nhs forth valley near patient testing monitoring …...nhs forth valley near patient testing...
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NHS Forth Valley Near Patient Testing Monitoring EMIS Templates
Purpose of templates
To support safe near patient testing systems in practices
To help collect data for the FV LES consistently using codes which can be searched
Important points
– Commencement of high risk drug treatment and duration of treatment can be displayed on the problems
summary list, which is important for safe practice – when initiating high risk drug treatment, a GP
needs to use the template in consultation manager (F6) and save the problem as significant and
permanent to ensure this.
– The template allows for recording of patient reported side effects, which could be captured by the
phlebotomist. Again, using in consultation mode ensures that the information is recorded in the
consultation history.
– Bundle data is asterisked on the relevant screens (required for methotrexate and azathioprine).
– A linked advice template for the drugs give specific advice on treatment, side effects, and the Forth
Valley monitoring schedule
– The most recent blood results are displayed and when results are reviewed there is a checkbox to record
whether these are normal or abnormal, with a freetext box to record appropriate action taken.
– Hyperlinks are provided to the Arthritis UK patient information booklet, the Web Mentor / EMIS
Reference patient leaflet
Initiation of high risk drug treatment
To record that a patient is starting on a high risk drug and display this (with duration) on the
problem summary (F11):
In Consultation manager (F6), select the FV ES NPT Index template
Click FV NPT and then the button for high risk treatment started (contains the ESCRO codes)
Select the drug which
is to be started (e.g.
sulfasalazine)
The drug name will be
added automatically.
Enter the expected
duration using freetext
box.
Click ok on this and
the FV ES NPT screen
In the FV ES NPT
index screen, click the
button for the relevant
drug
Discuss possible side
effects with the
patient, give Mentor
or Arthritis UK
patient leaflet
Check the box for
medication counselling
on the index screen
(top left as shown)
Ok all screens before
closing
The problem list should show the following problem:
Monitoring high risk drugs
The template can be used when taking the monitoring blood samples, and also after checking the results to
re-authorise the next prescription.
When saving the
consultation there will
be a new problem.
The problem should
appear as significant –
if not change it to
significant and click
finish (if saved as
minor, the problem
will drop off the active
problem list after 28
days)
When blood is
being taken by the
phlebotomist, the
template can be
used to record
that the test
request has been
sent, and also
whether the
patient has
experienced any
side effects.
The monitoring
schedule can be
checked before a
diary entry made
for inviting a
patient for a blood
test.
Reviewing blood results
When reviewing blood
results, the GP can
access these via the
NPT index screen.
Record whether the
results are normal or,
if abnormal,
Enter appropriate action
in the freetext box and
diary date for patient
recall.
If results are normal,
re-authorise the drug
(for 1 or 2 months as
appropriate).
Click ok and save
consultation (F8)
Access the advice
screen if required
See button on left
side index list
APPENDIX: NHS Forth Valley Near Patient Testing LES data requirements
LES requirements
(Bundles in bold)
Data entry required Preferred code Comments
Develop and
maintain a register of
patients on LES NPT
drugs
Patient on drugs register:
could be done by search
for patient on specific
drugs but best to code
patient on high risk drug
as will show on problem
summary
High risk drug started 66P5
High risk drug stopped 66P6
Need to save as significant permanent
problem to show on summary / active
problem list.
Include duration as extension.
Drug name automatically added from
drug screen.
1. Appropriate tests
are carried out in
correct time scale
(B)
Has there been a full
blood count in the past 12
weeks (AZA) or 8 weeks
(MTX) as per local
guidance
FBC 424
Automatically in system via lab import
and last results displayed on screen
2. Appropriate
action are taken
and documented for
any abnormal
results in previous
12 weeks (B)
If any significantly abnormal results occurred in the previous 12 weeks has action been recorded in the consultation record?
Lab test result abnormal 419 Use freetext box on template and save in consultation record
3. Conduct
appropriate review
of blood test prior
to issuing of
Patients’ blood tests are reviewed prior to a prescription of high-risk drugs being issued
Lab test result normal 418
Lab test result abnormal 419
Needs checked when GP checks test results – could be done when first see results or when drug is re-authorised
prescription (B)
4. Provide
appropriate
vaccination (B)
Pneumococcal vaccine
and a flu vaccination
Flu 65ED
Pneumococcal 6572
Flu declined 8I3Q
Pneumococcal declined 9OX5
Provide patient
education
The practice should offer
the patient with written
education about their drug
and record that this has
taken place in the notes
annually.
Medication counseling 6774
This could be done by phlebotomist
5. Side effects (B)
Is it documented that the
patient was asked about
any new or recent side
effects the last time blood
was taken for drug
monitoring?
Drug side effects checked 8BIZ
This could be done by phlebotomist and
GP notified if any side effects present