National award for end-of-life pain relief app

The Safer Prescription of Opioids Tool (SPOT) app has been awarded the Royal College of Surgeons of Edinburgh (RCSEd) Dundas Medal 2022. The award, introduced by RCSEd and Scottish charity PATCH, recognises efforts to improve the provision of palliative care for patients in hospital.

The conversion process between different opioids is not straightforward and often requires complex calculations. The SPOT app allows clinicians to safely convert between different types of opioids, reducing the risk of over- or under-dosing.

SPOT was founded by Dr Roger Flint, a University of Dundee graduate, and developed in collaboration with colleagues from the University’s School of Medicine. The idea arose following Dr Flint’s own difficult experience as a junior doctor in Ninewells Hospital.

After only recently graduating from the University, Dr Flint, working out-of-hours and covering three wards, was asked to change the type of pain relief medication for a patient receiving end-of-life care. As a new junior doctor he was not confident in his conversion calculations and prescribing the correct dosage of opioids. The patient had to wait some time before receiving pain relief, until a more senior doctor could check Dr Flint’s calculations.

“The experience has haunted me ever since,” said Dr Flint. “It seemed absurd that in the time of apps to book flights and order a taxi there was not an equivalent to help prescribers in this situation.

“SPOT enables clinicians to independently and remotely double-check their opioid conversions safely, quickly and conveniently at the patient’s bedside, whilst providing access to nationally adopted best-practice Scottish Palliative Care Guidelines.

“It helps to reduce and mitigate risk, preventing conversion errors leading to harm and increasing spread of opioid options for each individual to have personalised approaches implemented.”

The app was designed, developed and validated as a result of research led by the University’s School of Medicine. Professor Jacob George, who is Academic Lead for SPOT, received the Dundas Medal at an awards ceremony alongside others on the SPOT team.

“Receiving the Dundas Medal is further recognition of the innovation that has come from the School of Medicine in solving a real-world clinical problem,” said Professor George.

“Opioids are very complicated and patients can potentially suffer significant harm, sometimes even death, if mistakes are made in the conversion process. Opioids are one of the top five most dangerous drugs that we prescribe in the clinical practice worldwide, and it's almost always in the top five of the most dangerous drugs in terms of causing harm.

“SPOT enables doctors, particularly junior doctors who are not familiar, to convert safely from one type of opioid to another. It is a huge patient safety advance in opioid prescribing.”

SPOT is now in daily use in NHS Borders, part of the NHS Scotland Covid-19 Palliative Care policy and recommended for national adoption across Scotland by the Scottish Partnership for Palliative Care.