertaken via iCURe DISCOVER programme3. Feedback is that FLAG-Me Vision is well received by people with sight impairments and pharmacists alike. Future plans include piloting this software with pharmacy software suppliers within one community pharmacy chain in Greater Manchester.

References
1. Elliot RA, Camacho E, Jankovic D. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf. 2021;30:(2)96-105
2. Adeyemi I, Sanders C, Ong BN, et al. Challenges and adaptations to public involvement with marginalised groups during the COVID-19 pandemic: commentary with illustrative case studies in the context of patient safety research. Res Involv Engagem. 2022;8(1):13
3. https://www.icureprogramme.com