Stakeholder perspectives on evidence for digital mental health interventions: Implications for accreditation systems.

BACKGROUND: Digital mental health interventions can be effective for treating mental health problems, but uptake by consumers and clinicians is not optimal. The lack of an accreditation pathway for digital mental health interventions is a barrier to their uptake among clinicians and consumers. However, there are a number of factors that may contribute to whether a digital intervention is suitable for recommendation to the public. The aim of this study was to identify the types of evidence that would support the accreditation of digital interventions. METHOD: An expert workshop was convened, including researcher, clinician, consumer (people with lived experience of a mental health condition) and policymaker representatives. RESULTS: Existing methods for assessing the evidence for digital mental health interventions were discussed by the stakeholders present at the workshop. Empirical evidence from randomised controlled trials was identified as a key component for evaluating digital interventions. However, information on the safety of users, data security, user ratings, and fidelity to clinical guidelines, along with data from routine care including adherence, engagement and clinical outcomes, were also identified as important considerations when evaluating an intervention. There are considerable challenges in weighing the evidence for a digital mental health intervention. CONCLUSIONS: Empirical evidence should be the cornerstone of any accreditation system to identify appropriate digital mental health interventions. However, robust accreditation systems should also account for program and user safety, user engagement and experience, and fidelity to clinical treatment guidelines.

The contribution of labelling to safe medication administration in anaesthetic practice.

The administration of medications is central to anaesthetists' care of patients. Errors are inevitable in any human endeavour, but should be distinguished from violations. The incidence of medication errors in anaesthesia has been estimated as 1 per 13,000 administrations, excluding errors in recording. Adverse medication events follow a proportion of these errors. Labelling is a key element of medication safety. There is a long-standing need for improvements in the labelling of ampoules and vials. An international standard exists for labelling syringes used during anaesthesia (ISO 26825). Australia has recently released national recommendations for labelling lines and injectable medications that complement this and other relevant standards. The provision of at least some medications in pre-filled syringes would reduce the number of steps involved in medication administration, increase the certainty that syringe labels are correct and probably reduce medication errors. Pre-printed, peel-off flag labels on ampoules and vials are a less expensive alternative to pre-filled syringes to facilitate correct labelling. The medication name on user-applied labels should be matched to that on the relevant ampoule or vial at the time of drawing up any medication. All lines and catheters should be labelled. Any medicine or fluid that cannot be identified (e.g., in an unlabelled syringe or other container) should be considered unsafe and discarded. Reducing adverse medication events will require the engagement of individual anaesthetists.