Automatically Activated Handy Protocols

Automatically Activated Handy Protocols

Introduction



We're really pleased that you have subscribed to the Primary Care IT toolset for EMIS Web. We're run by GPs and their teams, for GPs and their teams. Our ideas are inspired by national guidance and best practice, blended with suggestions from our subscribers who are a fantastic source of ideas.  We have installed all of the tools within this brochure on your EMIS Web system and set the triggers live for you. These represent many years of development, best practice and blend really well with our other tools - OneResults, OneMonitoring, our OneTemplates and OneLaunchers. 
                                                            - Dustyn Saint



HP003 AF Detector 1 - Pulse Rhythm Checker

Type: Protocol

Purpose: 
To increase pick up of atrial fibrillation by trigger recording of the rhythm of the pulse whenever pulse is entered.

Supporting key areas 
Safe 
Managing risks 
Effective 
Assessing needs and delivering evidence based treatment
Staff skills and knowledge
Supporting people to live healthier lives 
Responsive 
Timely access to care and treatment
Well-led 
Vision and strategy
Culture of the organisation 
Management of risk and performance
Learning, improvement and innovation 

System Dependencies: 
This protocol depends on your clinicians coding the  recording of pulse rate. Your clinicians may need to be informed of the importance of this. 

Automatic triggers 
System Trigger: Add a code
Run mode: Always run 
Enable trigger for: All clinicians 
Clinical codes: Pulse rate C= 78564009, D= 130365016 

Fitting your practice 
As with all alerts you need to consider the volume of pop ups you currently have in operation: there is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice. 


HP004 AF Detector 2 - Irregular Pulse and no ECG

Type: Protocol alert

Purpose: 
To highlight to users where a patient has had an irregular pulse recorded but has not had a subsequent ECG.

Supporting key areas 
Safe 
Managing risks 
Effective
Assessing needs and delivering evidence based treatment
Staff skills and knowledge
Supporting people to live healthier lives 
Responsive
Timely access to care and treatment
Well-led 
Vision and strategy 
Culture of the organisation
Management of risk and performance
Learning, improvement and innovation 

System Dependencies: 
This protocol depends on your clinicians coding the recording of pulse rhythm and recording of ECGs. Your clinicians may need to be informed of the importance of this. 

Automatic triggers 
System Trigger: Load a record, update record
Run mode: Always run 
Enable trigger for: All clinicians 

Fitting your practice 
This protocol alert flags a reminder for your team to conduct an ECG if an irregular pulse has previously been recorded and no subsequent ECG is coded in the records.
As with all alerts you need to consider the volume of pop ups you currently have in operation: there is a real risk of "alert fatigue" if you have too many. This will differ from practice to practice.


HP005 Chaperone Offered

Type: Protocol

Purpose: 
To document the offer of a chaperone when an intimate examination is performed. Works with chaperone accepted protocol.

Supporting key areas 
Safe 
Safeguarding and protection from abuse
Managing risks 
Effective
Staff skills and knowledge
How staff, teams and services work together
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 
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: Add a code
Run mode: Always run 
Enable trigger for: All job categories
Clinical codes: GUT sample take for organism C= 269950006 D= 404607011, Examination of genitourinary system C= 268945009 D= 402486014, Rectal examination C= 410007005 D= 2471738015, 
Breast lump detected by clinician examination C= 197981000000104 D= 297981000000117

Fitting your practice 
You need to make sure that your clinicians record intimate examinations with the appropriate codes. 
Of course you also need to make sure that chaperones are available and appropriately trained.


HP006 Chaperone Accepted

Type: Protocol

Purpose: 
To document the details of the member of staff chaperoning the clinician. Works with chaperone accepted protocol. 

Supporting key areas 
Safe 
Safeguarding and protection from abuse
Managing risks 
Effective
Staff skills and knowledge
How staff, teams and services work together
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 
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: Add a code
Run mode: Always run 
Enable trigger for: All job categories
Clinical codes: Chaperone offered C= 1104081000000107 D= 2763841000000115 

Fitting your practice 
The protocol reminds you, but your staff need to enter the full name of the staff member who has 
chaperoned after the "Chaperone accepted" code.


HP007 Diabetes and Otitis Externa

Type: Protocol

Purpose: 
To highlight to team members where a diabetic patient has otitis externa and is at higher risk of osteomyelitis 

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 otitis externa or use the clinical system for prescribing 

Automatic triggers 
System Trigger: Add a code, issue a drug
Run mode: Always run
Clinical codes: Otitis  externa  C=  3135009 D=  6305018, Infective otitis externa C= 86981007 D= 144257010, 
Other otitis externa C= 3135009 D= 17531000006112, 
Acute infective otitis externa C= 267665002 D= 399494015, 
Unspecified infective otitis externa C=  86981007 D=  76991000006111, Acute eczematoid otitis externa C= 54272002 D= 1788053014, 
Chronic infective  otitis externa C= 232224009 D= 347942018, Infective otitis externa NOS C= 86981007 D= 86981007, 
[X] Otits externa in other diseases classified elsewhere C= 3135009 D= 417551000006111, 
[X] Other otitis externa C= 3135009 D= 412461000006110, 
[X] Other infective otitis externa  C=  86981007 D=  86981007, Bacterial otitis externa C= 280221000009107 D= 3312005019, 
[X] Otitis externa in viral diseases classified elsewhere C= 86981007 D= 417561000006113, 
[X] Otitis externa/other infectious+parasitic diseases CE C= 86981007 D = 417571000006118, 
Acute chemical otitis externa C= 7915005 D= 131338019, 
Acute radiation otitis externa C= 194217007 D= 298977015, 
Adverse reaction to otitis externa C= 1010791000006103 D= 1010791000006119, Candidal otitis externa C= 16681000 D= 28246017, 
Chronic mycotic otitis externa C= 111898002 D= 179051014, 
Chronic otitis externa due to aspergillosis C= 194207002 D= 298966014, Chronic otitis externa due to moniliasis C= 104208007 D= 298967017, 
Erysipelas otitis externa C= 194202008 D=  298955019, Haemorrhagic otitis externa C= 33934002 D= 56652016, 
Herpes simplex otitis externa C= 111856000 D= 179027016, 
Herpes simplex otitis externa C=  111856000 D=  822181000006114, Herpes z osterotities externa C= 21954000 D= 822201000006110, Herpes zoster otitis externa C= 21954000 D= 481174015, 
Impe tig o -o titis e xt erna C= 194203003 D= 298960015, 
Infective otitis externa due to erysipelas C= 194202008 D= 298954015, 
Infective otitis externa due to herpes simplex C= 111856000 D= 365556016, 
Infective otitis externa due to  herpes zoster  C=  21954000 D=  778951000006117, Infective otitis externa due to impetigo C= 194203003 D= 298959013, 
Malignant otitis externa C= 94146005 D= 155682018, 
Acute non-infective otitis externa  C= 232232001 D= 347952019, Other chronic otitis externa C= 232224009 D= 354181000006111, Chronic non-infective otitis externa C= 232236003 D=  347956016, Acute allergic otitis externa C= 232234000 D= 347954018,
Other reactive otitis externa C= 3135009 D= 18671000006113, 
Other specified infective otitis externa C=  86981007 D=  9991000006113.
Add Drug group, approved name or ingredient: 
Sofradex, otomize, acetic acid 2% ear spray, ear calm 2% spray, gentisone hc, genti - sol, cidom y c in ear drops 0.3%, cidom y cinear / eye drops 0.3%, garamycin ear drops 0.3% 

Fitting your practice 
Your team need to know that they will be prompted if they treat diabetics for otitis externa.


HP008 Folic Acid High Dose Reminder

Type: Protocol alert

Purpose: 
Triggers an alert to any clinician prescribing folic acid where a high dose preparation is needed. 

Supporting key areas
Safe
Managing risks 
Safe care and treatment
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
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: 
That your clinicians record medication issues on EMIS 

Automatic triggers 
System Trigger: Select a drug
Run mode: Always run 
Enable trigger for: Your chosen job categories 
Add Drug group, approved name or ingredient: Folic Acid 400mcg tablets
Folic Acid 400 mcg/5ml oral solution sugar free Folic Acid 100mcg tablets 

Fitting your practice 
Your team need to be aware that this alert will trigger when appropriate for the patient. 


HP011 Safeguarding Information (Enhanced/Pro only)

Type: Protocol alert

Purpose: 
To ensure that when children or vulnerable adults are seen that the local safeguarding contacts and information is accessible via a protocol alert 
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 a child's record, or vulnerable adults record is loaded. 

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

Fitting your practice
This protocol highlights local safeguarding information for relevant patients to your team. 


HP012 Same Day Diabetes Foot Access

Type: Protocol

Purpose: 
This protocol triggers an alert when booking appointments for diabetic patients to ask admin 
teams to check that this isn't for a foot problem, which should trigger a same day appointment. 

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: 
None 

Automatic triggers 
System Trigger: Book an appointment
Run mode: Always run 

Fitting your practice 
Your team need to know that they will be prompted if they book an appointment for a diabetic patient to double check that it isn't for a foot problem.


HP013 eGFR Value Alert When prescribing

Type: Protocol alert

Purpose:
This protocol displays an alert when any prescribing activity is undertaken to show the value and date of the last eGFR result. 

Supporting key areas 
Safe 
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 
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 any prescribing activity is undertaken 

Automatic triggers
System Trigger: add a drug, issue a drug, select a drug 
Drug groups: All
Enable trigger for: All job categories 

Fitting your practice
Your clinicians need to be aware that this alert will highlight the eGFR to them when they are prescribing. 


HP014 Carer Status

Type: Protocol alert

Purpose: 
To highlight to team members where patients are carers, or where they have a carer.

Supporting key areas 
Safe
Safeguarding and protection from abuse
Managing risks 
Effective
How staff, teams and services work together
Supporting people to live healthier lives 
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 
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 relies on your clinicians coding carer status correctly using the One Template 


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

Fitting your practice 
Team members need to know that they will see protocol alerts for carers and if patients have carers. They can update the information by double clicking on the alert, or by using the relevant section of the One Template.


HP016 Important information

Type: Protocol alert

Purpose: 
To highlight to team members where the patient has protected characteristics or other accessibility considerations.

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 
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 
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 One Template for review and coding considerations using this. Where there are recorded issues with consent, hearing, sight, mobility, or any other teams involved with the patient these will be highlighted within this protocol alert.

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

Fitting your practice 
Your team need to know that this protocol alert will highlight important information to them. Your clinical team need to understand that where they record others involved in a patients care, they should use free text to record more detailed useful information, because this will then be displayed in this alert - e.g. mobile phone number etc.


HP020 DNACPR Status Alert

Type: Protocol alert

Purpose: 
To inform DNAR status and progression of discussions around resuscitation.

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
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
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 DNAR and associated discussions using the One Template 

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

Fitting your practice 
Your team need to know that coding DNAR is important and also that the alert will appear in the bottom right hand corner alert box where this detail exists. If you are using patient alerts to record this currently, you would need to have a plan in place to move over to this way of recording DNAR status.


HP022 - 2WW referral admin chaser 

Type: Protocol

Purpose: 
To ensure safety netting when patients are referred via a 2 week wait pathway

Supporting key areas 
Safe 
Managing risks 
Safe 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 the codes: 
  • Fast track cancer referral C= 199251000000107 D= 301081000000115 
  • Priority cancer referral C= 199251000000107 D= 473311000000110 
                       are used. 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 enhanced package. 

Automatic triggers
System Trigger: Save consultation
Run mode: Always run 
Enable trigger for: All job categories 

Fitting your practice
This protocol reminds clinicians to safety net patients who have been referred on a 2 week wait pathway. If the clinician has forgotten to do this, they are asked if they want a task to be sent to the admin team to inform the patient. 


HP023 eGFR and Metformin alert

Type: Protocol alert

Purpose: 
This protocol displays an alert when a patient is on metformin and has a reduced eGFR, it also displays the value and date of the last eGFR result.

Supporting key areas
Safe 
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 
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 any prescribing activity is undertaken 

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

Fitting your practice
Your clinicians need to be aware that this alert will show them when they need to consider a medication review based on a patient with low eGFR who is taking metformin.


HP024 2WW Referral task to secretary

Type: Protocol

Purpose: 
To ask users if they want to send a task to the secretary when a 2 week wait cancer referral has been sent.
Supporting key areas 
Safe 
Managing risks 
Effective
Monitoring outcomes and comparing with similar services 
Staff skills and knowledge
Consent to care and treatment
Responsive
Person-centred care
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 depends on you coding your 2 week wait referrals appropriately. We suggest you code all referral documents with the appropriate code.

Automatic triggers 
System Trigger: Save consultation
Run mode: Always run 

Fitting your practice 
Your clinicians need to be aware that if they create a 2WW there will be a prompt to ask them to send a task to the secretaries when they save the record.


HP037 DMARD Medication Review >3  months 

Type: Protocol

Purpose: 
To highlight where patients who are taking DMARDs have a medication review that is more than 3 months from the current date. Hence ensuring that appropriate monitoring is undertaken. 

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: Save consultation
Run mode: Always run 
Enable trigger for: All groups 

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


HP039 Depression Review Coding Prompt

Type: Protocol

Purpose: 
For QOF DEP003, prompting to code depression review after a consultation 

Supporting key areas 
Safe 
Managing risks 
Safe care and treatment
Effective
Assessing needs and delivering evidence-based treatment
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: 
This will only prompt if your clinicians have accurately coded depression within EMIS. Where this hasn't been the case, our possible new diagnosis will highlight this to the user to consider coding depression. 

Automatic triggers 
System Trigger: Save consultation
Run mode: Always run 
Enable trigger for: All job categories 

Fitting your practice 
Your team need to be aware that if they don't code depression interim review when seeing patients for review that they will be prompted to do so. 


HP049 Emergency contraception

Type: Protocol

Purpose: 
Triggers an alert to any clinician prescribing emergency contraception, who has not given advice about long acting reversible contraception. 

Supporting key areas 
Safe 
Managing risks 
Medicines management
Effective
Staff skills and knowledge
How staff, teams and services work together 
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 clinicians record medication issues on EMIS 

Automatic triggers 
System Trigger: Add a drug
Run mode: Always run 
Add Drug group, approved name or ingredient: Levonelle 750 mcg tablets 
Levonelle -2 750 mcg tablets 
Levonelle One Step 1.5mg tablets Upostelle 1500 mcg tablets 
Levonorgestrel 1.5mg tablets E merr es U na 1.5mg tablets 

Fitting your practice 
Your team should be aware of the need for advice about LARC, this protocol will enforce it. 


HP053 LD health check due

Type: Protocol alert

Purpose:
To highlight via protocol alert where a learning difficulties health - check is due. 

Supporting key areas 
Safe 
Safeguarding and protection from abuse
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 
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 and capability
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 is dependent on you having an accurate register of patients with learning difficulties and appropriately coding their reviews. 

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

Fitting your practice 
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. 


HP054 Learning difficulties considerations

Type: Protocol Alert

Purpose: 
This alert highlights important considerations for patients with learning difficulties.

Supporting key areas 
Safe
Safeguarding and protection from abuse
Managing risks 
Self care and treatment
Effective
Assessing needs and delivering evidence-based treatment
How staff, teams and services work together 
Supporting people to live healthier lives
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 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 display relevant  information if it is entered by your clinical team during reviews. They will be prompted to do this by using the One Template. If they don't use the One Template for reviews, the data will not be entered correctly and the usefulness of this protocol will reduce

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

Fitting your practice
Your team must understand the importance of putting relevant information (carers info, double appointments requirements) into the record using the One Template during the Learning Difficulties review .


HP065 COPD Exacerbation Meds Trigger

Type: Protocol

Purpose: 
To flag where exacerbation of COPD is not coded when patients with COPD are  prescribed steroids or antibiotics.

Supporting key areas 
Safe 
Managing risks 
Medicines management
Effective
Staff skills and knowledge
How staff , teams and services work together 
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 is dependent on you having coded your 
COPD patients correctly, but otherwise automatically launches 

Automatic triggers 
System Trigger: Add a drug
Run mode: Always run 
Enable trigger for: All clinical prescribers
Add Drug group, approved name or ingredient: Prednisolone tablets, prednisolone 5mg tablets, antibacterial drugs including all child codes 

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. 


HP066 Platelets and Cancer Risk

Type: Protocol Alert

Purpose: 
High platelet results have been shown to be associated with a much higher risk of cancer in patients. Where high platelets have been recorded previously and there is no documented diagnosis to account for this, this protocol will highlight the risk to the user.

Supporting key areas 
Safe 
Managing risks 
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
Responsive
Person-centred care
Timely access t o 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: 
That platelets are recorded using the codes 42P or 42PZ 

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

Fitting your practice
It would be useful to highlight to your clinicians the risk of raised platelet count and its association with the risk of cancer. They need to be aware that this protocol will highlight that risk to them where appropriate.


HP067 Hyperkalaemia Warnings

Type: Protocol Alert

Purpose: 
This protocol alert highlights hyperkalemia or previous hyperkalemia in keeping with the patient safety alert from NHS improvement.

Supporting key areas
Safe 
Managing risks 
Medicines management
Learning when things go wrong 
Effective
Assessing needs and delivering evidence-based treatment
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 
Engagement and involvement
Learning, improvement and innovation

System Dependencies: 
That results of potassium levels are coded in the clinical record. 

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

Fitting your practice
It would be useful to highlight to your clinicians the patient safety alert so that they are aware of what action they should take.


HP068 Hyperkalaemia Alert Closer

Type: Protocol

Purpose: 
This protocol highlights the current or previous hyperkalemia and asks the user to confirm that action has been taken, closing off the alert for future occurrences. 

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 
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: 
That results of potassium levels are coded in the clinical record.

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

Fitting your practice
Your team need to be aware that this protocol will ask them to record actions taken as a result of hyperkalaemia.


HP069 Previous GDM no HbA1c in last 12 months

Type: Protocol Alert

Purpose: 
This protocol will alert users where a patient has previously had 
gestational diabetes mellitus and hasn't had an HbA1c in the last 12 months. 

Supporting key areas 
Safe 
Managing risks 
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparison 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 
Leadership capacity and capability
Vision and strategy 
Culture of the organisation
Governance and management
Management of risk and performance
Management of information 
Engagement t and involvement
Learning, improvement and innovation 

System Dependencies: 
The protocol is dependent on the accurate recording of gestational diabetes within the clinical record and the accurate recording of HbA1c results 

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

Fitting your practice
Make sure that your practice teams are aware that this alert will show where appropriate. It can be particularly useful for phlebotomists who may be taking blood to be empowered to check an HbA1c where this alert has been shown. 


HP085 Steroids & No Bone Sparing Agent

Type: Protocol Alert

Purpose: 
Where a patient has had more than 3 courses of steroids in the last 12 months and hasn't had any bone protection prescribed, this protocol alert will highlight the need for review.

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 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
Describe any local measures that are needed to embed the protocol within the practice.


HP089 Bronchodilator overuse

Type: Protocol

Purpose: 
This protocol alerts clinicians to patients that have had more than 12 issues of beta-agonist within the last 12 months, putting the patient at increased risk of death ( as highlighted b y the national review of asthma deaths ). 

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: Issue a drug, load record, update record
Run mode: Always run 
Enable trigger for: All job categories 
Add Drug group, approved name or ingredient: ventolin includes all child codes, terbutaline includes all child codes, salbutamol includes all child codes 

Fitting your practice
You need to consider how many 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. 


HP095 Pancreatic Cancer Suspicion

Type: Protocol Alert

Purpose: 
This protocol alert highlights to the clinician where there may be a risk of pancreatic cancer according to the NICE 2015 guidelines - including patients over the age of 60 with: diarrhoea/back pain/abdominal pain/nausea or vomiting/constipation or new onset
diabetes. 

Supporting key areas 
Safe
Managing risks 
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 
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 job categories 

Fitting your practice
You need to let your clinicians know that this protocol will flag where they need to consider pancreatic cancer.


HP096 Both PPI & Thyroxine Alert

Type: Protocol Alert

Purpose: 
Thyroxine needs an acidic environment for best absorption. Where patients are on a PPI, the impact of this on the absorption of thyroxine will be highlighted to our team.

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 job categories 

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


HP097 Cancer Care Review Needed

Type: Protocol

Purpose: 
When adding a new diagnosis of cancer , this will highlight to the user that a review is  needed within 3  months of the diagnosis and also code a due diary entry to this effect. This is useful for administration teams to make them aware of the requirements for QOF, and also to ensure patients are reviewed with their GP in a timely fashion. 

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
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
Concerns and complaints 
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 diagnoses as well as cancer care reviews. 

Automatic triggers
System Trigger: Add a code
Run mode: Always run 
Enable trigger for: All job categories
Clinical codes: 
Malignant neoplasm of lip, oral  cavity and pharynx C=  271323007 D= 4406052010,
Malignant neoplasm of digestive organs and peritoneum C= 269456006 D= 725971000006119, 
Malignant neoplasm of thoracic cavity  structure  C=  428100006 D=  2691955010,
Malignant neoplasm of bone, connective tissue, skin and breast C= 271467005 D= 406262013, 
Malignant neoplasm of genitourinary organ C=  271468000 D= 40623015,
Malignant neoplastic disease C= 363346000 D= 1208875016, 
Malignant neoplasm of lymphatic and hematopoietic tissue C= 269475001 D= 403705015. 

Fitting your practice
Your clinical coders (and other team members) need to know to take action when they see this alert. You may wish to setup a recall search to look for the due diary entry for patients (albeit many surgeries use the QOF reports to identify these patients). 


HP099 Palliative Care Stage Alert

Type: Protocol Alert

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. 

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 o f 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. 


HP100 Palliative Care Preferred Place  of Death

Type: Protocol Alert

Purpose: 
Where a patient is on the palliative care register, this protocol alert will highlight if they have had a discussion about preferred place of  death. The user can update the details by double clicking on  the protocol alert. 

Supporting key areas 
Safe 
Safeguarding and protection from abuse
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparison 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.

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 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.


HP101 High Risk Diabetes + PCOS

Type: Protocol alert

Purpose: 
To flag where patients are at high risk of diabetes and have not had a recent blood test to monitor that risk. 

Supporting key areas 
Safe 
Managing risks 
Self care and treatment
Effective
Assessing needs and delivering evidence-based treatment
Supporting people to lead healthier lives 
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 high risk diabetic patients correctly, but also looks at previous HbA1cs and automatically launches. 

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

Fitting your practice 
Alert your team that a protocol alert will highlight where patients may need an HbA1c doing. 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. 


HP102 Consider Palliative Care Radar

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.

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.


HP103 Anticholinergic Burden Awareness (ACB1)

Type: Protocol Alert

Purpose: 
This  protocol  alert will highlight to clinicians where a patient is over the age of 65 and has an anticholinergic score of 3 or more. Double clicking on the alert will take you to a template which highlights the drugs that are responsible for the ACB 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: 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 medication reviews. 


Type: Protocol alert

Purpose: 
To highlight to team members where consent to share information with other people exists.

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 
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 
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 coding consent to share data using the code 9NdG "Consent to 
share patient data with specified 3rd party" and then entering the details of the third party with the relationship 

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

Fitting your practice 
Your team need to know about adding consent to the record, and also that the alert will appear in the bottom right hand corner alert box where this consent exists. If you are using patient alerts to record this currently, you would need to have a plan in place to move over to this way of recording consent.


HP108 Warfarin interactions

Type: Protocol

Purpose: 
To flag where antibiotics have been prescribed for patients on warfarin and ensure a task is  sent  to  the  nursing team to organise an INR is organised in a week. 

Supporting key areas 
Safe 
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
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 all issues of medication, but otherwise automatically launches 

Automatic triggers 
System Trigger: Add a drug
Run mode: Always run 
Enable trigger for: All clinical prescribers
Add Drug group, approved name or ingredient: all antibiotics excluding topical treatments 

Fitting your practice 
Alert your team that if they prescribe antibiotics to patients on warfarin that they will be nudged to arrange a follow up INR in a week by the protocol. 




HP195 Steroid Treatment Card

Type: Protocol alert

Purpose: 
To flag patients are on steroid treatment and need to be given a steroid treatment card, or where one has been given previously but not updated in the last year.

Supporting key areas 
Safe 
Managing risks 
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
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 all issues of steroid medication and issues of steroid cards, but otherwise automatically launches 

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

Fitting your practice 
Alert your team that if they prescribe steroids they will be warned to ensure there is a steroid alert card provided to the patient

Version control
Updated 12/11/22
- Added steroid treatment card alert

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