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.
HP041 Consent to Share Info Status
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 for: All 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 for: All 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 for: All 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 for: All 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.
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 ingredient: All 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 ingredient: Labetalol, 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 ingredient: Salmeterol 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 ingredient: Haloperidol, 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
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