Optional Handy Protocols

Optional Handy Protocols

Optional Handy Protocols

Introduction

If you want any of these protocol adding to your system and setting live, please either download from the website or ask our team to install for you.                                                                           



HP001 A&E Self harm Safeguarding

Type: Protocol with document

Purpose:
To ensure self harm is highlighted to GPs for patients attending A&E and creates a letter to invite the patient in for a
review. For high risk patients the safeguarding lead is informed.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective
How staff, teams and services work together
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol launches a protocol when the codes:
• Seen in hospital casualty C=185210004 D=285194015
• Seen in accident and emergency C= 185210004 D= 667121000000119
• Admission to accident and emergency department C= 50849002 D= 1230914014
• Self referral to accident and emergency department C= 507291000000100 D= 1127501000000112
   are used. It is important that your administrative staff use these codes when recording an A&E attendance

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: 285194015, 667121000000119, 1230914014, 1127501000000112

Fitting your practice
This protocol flags a reminder for your team to check for self harm codes when filing A&E letters, and if they are present
creates a letter to invite the patient in for a review. It also flags where any other additional risks may be present and if
there are, ensures your safeguarding lead is notified.


HP002 Multiple A&E attendances

Type: Protocol alert

Purpose:
To ensure that patients who have had multiple attendances in A&E are highlighted to both clinicians and admin teams to ensure appropriate care.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective
How staff, teams and services work together
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This launches a protocol alert when the code 9N19 has been used more than 3 times in the last 12 months. It is important that your administrative staff use these codes when recording an A&E attendance.

Automatic triggers
System Trigger: Load Record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
This protocol highlights where there have been 3 or more A&E attendances over the last 12 months for adults or 2 or more for children under the age of 2. It relies on you using the code Seen in hospital casualty (C=185210004, D= 285194015) to code A&E attendances.



HP009 Registered patient lives outside practice area

Type: Protocol alert

Purpose:
To highlight to your team where patients are registered and live outside of the practice area.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective
How staff, teams and services work together
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your registered patients who live outside your practice area coded using Registered patient lives outside practice area C= 824381000000105 D= 214540100000115.

Automatic triggers
System Trigger: Load and update patient record
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Alert your team that this protocol alert will highlight registered patients who live outside the practice area. You may also want to consider the volume of protocol alerts you currently have in operation when deciding whether to set this live. There is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 



HP010 Remove Safeguarding Codes

Type: Protocol

Purpose:
Resolving safeguarding codes is notoriously difficult and often consumes a large amount of time trying to find the appropriate code to resolve the issue, which depends on the original code used. This protocol automates this process for you.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective
Staff skills and knowledge
Well-led
Leadership and capability 
Vision and strategy 
Culture of the organisation 
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
None - manually launched

Fitting your practice
Your team should be shown how to launch protocols using F12. For clinical members of the team it would make sense to have this on the F12 launcher for them to use when needed.



HP015 QRISK2 Checker (Advanced version in Pro package)

Type: Protocol

Purpose:
To allow clinicians to assess if QRISK2 is valid to be used in the patient they are assessing. Then to support the clinician in making that assessment and giving them advice in line with NICE guidance. Where our professional package is used, users will also be able to send the patient a letter or text information with a patient decision aid.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence based treatment
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol needs to be launched manually via F12. It is dependent on having accurate coded data within the clinical record.

Automatic triggers
None, this needs to be launched manually via F12

Fitting your practice
This protocol has to be launched manually, so clinicians need to be trained on it's functionality and advised on how to launch it using F12.




HP018 Family History Third Party Coder

Type: Protocol

Purpose:
Triggers an alert whenever family history is entered into the record to add an option of adding associated codes to record third party data.

Supporting key areas
Safe
Managing risks
Effective
Staff skills and knowledge 
How staff, teams and services work together
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Privacy and dignity
Well-led
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
That your clinicians record family history in EMIS using codes.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: Your chosen job categories
Clinical codes: FH - Family history C= 57177007 D= 1231692017.

Fitting your practice
Your team need to be aware of the importance of coding third party data within the records. 



HP019 Inappropriately Coded Problems

Type: Protocol

Purpose:
This protocol will ensure that teams within your practice don't make their problem lists untidy by flagging codes that are inappropriate to use as a problem title. This will ensure consistency of coding of problems by making sure that certain codes are not recorded as problems.

Supporting key areas
Safe
Managing risks
Effective
Staff skills and knowledge 
How staff, teams and services work together
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Governance and management
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All groups
Clinical codes: Medication review C= 182836005 D= 282653015, Medication review with patient C= 88551000000109 D= 137851000000113, Medication review without patient C= 391156007 D= 1485178017, Medication review with practice nurse C= 803361000000109 D= 1796041000000119, Medication review done by nurse C= 719478008 D= 3316498015, Medication review of medical notes C= 93311000000106 D= 158421000000116, Medication review done by pharmacist C= 719329004 D= 3316004018, Medication review C= 182836005 D= 712411000006117, Medication requested C= 182888003 D= 282730013, Had a chat to patient C= 183093006 D= 283022014, Annual asthma review C= 394700004 D= 1488421017, Diabetic annual review C= 170777000 D= 170777000, Diabetes medication review C= 394725008 D= 1488441010, Diabetic 6 month review C= 198501000000100 D= 299261000000111, Diabetes type 1 review C= 279291000000109 D= 479511000000117, Diabetes type 2 review C= 279321000000104 D= 479571000000110, Diabetes Year of Care annual review C= 887681000000105 D= 2287311000000111, Depression screening using questions C= 200971000000100 D= 305421000000112, Recommend travel vaccinations C= 171072005 D= 265110017, Treatment not tolerated C= 407563006 D= 2159164018, CLO test for heliobacter pylori C= 1009241000000103 D= 2582191000000111.

Fitting your practice
This may be a useful practice to discuss at a practice meeting to raise awareness and agree a list of codes that it is agreed will not be used. It is sensible to add any codes that you come across over time so that the list continues to expand.



HP021 Reception Message following phone call

Type: Protocol

Purpose:
An automatic pop up telling receptionists the patient has had a failed encounter today and passing on any message for the patient (saving having to look in tasks or care record).

Supporting key areas
Effective 
How staff, teams and services work together
Responsive
Person-centred care
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your failed encounters with associated text detailing any information for the patient.

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All admin team

Fitting your practice
Alert your team that they need to use the failed encounter code and then detail any message for the patient (e.g. script left, med3 done, referral done etc) as free text after the code - this will then be passed to the patient by the admin team.



HP025 Safeguarding Interpreter Impairment check

Type: Protocol

Purpose:
Loads a template on starting a consultation with a minor to record who has attended with them, also recording interpreter use if non English speaking.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective 
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
How staff, teams and services work together
Supporting people to lead healthier lives
Caring
Privacy and dignity
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership and capability 
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Start consultation
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Alert your team that this alert will trigger when starting consultations with minors. This will allow them to record important safeguarding information and whether an interpreter is used or not. Local discussion is needed as to whether this is a priority area for your practice.



HP026 Sick day rules

Type: Protocol

Purpose:
To highlight where patients are on medication that means they need to be aware of sick day rules and haven't been informed of this in the last 12 months.

Supporting key areas
Safe
Managing risks
Self care and treatment
Medicines management
Effective 
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge 
How staff, teams and services work together 
Supporting people to lead healthier lives
Caring
Involving people in decisions about their care
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability 
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on you using EMIS to record your prescribing.

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Alert your team that this protocol alert will highlight patients who need to be informed of the sick day rules. You may also want to consider the volume of protocol alerts you currently have in operation when deciding whether to set this live. There is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 



HP027 High Risk Diabetes + PCOS

Type: Protocol alert

Purpose:
To highlight to team members where a patient has pre-diabetes or PCOS and highlight any monitoring that has been done or is needed.

Supporting key areas
Safe
Managing risks 
Effective 
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge 
How staff, teams and services work together 
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
That your teams code PCOS appropriately.

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Your team need to know that they will see alerts for patients with pre-diabetes, PCOS or previously raised HBa1C levels.



HP028 Possible New Diagnosis

Type: Protocol alert

Purpose:
This protocol alert highlights where there may be new possible diagnoses that haven't yet been coded based on either drugs or other codes within the record. This replicates the blizzard institute searches - but highlights them to clinicians as they see patients. It is the same information as is found in the OneTemplate.

Supporting key areas
Safe
Managing risks 
Medicines management
Effective 
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All clinical prescribers

Fitting your practice
Alert your team that this protocol alert will highlight possible new diagnoses. You may also want to consider the volume of protocol alerts you currently have in operation when deciding whether to set this live. There is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 



HP029 Exception Reporting

Type: Protocol alert

Purpose:
To highlight to clinicians where exception reporting has previous taken place for a patient.

Supporting key areas
Safe
Managing risks 
Medicines management
Effective 
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: Your chosen job categories

Fitting your practice
Your team should be aware of the fact that this protocol alert will highlight where previous exception reporting has taken place and take action when they see it. Care needs to be taken that this may not have been within your own practice and you need to make sure that your own guidelines on exception recording are adhered to.



HP031 Last Med3 Issued (Panel)

Type: Protocol alert

Purpose:
Informs clinicians of the date of the last med3 issue via protocol alert. Handy when duty doc!

Supporting key areas
Safe
Self care and treatment
Effective 
How staff, teams and services work together
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your Med 3 issues correctly.

Automatic triggers
You can launch this manually from F12 or choose to launch automatically on:
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: Your chosen job categories

Fitting your practice
Your team should be shown how to launch protocols using F12. For clinical members of the team it would make sense to have this on the F12 launcher for them to use when needed. As with all alerts you need to consider which users this will be most useful for and also consider the volume of protocol alerts you currently have in operation when deciding whether to load this on patient record loading. There is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 



HP032 Last Med3 Issued (Zap)

Type: Protocol

Purpose:
Informs clinicians of the date of the last med3 issue when manually triggered using F12. Handy when duty doc!

Supporting key areas
Safe
Self care and treatment
Effective 
How staff, teams and services work together
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability 
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your Med 3 issues correctly.

Automatic triggers
You can launch this manually from F12 or choose to launch automatically on:

Fitting your practice
Your team should be shown how to launch protocols using F12. For clinical members of the team it would make sense to have this on the F12 launcher for them to use when needed. 



HP033 Coding Results Diabetic Retinopathy Screen

Type: Protocol

Purpose:
To ensure that the detail of diabetic retinopathy screening is recorded in the records.

Supporting key areas
Safe
Managing risks
Effective 
Staff skills and knowledge
How staff, teams and services work together
Responsive
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol relies on your clinicians coding intimate examinations correctly.

Automatic triggers
System Trigger: Update patient record
Run mode: Always run
Enable trigger for: For staff who are coders/admin

Fitting your practice
Your coding staff need to be aware that they will receive a prompt when entering diabetic eye screening results to put in more detail. The protocol will streamline the process for doing this.



HP034 - 3 or more DNA's past 6 months

Type: Protocol alert

Purpose:
To highlight to all members of the team patients who have had 3 or more DNAs in the last 6 months. This highlights potential safeguarding issues and makes sure that DNAs are minimised by proactively addressing.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective 
How staff, teams and services work together
Care
Involving people in decisions about their care
Responsive
Timely access to care and treatment
Well-led
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This protocol counts instances of the code
•       Did not attend - no reason C= 270426007 D= 405044018 in the last 6 months. It is important that your administrative staff use these codes when recording DNAs

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: For local decision

Fitting your practice
You need to think about who it is most appropriate for this protocol alert to show for. Administration team and clinicians may both benefit - administrators to reinforce the importance of attending and clinicians to bear in mind safeguarding issues or also discuss rational use of your services. You will need to consider the volume of protocol alerts you currently use and decide if it is appropriate to add another to avoid "alert fatigue".



HP035 Height Corrector

Type: Protocol alert

Purpose:
To flag where a clinician has recorded height in metres rather than centimeters which will lead to incorrect calculation results using clinical calculators within EMIS.

Supporting key areas
Safe
Managing risks
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: All groups
Clinical codes: Standing height C= 248333004 D= 370729019

Fitting your practice
This is an automated protocol, so no additional measures are required.



HP036 Diabetic Retinopathy Screen Prompt - Exportable

Type: Protocol

Purpose:
To highlight where diabetic retinopathy screening hasn't been undertaken or has been declined and prompt the user to consider a referral.

Supporting key areas
Safe
Managing risks
Effective
Staff skills and knowledge
How staff, teams and services work together
Responsive
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All groups
Clinical codes: Diabetes mellitus C= 73211009 D= 121589010

Fitting your practice
This is an automated protocol, so no additional measures are required.



HP038 Subject Access Requests Status

Type: Protocol
Purpose:
A protocol that allows the recording of SAR status at each stage so that anybody querying their status can be informed which stage they are at.

Supporting key areas
Safe
Managing risks
Effective
Staff skills and knowledge
How staff, teams and services work together
Caring
Involving people in decisions about their care
Privacy and dignity
Well-led
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This protocol needs the practice to use the protocol to record the receipt of SARs if they are then to use it to track SAR status

Automatic triggers
System Trigger: Manually via F12

Fitting your practice
Your team need to know that they need to launch the protocol when dealing with SARs to register their receipt and then to update their status at each stage of the process.



HP040 No Online Access Alert

Type: Protocol alert

Purpose:
To highlight to team members where the patient doesn't have online access, to try to increase online services registration.

Supporting key areas
Effective
How staff, teams and services work together
Consent to care and treatment
Caring
Involving people in decisions about their care 
Privacy and dignity
Well-led
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This protocol relies on your team using the code 9lW to record access to online records

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
This would fit well with a campaign to try to drive up online access to reduce receptionist workload. Consideration needs to be given to the internal processes you use to review records prior to giving online access. The practice may wish to consider defining which job categories this protocol triggers for.



Type: Protocol

Purpose:
When starting a consultation, this protocol will highlight if you have data sharing recorded for your patient, including when this was given. It will also ask you if you want to update this information so it is current.

Supporting key areas
Safe
Managing risks
Effective
Staff skills and knowledge
How staff, teams and services work together
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Privacy and dignity
Well-led
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
There are no system dependencies for this protocol

Automatic triggers
System Trigger: Add a consultation
Run mode: Always run
Enable trigger forAll job categories

Fitting your practice
Your team need to know that they will be prompted to update sharing information when they open the clinical record of the patient.



HP042 Military Service Referrals

Type: Protocol

Purpose:
To ensure that veterans are prioritised when they are referred for a problem associated with their military service. 
Supporting key areas
Safe
Managing risks
Self care and treatment
Effective
How staff, teams and services work together
Responsive
Timely access to care and treatment
Well-led
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol launches a protocol when any 8H referral code when the following codes for military service are in the record:
• Active duty military C= 702348006 D= 2995730017
• Military veteran C= 753651000000107 D= 1657891000000115
The best way of ensuring this is launched is to attach these codes to your 2ww documents. We will do this for you if you subscribe to our professional package.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger forAll groups
Clinical codes: Referral for further care C= 183444007 D= 283512014

Fitting your practice
Depending on how your practice operates, it may be the clinician or the secretary who code the referral. Whoever codes the referral, it is important that either they flag it as urgent, or pass on the message to whoever is responsible for sending the referral that it is urgent.



HP043 Cancer Referral Outcome Chaser

Type: Protocol

Purpose:
This is a protocol to safety net 2 week wait referrals. Where a 2 week wait referral has been made but no subsequent outcome recorded, it will prompt you to enter this detail into the record - hence ensuring that every 2 week wait referral has an outcome.

Supporting key areas
Safe
Managing risks 
Learning when things go wrong
Effective
How staff, teams and services work together
Responsive
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on your 2 week waits being coded with the subcodes below
Fast track cancer referral C= 199251000000107 D= 301081000000115
or Priority cancer referral C= 199251000000107 D= 473311000000110

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger forAll groups

Fitting your practice
You must use the codes Fast track cancer referral or Priority cancer referral to record 2 week wait referrals. Your coding team need to understand the importance of coding the clinic attendances for 2 week waits with Seen in fast track suspected cancer clinic C= 382761000000101 D= 754441000000113 when receiving documents from secondary care. Your clinical team need to be aware that where this hasn't been coded, they will be alerted to take action to record the outcome.



HP044 QRISK Status

Type: Protocol Alert

Purpose:
To highlight to clinicians where a cholesterol has been received and no subsequent QRISK has been undertaken, or where a QRISK has been undertaken and the risk is high.

Supporting key areas
Safe
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Supporting people to live healthier lives
Caring
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
The codes assessed for cholesterol are
Serum cholesterol level C= 1005671000000105 D= 2551271000000118 and
Plasma total cholesterol level C= 1017161000000104 D= 2552911000000113.
If these are not used to record cholesterol the protocol will not work. 

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger forAll clinical job categories

Fitting your practice
You may need to have some discussion about how QRISK is usually calculated when you receive a new cholesterol result. You could utilise our other handy protocol to make sure this is recorded accurately following results.



HP046 Eligible for NHS Health check

Type: Protocol

Purpose:
To allow staff to check patients to see if they are eligible for an NHS health check.

Supporting key areas
Effective
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
That your records are contemporaneous and correct

Automatic triggers
None for this protocol, launch by using F12

Fitting your practice
Your team should be shown how to launch protocols using F12. For reception staff it would make sense to have this on the F12 launcher for them to use when needed.



HP047 Eligible for Pneumo vaccination

Type: Protocol

Purpose:
To allow staff to check patients to see if they are eligible for a pneumonia vaccination.

Supporting key areas
Effective
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
That your records are contemporaneous and correct

Automatic triggers
None for this protocol, launch by using F12

Fitting your practice
Your team should be shown how to launch protocols using F12. For reception staff it would make sense to have this on the F12 launcher for them to use when needed.



HP048 Eligible for Shingles

Type: Protocol

Purpose:
To allow staff to check patients to see if they are eligible for a shingles vaccination.

Supporting key areas
Effective
How staff, teams and services work together 
Supporting people to live healthier lives 
Consent to care and treatment
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
That your records are contemporaneous and correct

Automatic triggers
None for this protocol, launch by using F12

Fitting your practice
Your team should be shown how to launch protocols using F12. For reception staff it would make sense to have this on the F12 launcher for them to use when needed.



HP050 Helicobacter and Eradication automatic

Type: Protocol

Purpose:
To automatically prescribe Helicobacter Pylori eradication therapy when coded that this is present.

Supporting key areas
Safe
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on your teams coding positive helicobacter results correctly, but otherwise automatically launches

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Clinical codes: Helicobacter serology positive C= 168271003 D= 261342014,
Helicobacter breath test positive C= 168378007 D= 261494012,
Helicobacter gastritis C= 89538001 D= 819581000006115,
Helicobacter pylori test positive C= 513161000000105 D= 114108100000119,
Helicobacter pylori stool test positive C= 736696002 D= 3521950014

Fitting your practice
Alert your team that if code a patient as having helicobacter pylori that this protocol will automatically prescribe the eradication therapy for them.



HP050 Helicobacter Eradication F12

Type: Protocol

Purpose:
To automatically prescribe Helicobacter Pylori eradication therapy when launched via F12 launcher.

Supporting key areas
Safe
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
None for this protocol, launch by using F12

Fitting your practice
Alert your team that they need to launch this protocol via the F12 menu.



HP051 Housebound

Type: Protocol alert

Purpose:
A protocol alert which highlights to your team where patients are housebound.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Effective
How staff, teams and services work together
Consent to care and treatment
Caring
Kindness, respect and compassion
Privacy and dignity
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your housebound patients using the code
Housebound C= 160689007 D= 250485014
or Temporarily housebound C= 428415003 D= 2691830017, but otherwise automatically launches

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Alert your team that if they don't code exacerbations of COPD that they will be nudged to do so by the protocol.



HP055 Last text message sent

Type: Protocol

Purpose:
This protocol can be used to instantly display the last message sent to the patient via MJOG.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Self care and treatment
Medicines management
Learning when things go wrong
Effective
How staff, teams and services work together
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on you having coded your MJOG messages

Automatic triggers
None - manually launched

Fitting your practice
Your team should be shown how to launch protocols using F12. For administrative members of the team it would make sense to have this on the F12 launcher for them to use when needed.



HP056 MRSA decolonisation

Type: Protocol

Purpose:
To automatically prescribe MRSA eradication therapy when coded that this is present.

Supporting key areas
Safe
Self care and treatment
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Supporting people to lead healthier lives
Caring
Involving people in decisions about their care
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation
Governance and management
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on your teams coding positive MRSA results correctly, but otherwise automatically launches

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Clinical codes: MRSA (methicillin resistant Staphylococcus aureus) screening test C= 9930710000001707 D= 2570611000000115, Methicillin resistant staphylococcus aureus C= 266096002 D= 465611000000114

Fitting your practice
Alert your team that if code a patient as having MRSA that this protocol will automatically prescribe the eradication therapy for them.




HP058 PAM Level or Score alert

Type: Protocol Alert

Purpose:
This alert displays PAM levels or scores where they have been recorded in the record.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Self care and treatment
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Supporting people to live healthier lives
Caring
Involving people in decisions about their care
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation
Governance and management
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol relies on the coding of PAM levels using the code Patient Activation Measure Level C= 962851000000103 D= 2453441000000115
and PAM score using Patient Activation Measure Score C= 713644003 D= 3296561011.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: Variable depending on requirement

Fitting your practice
This protocol will only be useful to you if you are utilising PAM (Patient Activation Measures) in your management of patients.

HP062 Shingles Alert

Type: Protocol

Purpose:
A protocol alert which shows where a patient is eligible for a shingles vaccine and hasn't had one yet.

Supporting key areas
Safe
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
How staff, teams and services work together
Supporting people to live healthier lives
Caring
Involving people in decisions about their care
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All relevant team members

Fitting your practice
Alert your team that this protocol alert will highlight patients who are eligible but haven't yet had a shingles vaccine. You may also want to consider the volume of protocol alerts you currently have in operation when deciding whether to set this live. There is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 

HP063 HbA1c Appropriate for Diagnosis

Type: Protocol

Purpose:
This protocol checks if it is appropriate to use an HbA1c blood test to make a diagnosis of diabetes, checking the record for low eGFR, steroids, iron deficiency anaemia, haemolytic anaemia, alcoholism/liver disease, pernicious anaemia, pregnancy, marked hyperlipidaemia.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol will only work correctly if you use EMIS contemporaneously to record medical conditions and results.

Automatic triggers
System Trigger: Manually using F12

Fitting your practice
Your clinicians need to know that they can use this protocol to check if HbA1c can be used accurately to make a diagnosis of diabetes.


HP064 Hba1c interpretation

Type: Protocol

Purpose:
This protocol looks at new HbA1c results to help the user interpret them. Where they are in the diabetic or prediabetic range and this is not coded in the record it will be highlighted to the user. If they have diabetes, it will give the user information about the target HbA1c and the medication that the patient is currently taking.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy 
Culture of the organisation
Governance and management
Management of risk and performance 
Management of information 
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on coding of diabetes and pre-diabetes appropriately within the record as well as HbA1c to record levels.

Automatic triggers
System Trigger: Trigger manually using F12

Fitting your practice
Your clinicians need to be aware that they can use this protocol to interpret new HbA1c results that come back from the lab. 

HP070 Esmya (Ulipristal) New Rx Preventer

Type: Protocol

Purpose:
To make users aware of MHRA guidance if attempting to prescribe Esmya (Ulipristal) for uterine fibroids.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care 
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
The effectiveness of this intervention will only be realised if you are using EMIS clinical record system for all prescription issues.

Automatic triggers
System Trigger: Select a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: Esmya 5mg tablets (Gedeon Richter (UK) Ltd), Ulipristal 5mg tablets

Fitting your practice
There is nothing else required to allow this to fit in with your practice.

HP071 Esmya (Ulipristal) LFT Zap

Type: Protocol Alert

Purpose:
Where a patient is already receiving Ulipristal treatment, this protocol will highlight if the required monitoring of liver function has been undertaken and highlight any abnormalities.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care 
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
The effectiveness of this intervention will only be realised if you are using EMIS clinical record system for all prescription issues and all pathology results are also contained within the clinical record.

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
There is nothing else required to allow this to fit in with your practice.

HP072 Esmya (Ulipristal) LFT absent panel

Type: Protocol

Purpose:
Where a patient is already receiving Ulipristal treatment, this protocol will block further issues if the required monitoring of liver function has not been undertaken and highlight any abnormalities.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care 
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
The effectiveness of this intervention will only be realised if you are using EMIS clinical record system for all prescription issues and all pathology results are also contained within the clinical record.

Automatic triggers
System Trigger: Issues a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: Esmya 5mg tablets (Gedeon Richter (UK) Ltd), Ulipristal 5mg tablets

Fitting your practice
There is nothing else required to allow this to fit in with your practice.

HP073 Esmya (Ulipristal) Signs of liver disease

Type: Protocol

Purpose:
Where a patient is already receiving Ulipristal treatment, this protocol will warn if any codes suggesting liver disease are entered into the record to make sure the user is aware of the Ulipristal prescription and the need for review.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care 
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
The effectiveness of this intervention will only be realised if you are using EMIS clinical record system for all prescription issues and contemporaneous notes are also contained within the clinical record.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: 
Abdominal colic C= 9991008 D= 17444017,
Non-colicky abdominal pain C= 162038003 D= 252571013,
Abdominal discomfort C= 43364001 D= 72350017,
Abdominal pain C= 21522001 D= 36112013,
Central abdominal pain C= 162046002 D= 252584016,
H/O: jaundice C= 161536006 D= 251733018,
Yellow or jaundiced colour C= 267030001 D= 397876013,
Generalised abdominal pain C= 102614006 D= 252305018,
Upper abdominal pain C= 83132003 D= 137890011,
Lower abdominal pain C= 54586004 D= 90723010,
O/E: jaundiced colour C= 16274002 D= 253649017,
O/E: abdo. pain on palpation C= 268941000 D= 402479018,
O/E: liver palpated C= 268943002 D= 402482011,
[RFC] Jaundice C= 906071000006107 D= 906071000006111,
Obstructive jaundice C= 59848001 D= 99418019,
[D] Jaundice (not of newborn) C= 18165001 D= 299051000006110,
Jaundice C= 18165001 D= 30676010,
[D] Jaundice (not of newborn) NOS C= 18165001 D= 299061000006112,
[D] Abdominal pain C= 21522001 D= 292271000006119,
[D] Upper abdominal pain C= 83132003 D= 30651000006110,
Nonspecific abdominal pain C= 304542004 D= 446863014,
[D] Abdominal pain NOS C= 21522001 D= 292281000006116.

Fitting your practice
There is nothing else required to allow this to fit in with your practice.

HP074 Gout Prophylaxis

Type: Protocol

Purpose:
To highlight to clinicians where prophylaxis against gout hasn't been prescribed when starting urate lowering therapy.

Supporting key areas
Safe
Managing risks
Self care and treatment
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This is dependent on your team using EMIS to record their prescriptions.

Automatic triggers
System Trigger: Add a drug
Run mode: Always run
Enable trigger for: All clinical prescribers
Add Drug group, approved name or ingredient: Allopurinol and child codes

Fitting your practice
Alert your team that if they don't prescribe prophylaxis when starting urate lowering therapy that they will be nudged to do so by the protocol.

HP075 Urate control in gout

Type: Protocol Alert

Purpose:
Where patients are on uricosuric treatment for gout, this protocol alert will let you know if they are controlled to British Society of Rheumatology suggested treatment targets.

Supporting key areas
Safe
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This is dependent on your team using EMIS to record their prescriptions and pathology results.

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
This protocol works well with our British Society of Rheumatology audit searches. We would suggest running the searches, performing the audit and then using this protocol to implement change within your practice.

HP076 NICE hypercholesterolaemia

Type: Protocol

Purpose:
The protocol will highlight if any of the conditions that NICE identify as needing review exist and pop up with an alert to highlight this to clinicians. This will only happen once for the non-cholesterol related features. 

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This is dependent on your team using EMIS to record contemporaneous records, including family history. Where relevant information has not been accurately recorded in EMIS the alert will not highlight the relevant information.

Automatic triggers
System Trigger: Manually using F12

Fitting your practice
Your clinicians need to know that they can use this protocol to check for NICE alerts relating to hypercholesterolaemia.

HP077 NICE hypercholesterolaemia alert

Type: Protocol Alert

Purpose:
The protocol alert will highlight if any of the conditions that NICE identify as needing review exist and display a protocol alert to highlight this to clinicians. This will only happen once for the non-cholesterol related features. 

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
How staff, teams and services work together 
Supporting people to live healthier lives
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This is dependent on your team using EMIS to record contemporaneous records, including family history. Where relevant information has not been accurately recorded in EMIS the alert will not highlight the relevant information.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Your clinicians need to know that this alert will highlight NICE alerts relating to hypercholesterolaemia.

HP078 COPD FEV1>50% ICS Alert

Type: Protocol Alert

Purpose:
This protocol alert will highlight where a patient with COPD and an FEV1 of more than 50% is on inhaled corticosteroids. This will help you to comply with NICE and MHRA guidance that you should only use an ICS in patients with severe disease (NICE CG101).

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement 
Learning, improvement and innovation

System Dependencies:
This is dependent on your team using EMIS to record contemporaneous records, including spirometry and medication issues. Where relevant information has not been accurately recorded in EMIS the alert will not highlight the relevant information.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
Your clinicians need to know that this alert will highlight NICE alerts relating to inhaled corticosteroids.

HP079 Coding Results of Diabetic Retinopathy Screening

Type: Protocol

Purpose:
This protocol is designed to assist your admin team in the coding of the outcome of the National Diabetes Retinopathy Screening Program. It prompts staff to consider coding R0-4 and M0-1 for each eye through the use of a protocol rather than a template at the point of attaching the results document to the patient’s records. 

Supporting key areas
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Concerns and complaints
Well-led
Management of information

System Dependencies:
None

Automatic triggers
System Trigger: None - launch manually from F12

Fitting your practice
Your admin team need to know that this protocol exists to streamline the coding of diabetic retinopathy screening and how to launch it from their F12 launcher.

HP080 COPD Exacerbations counter Zap

Type: Protocol Alert

Purpose:
This protocol alert will provide the user with a count of the number of exacerbations that a patient with COPD has had in the last 2 years, aiding awareness of the severity of the condition.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This exacerbations counter zap will only work if all exacerbations are coded within EMIS. Another of our handy protocols will highlight to users where it looks like an exacerbation may have occurred but hasn't been coded.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
After activation your clinicians need to be aware that they can see the number of exacerbations in the last 2 years by looking at the protocol alert box for their COPD patients.

HP081 COPD Poor Control Treatment Advice

Type: Protocol Alert

Purpose:
This protocol looks at the patient with COPD and highlights where it appears that they have poor control, giving the user advice on what action is required to address this.

Supporting key areas
Safe
Medicines management
Track record
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This protocol alert is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
After activation your clinicians need to be aware that they they will be given advice where patients are poorly controlled by looking at the protocol alert box for their COPD patients.

HP082 COPD ref Pulm rehab post Exacerbation (Enhanced only)

Type: Protocol

Purpose:
This protocol flags the need for a pulmonary rehabilitation referral following exacerbation of COPD in keeping with NICE QS10, standard 5.

Supporting key areas
Safe
Self care and treatment
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Caring
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol will only work if all exacerbations are coded within EMIS. Another of our handy protocols will highlight to users where it looks like an exacerbation may have occurred but hasn't been coded.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: Acute exacerbation of chronic obstructive pulmonary airways disease C= 195951007 D= 301453013,
Acute infective exacerbation of chronic obstructive pulmonary airways disease C= 285381006 D= 424365019,
Acute non-infective exacerbation of chronic obstructive pulmonary disease C= 847091000000104 D= 2196421000000114.

Fitting your practice
You may need local discussion with commissioners about the thresholds at which they expect referrals for pulmonary rehabilitation to be made. Your clinicians and clinical coders need to be aware that they will be prompted to refer the patient when an exacerbation is coded. Some discussion about internal processes for non-clinicians will be necessary.

HP083 COPD Spirometry Reversibility Reminder

Type: Protocol

Purpose:
This protocol will alert the clinician to request spirometry with reversibility as well as giving the user valuable information to inform the patient of to make sure that the spirometry performed is accurate.

Supporting key areas
Safe
Managing risks
Effective
Assessing needs and delivering evidence-based treatment
Staff skills and knowledge
How staff, teams and services work together
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
It is important that your clinicians code the referral for spirometry for this protocol to work effectively.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: Referral for spirometry C= 415261001 D= 2533652017.

Fitting your practice
Some discussion about the referral process for spirometry within your practice is required. In some practices a task is sent to reception who then book the spirometry with the detailed advice, whereas in others it is the clinicians who give the patient the information and tell the patient to book the appointment at reception. The protocol can be altered to launch from an alternative code or situation if this fits better with your own practice. We will discuss this with you if you are an enhanced package subscriber.

HP086 Valproate Prescribing (PPP)

Type: Protocol

Purpose:
This protocol highlights the requirements of the MHRA alert regarding Valproate and informs the user of any actions that need to be undertaken.

Supporting key areas
Safe
Managing risks
Medicines management
Learning when things go wrong
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
Consent to care and treatment
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol alert is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements such as contraception or hysterectomy.

Automatic triggers
System Trigger: Add a drug, Issue a drug, Load record
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: Sodium Valproate including all child codes, Valproic acid including all child codes.

Fitting your practice
No adjustment is required, the protocol is self explanatory.

HP087 Topiramate & Pregnancy

Type: Protocol

Purpose:
This protocol highlights the requirements for contraception when using topiramate and informs the user of any actions that need to be undertaken.

Supporting key areas
Safe
Managing risks 
Medicines management 
Learning when things go wrong
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
Consent to care and treatment
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol alert is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements such as contraception or hysterectomy.

Automatic triggers
System Trigger: Add a drug, Issue a drug, Load record
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: Topiramate including all child codes

Fitting your practice
No adjustment is required, the protocol is self explanatory.

HP088 Asthma - Multiple PO Steroids

Type: Protocol Alert

Purpose:
This protocol alert highlights where asthmatic patients have had more than 2 courses of oral steroids in the last 12 months, flagging that they should be reviewed and their medication adjusted.

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol alert is dependent on accurate coded information within EMIS web, contemporaneously recording medication

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
You need to consider how many protocol alerts you have active within your practice. This would fit well following an audit to look at patients who are highlighted as high risk by the national review of asthma deaths searches and then a period of time where this is focussed on within the practice.

HP090 COPD Information Panel

Type: Protocol

Purpose:
This protocol gives the user interpretation of the last spirometry and also wider information about COPD; bringing together information that is useful to the clinician in management of COPD.

Supporting key areas
Safe
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
How staff, teams and services work together
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Vision and strategy
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements.

Automatic triggers
System Trigger: Add a code, or you may wish to just use on F12
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: Chronic obstructive pulmonary disease C= 13645005 D= 475431013, Asthma C= 195967001 D= 301485011.

Fitting your practice
Your clinicians need to be aware of how to launch the protocol via F12, some discussion will be needed to decide if an automatic trigger is added. Whilst every effort is made to ensure accuracy, the use of codes varies widely, depending on spirometer, software and convention and as such the clinician is ultimately responsible for interpretation of spirometry and appropriate management of the patient.

HP091 Simvastatin to Atorvastatin Switch

Type: Protocol Alert

Purpose:
Where a patient is taking simvastatin and the cholesterol remains above 4, this protocol will alert the user to consider swapping the patient to atorvastatin.

Supporting key areas
Safe
Managing risks
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Staff skills and knowledge 
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
You need to consider how many protocol alerts you have active within your practice. This would fit well following an audit to look at patients who are not achieving treatment targets using simvastatin, and then a period of time where this is focussed on within the practice.

HP092 COPD Review After Exacerbation (Enhanced package)

Type: Protocol

Purpose:
This protocol flags the need for a pulmonary rehabilitation referral or follow up after an exacerbation of COPD in keeping with NICE QS10, standard 5.

Supporting key areas
Safe
Self care and treatment
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services
Caring
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol will only work if all exacerbations are coded within EMIS. Another of our handy protocols will highlight to users where it looks like an exacerbation may have occurred but hasn't been coded.

Automatic triggers
System Trigger: Load record and Update record
Run mode: Always run
Enable trigger for: All clinical job categories
Clinical codes: Acute exacerbation of chronic obstructive pulmonary airways disease C= 195951007 D= 301453013,
Acute infective exacerbation of chronic obstructive pulmonary airways disease C= 285381006 D= 424365019,
Acute non-infective exacerbation of chronic obstructive pulmonary disease C= 847091000000104 D= 2196421000000114.

Fitting your practice
You may need local discussion with commissioners about the thresholds at which they expect referrals for pulmonary rehabilitation to be made. Your clinicians and clinical coders need to be aware that they will be prompted to refer the patient when an exacerbation is coded. Our team will need to have copies of your local referral pathways, or you will need to set recall searches if you are undertaking post exacerbation reviews internally. Some discussion about internal processes for non-clinicians will be necessary.

HP094 FP34D Checker (PPV)

Type: Protocol

Purpose:
To make sure that all pneumococcal vaccinations performed are claimed for and that the practice doesn't lose out on income.

Supporting key areas
Safe
Medicines management
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation 
Governance and management 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: Pneumococcal vaccination C= 12866006 D= 22068011

Fitting your practice
You need to let your clinicians know that this protocol will flag for the generation of a prescription if it is required in order to claim payment.

HP098 Influenza Vacc by Health Care Provider

Type: Protocol

Purpose:
This protocol identifies influenza vaccinations given by a midwife and makes sure that these are coded in a way that ensures that the practice doesn't inappropriately claim for them via CQRS.

Supporting key areas
Safe
Medicines management
Effective
How staff, teams and services work together
Well-led
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording both medication and other clinical care elements.

Automatic triggers
System Trigger: Add a code
Run mode: Always run
Enable trigger for: All job categories
Clinical codes: Seasonal influenza vaccination given by midwife C= 1066171000000108 D= 2677731000000114

Fitting your practice
Any midwife who administers influenza vaccination within your surgery needs to understand to use either the code esctse843901 or to code it by using the code Seasonal influenza vaccination given by other healthcare provider C= 955651000000100 D= 2437091000000112 (which is the code that this protocol autocodes)

HP104 Anticholinergic Burden Calculator (ACB2)

Type: Protocol

Purpose:
This protocol will inform clinicians of the anticholinergic burden score that the patient has, as well as the drugs that contribute to the score.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Caring
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording medication issues. 

Automatic triggers
System Trigger: Manually using F12

Fitting your practice
Your team need to know that this protocol can be launched manually using F12. This may be a useful protocol to highlight after working your way through the QI standards for medication reviews.

HP105 Issue a Rescue Pack for COPD

Type: Protocol

Purpose:
This protocol can be used to issue and record the issue of a rescue pack of antibiotics and/or steroids for patients with COPD.

Supporting key areas
Safe
Self care and treatment
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
Consent to care and treatment
Caring
Involving people in decisions about their care
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Manually using F12

Fitting your practice
Your clinicians need to be aware of the protocol and how it can be used to record issues of rescue packs as well as code these within the record.

HP106 OneTemplate Launcher Platform (Enhanced package)

Type: Protocol

Purpose:
This protocol acts as a choice launcher for the OneTemplates within your system.

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Self care and treatment
Medicines management
Track record
Learning when things go wrong
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Privacy and dignity
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Engagement and involvement
Learning, improvement and innovation

System Dependencies:
None

Automatic triggers
System Trigger: Add a consultation or launch manually using F12
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
You need to discuss and decide if you want to launch the option when a consultation is started or if you want to highlight the manual F12 launcher to your teams.

HP110 - PINCER01 NSAIDs Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing.


This supports PINCER Queries A, B, I & K

Query A
 In a patient aged 65 years or more, prescription of anora lNSAID without co-prescription of an ulcer healing drug
Query B
Prescription of an oral NSAID, without co-prescription of an ulcer healing drug, to patient with a history peptic ulceration (includes prior bleeds and oesophageal  varices)
Query I
Prescription of an oral NSAID to a patient with heart failure
Query K
Prescription of an oral NSAID to a patient with chronic renal failure with an eGFR < 45

This protocol issues heads-up alerts if hazardous prescribing is attempted. It supports the co-prescribing of Lansoprazole 30mg OD or Omeprazole 20mg OD where a GI risk is noted.

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Issue a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: Call oral nsaids except aspirin 75mg or gels, creams, sprays, injectables.

Fitting your practice
A culture of coding and summarising records well will give this protocol more reliability. Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable. This protocol alerts users to both Heart Failure & CKD sequentially and so may present two alerts. It records the heads-up alert appearing by adding ‘Additional Note’ to the records.

HP111 - PINCER02 NSAIDs Alert

Type: Protocol/Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Queries A, B, I & K

Query A
 In a patient aged 65 years or more, prescription of anora lNSAID without co-prescription of an ulcer healing drug
Query B
Prescription of an oral NSAID, without co-prescription of an ulcer healing drug, to patient with a history peptic ulceration (includes prior bleeds and oesophageal  varices)
Query I
Prescription of an oral NSAID to a patient with heart failure
Query K
Prescription of an oral NSAID to a patient with chronic renal failure with an eGFR < 45

This protocol adds an alert to the protocol alert box if hazardous prescribing already exists.

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
A culture of coding and summarising records well will give this protocol more reliability. Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable. 

HP112 - PINCER03 Antiplatelet Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Queries C & F

Query C
Prescription of an antiplatelet drug to a patient with previous peptic ulcer or GI bleed without co-prescription of an ulcer healing drug
Query F
Prescription of aspirin in combination with another antiplatelet drug without co-prescription of an ulcer healing drug

This protocol issues heads-up options box if hazardous prescribing is attempted. It supports the co-prescribing of Lansoprazole 30mg OD or Omeprazole 20mg OD where there is a GI risk noted or where dual antiplatelets are being used

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Issue a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: All antiplatelet drugs

Fitting your practice
A culture of coding and summarising records well will give this protocol more reliability. Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable.

HP113 - PINCER04 Antiplatelet Alert

Type: Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Queries C & F

Query C
Prescription of an antiplatelet drug to a patient with previous peptic ulcer or GI bleed without co-prescription of an ulcer healing drug
Query F
Prescription of aspirin in combination with another antiplatelet drug without co-prescription of an ulcer healing drug

This protocol adds an alert to the protocol alert box if hazardous prescribing already exists.

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Load record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
A culture of coding and summarising records well will give this protocol more reliability. Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable.

HP114 - PINCER05 Anticoag + NSAID Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query D

Query D
Prescription of warfarin or DOAC in combination with an oral NSAID

This protocol issues heads-up options box if hazardous prescribing is attempted (in this case at the point of ‘selecting a drug’, All oral NSAIDs).

Supporting key areas
Safe
Managing risks 
Medicines management 
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Select a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: All oral NSAIDs - except Aspirin 75mg or gels, creams, sprays, injectables

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP115 - PINCER06 NSAID + Anticoag Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query D

Query D
Prescription of warfarin or DOAC in combination with an oral NSAID

This protocol issues heads-up options box if hazardous prescribing is attempted (in this case at the point of ‘selecting a drug’, All oral anticoagulants).

Supporting key areas
Safe
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Will only identify where previous GI bleeds, peptic ulcers, esophageal varices and heart failure have been coded in the records. 

Automatic triggers
System Trigger: Select a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredient: All oral anticoagulants

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation. 

HP116 - PINCER07 NSAID + Anticoag Alert

Type: Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query D

Query D
Prescription of warfarin or DOAC in combination with an oral NSAID

This protocol adds an alert to the protocol alert box if hazardous prescribing already exists.

Supporting key areas
Safe
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
No additional system dependencies.

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP117 - PINCER08 Anticoag + Antiplatelet No PPI Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query E

Query E
Prescription of warfarin or a Direct Oral Anticoagulant (DOAC) and an antiplatelet in combination without co-prescription of an ulcer-healing drug

This protocol issues heads-up options box if hazardous prescribing is attempted (in this case at the point of ‘Issuing a drug’, All Oral Anticoagulants and Antiplatelets). This supports the co-prescribing of Lansoprazole 30mg OD or Omeprazole 20mg OD where DOAC + Antiplatelets are being used.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
No additional system dependencies.

Automatic triggers
System Trigger: Issue a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredientAll oral anticoagulants, all antiplatelets

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP118 - PINCER09 Anticoag + Antiplatelet No PPI Alert

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query E

Query E
Prescription of warfarin or a Direct Oral Anticoagulant (DOAC) and an antiplatelet in combination without co-prescription of an ulcer-healing drug

This protocol adds an alert to the protocol alert box if this hazardous prescribing already exists.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
No additional system dependencies.

Automatic triggers
System Trigger: Load patient record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP119 - PINCER10 NonSel BB + Asthma Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query G

Query G
Prescription of non-selective beta-blocking to a patient with asthma

This protocol issues heads-up options box if hazardous prescribing is attempted (in this case at the point of ‘Selecting a drug’, nonselective beta-blockers).

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Well maintained Asthma and COPD registers

Automatic triggers
System Trigger: Select a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredientLabetalol, propranolol, sotalol, timolol (tablets only), carvedilol, nadolol

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation. 

HP120 - PINCER11 NonSel BB + Asthma Alert

Type: Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query G

Query G
Prescription of non-selective beta-blocking to a patient with asthma

This protocol adds an alert to the protocol alert box if this hazardous prescribing already exists.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
Well maintained Asthma and COPD registers

Automatic triggers
System Trigger: Select a drug
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP121 - PINCER12 LABA no ICS Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query H

Query H
Prescription of a long-acting beta-2 agonist inhaler (excluding combination products with inhaled corticosteroid) to a patient with asthma who is not also prescribed an inhaled corticosteroid

This protocol issues heads-up warning box if hazardous prescribing is attempted (in this case at the point of ‘Issuing a drug’, a Long Acting Beta2 Agonist (LABA)). 

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
A well maintained Asthma register

Automatic triggers
System Trigger: Issue a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredientSalmeterol xinafoate, Formoterol fumarate (don't worry, the combination ICS inhalers can stay selected, the protocol filters these out)

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation.

HP122 - PINCER13 LABA no ICS Alert

Type: Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query H

Query H
Prescription of a long-acting beta-2 agonist inhaler (excluding combination products with inhaled corticosteroid) to a patient with asthma who is not also prescribed an inhaled corticosteroid

This protocol issues heads-up warning box if hazardous prescribing is attempted (in this case at the point of ‘Issuing a drug’, a Long Acting Beta2 Agonist (LABA)). 

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
A well maintained Asthma register

Automatic triggers
System Trigger: Issue a drug
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation. 

HP123 - PINCER14 Dem 65+ Antipsych Prescribing

Type: Protocol

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query J

Query J
Prescription of antipsychotics for >6 weeks in a patient aged ≥ 65 years with dementia but not psychosis

This protocol issues heads-up warning box if hazardous prescribing is attempted (in this case at the point of ‘selecting’ OR ‘issuing’ a drug’, all Antipsychotic medications). Due to system limitations, it does not define the duration of the prescription to 6 weeks but will trigger when selecting or issuing an antipsychotic.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
No additional system dependencies

Automatic triggers
System Trigger: Select a drug, Issue a drug
Run mode: Always run
Enable trigger for: All job categories
Add Drug group, approved name or ingredientHaloperidol, haloperidol decanoate, risperidone, olanzapine, olanzapine pamoate monohydrate, quetiapine fumarate.

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation. 

HP124 - PINCER15 Dem 65+ Antipsych Alert

Type: Protocol Alert

Purpose:
To support the PINCER project, designed to help spot and prevent hazardous prescribing. 


This supports PINCER Query J

Query J
Prescription of antipsychotics for >6 weeks in a patient aged ≥ 65 years with dementia but not psychosis

This protocol issues heads-up warning box if hazardous prescribing is attempted (in this case at the point of ‘selecting’ OR ‘issuing’ a drug’, all Antipsychotic medications). Due to system limitations, it does not define the duration of the prescription to 6 weeks but will trigger when selecting or issuing an antipsychotic.

Supporting key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Responsive
Person-centred care 
Well-led
Management of risk and performance
Management of information

System Dependencies:
No additional system dependencies

Automatic triggers
System Trigger: Select a drug, Issue a drug
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Training staff on the protocol and the PINCER queries is important as they may then spot situations where hazardous prescribing exists but where past coding has been unreliable; for example, if the prescribing has occurred outside of the organisation. 

HP125 Consider Palliative Care Radar with CMC embedded

Type: Protocol Alert

Purpose:
Where a patient has codes that suggest that they may have palliative care needs, this protocol alert will make the clinician consider if they should enroll them on the palliative care register. The user can update the details by double clicking on the protocol alert. It also highlights to the user if they have a coordinate my care record - used to share information with other providers (and when this was last reviewed)

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Caring
Kindness, respect and compassion
Involving people in decisions about their care
Privacy and dignity
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording cancer and other diagnoses.
 
Automatic triggers
System Trigger: Load record and update record
Run mode: Always run
Enable trigger for: All clinical job categories

Fitting your practice
Your team need to know that this information will be highlighted in the protocol alert box. This may be a useful alert to set after working your way through the QI standards for QOF palliative carer.

HP126 On palliative care register CMC alert

Type: Protocol

Purpose:
Where a patient is on the palliative care register, this protocol alert will highlight which stage they are recorded as being at (or if they don't have a stage recorded). The user can update the stage by double clicking on the protocol alert. It also highlights to the user if they have a co-ordinate my care record - used to share information with other providers (and when this was last reviewed).

Supporting key areas
Safe
Safeguarding and protection from abuse
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment 
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge 
How staff, teams and services work together 
Supporting people to live healthier lives 
Consent to care and treatment
Caring
Kindness, respect and compassion 
Involving people in decisions about their care 
Privacy and dignity
Responsive
Person-centred care 
Taking account of the needs of different people 
Timely access to care and treatment
Well-led
Leadership capacity and capability 
Vision and strategy 
Culture of the organisation 
Governance and management 
Management of risk and performance 
Management of information 
Learning, improvement and innovation

System Dependencies:
This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording palliative care status. Another of our handy protocols highlights patients who should possibly be enrolled on the palliative care register.
 
Automatic triggers
System Trigger: Load record and update record
Run mode: Always run
Enable trigger for: All job categories

Fitting your practice
Your team need to know that this information will be recorded in the protocol alert box. Some training for non-clinicians may be necessary so that they understand the implications and what action may need to be taken.


We hope you've found the leaflet useful.
If you have any feedback or ideas for future protocols
to add to our tools please email us at: theteam@primarycareprotocols.co.uk



    • Related Articles

    • Automatically Activated Handy Protocols

      Introduction We're really pleased that you have subscribed to the Primary Care IT toolset for EMIS Web. We're run by GPs and their teams, for GPs and their teams. Our ideas are inspired by national guidance and best practice, blended with suggestions ...
    • Flu Protocols

      Setting up Flu protocols Primary Care IT has produced a single flu administration protocol for the 2021/22 seasonal influenza season.  Our “Flu clinic 2021/22 PCIT” protocol has been built as a one-stop resource to manage flu administration for all ...
    • Why am I seeing random letters in a protocol?

      Some users may encounter strings of random letters during their work activity. It may appear in predefined associated text in templates, in multiple choice questions of protocols, and the tooltip when hovering the mouse over the red box. This is an ...
    • Using Check Patient in searches

      EMIS Population Reporting has a handy feature called Check Patient which can help to understand why a particular patient is or isn't included. There are two methods for using it. When a search has been run, the list of patients identified can be ...
    • Quick codes and text

      This guide will show you how to set up quick codes and text within EMIS Web.  This feature allows you to set up short cut codes, that automatically enter pre-defined text into the record.  This can be really handy for repetitive text that you need to ...