1. Setup - these help you asses where your surgery currently stands, giving you an view of what to do before commencing regular activity
   
2. Admin - identifies patients who require a recall or text or another sort of administrative action
   
3. Clinical - identifies patients who require a clinician to review the record and take some action

This article is an explanation of the content of these folders. For instructions on how to use these searches and embed them in your practice, see the PCIT Academy Lessons.

Setup

1. Patients appearing in Amber are overdue monitoring according to best practice.
   
2. Patients appearing in Red are very overdue and will be flagged in the CQC's own searches.

Patients appearing in these searches should have the PCIT CQC Navigator alert appear in their alert box. This will enable staff to double-click the alert for a coding template.

There is no way to add an exception to patients returned in these searches; CQC inspectors will still find these patients with their own searches so it is best that patients are displayed for your information if the patient has not been properly dealt with.

Amber/Red - Bloods

1. "High risk CKD" is defined as those with stage 4 or 5 CKD, or those whose latest eGFR is 30 or less
   
2. Hypothyroidism (last in range) shows you those patients whose latest TSH level was within acceptable margins (0.3-5 inclusive), but their latest TSH level was taken more than 18 months ago
3. Hypothyroidism (out of range) shows you those patients whose latest TSH level was less than 0.3 or more than 5, and their latest TSH level was taken more than 18 months ago
4. The rest of the searches here are regarding drugs so should be clear from the title
   
1. For Azathioprine, Methotrexate and Leflunomide, patients will appear if they have had an issue in the last 6 months
   
2. For all other drugs in this folder, patients will appear if they are on a current course
   

Red - BP

Red - Comms

Search title	Code Term
On Hydrochlorothiazide- NO skin cancer advice given	Medication side effects education
On SGLT-2 inhibitor - NO ADVICE about DKA & Fournier's gangrene given	Education about Fournier's gangrene AND Education about ketoacidosis
On teratogenic medication NO contraception advice given	Advice on risk of harm to fetus from maternal medication during pregnancy

Historically, PCIT enabled users to add the code "medication side effects education" to resolve the SGLT-2 requirement. More recently more appropriate codes have been added to the searches and alert.

Red - High Risk Patients

1. High risk asthmatics is defined as:
   
1. No record of COPD; AND
   
2. On the asthma register and not resolved; AND
3. 12 or more SABA inhalers in the previous 12 months
   
2. The review code list used for asthmatics is the same as the standard QOF codes, e.g. Asthma Annual Review 394700004
3. High risk diabetics is defined as:
   
1. On the diabetes register and not resolved; AND
   
2. Latest recorded HbA1c is 75 or above
   
4. The review code list used for diabetes is not nationally defined. PCIT have chosen the following commonly used codes:

   Code Term	ID
   Diabetic monitoring	170742000
   Diabetic annual review	170777000
   Diabetic 6 month review	198501000000100

The intention of these reports is as the high risk patients are coded with monitoring, they will appear in "High risk asthmatic/diabetic monitored in last 3m". This is essentially your work complete report!

Red - New diagnosis

1. Possible CKD excludes patients who have CKD stage 3, 4 or 5. However, if the patient's latest code is CKD resolved they may still be re-included in the search.
   
2. Possible Diabetes excludes anyone on the diabetes register, but re-includes anyone with a Diabetes Resolved code. It also excludes:
   
1. anyone with a GDM code in the last 12 months or;
   
2. anyone with a steroid-induced diabetes code in the last 12 months or;
   
3. anyone with the code haemoglobinopathy ever

Red - Zero

1. Ideally, all these searches should return 0 patients. Where you cannot resolve a patient, PCIT recommend adding the code "Patient Review", with associated text explaining reasons and actions taken. This will display in the PCIT report, and can be used to demonstrate to a CQC inspector.
   
2. It should be noted that the "Has AF raised CHA2DS2-VASc and not anticoagulated or excepted" does not include patient declined codes - this is purely from a patient safety point of view and does not align with AF008.

Admin

Monthly searches

1. APPOINTMENT searches are those patients that require a review, as outlined above in the CQC RED>High risk patients folder above
   
2. BLOODS are for those who require tests typically every 12 months or less. See the CQC RED>Bloods folder above
   
3. COMMS similarly is to manage those patients returned in CQC RED>Comms folder above
   
1. PCIT have produced some patient letters which you can merge with the search to complete this work

Weekly searches

1. These are similar in content to the CQC Red>Bloods/BP folder, with some different timeframes which follow NICE, BMA or MHRA guidelines.

Clinician

CrCl calculation

1. These reports are similar to the ones found in Setup>CQC Red>Zeros. As such, there should be ideally no patients in these searches.
   
1. For patients in these searches, they require a Creatinine Clearance calculating. The report will show you the latest DOAC and eGFR, or the latest CrCl with the patient's weight.

Medicines management

1. Medication review in last 3 months - these reports return all patients coded with a medication review, broken up by age. The idea behind these is to generally be aware of how many reviews are being done, and pick a handful to check. The CQC inspector may use their own report to randomly pick some patients and scrutinise their med review
   
2. Polypharmacy - PCIT have curated a list of drugs that should accurately capture patients on 10 or more meds. This excludes items such as a food supplements.
   
1. Patients in this list who have not been coded with a med review in the last 12 months will be flagged in PCIT report
   
3. Anyone with 10 or more issues of zopiclone, zolpiden, zaleplon, or benzodiazepine will be flagged with the CQC for warnings around drug dependencies.
1. Patients in this list who have not been coded with a med review in the last 12 months will be flagged in PCIT report
   
4. Similarly patients with 3 or more issues of gabapentin or pregabalin in the last 6 months will be flagged by CQC and PCIT reports

New diagnoses

1. These are covered above in Setup>CQC Red>New diagnosis

Zeros