Information within this training package is colour coded:
Blue is for information and includes hints and tips
Orange is an action that is required
Yellow is resource that you can use to send internal communications to others within your practice
Red is a key message that must not be forgotten or ignored
This is a dynamic template for managing chronic disease - so only things that are relevant to the patient you have in front of you are displayed. For example, if the patient is diabetic the diabetes section will show; if they aren't it won't.
It's so smart - examples (just a few of the many):
- If a diabetic patient is on injectables there is a section to check injection sites, if not there isn't
- Depending on smoking status different length and detail of information is shown (smokers lots, smokers with COPD even more, never smoked very little shown)
- At the top of the COPD page the template automatically tells you what GOLD classification the patient is and what ABCD group they fall into
- If a diabetic patient is on drugs that cause hypos there's a hypos awareness section which shows, if not then it doesn't
- If a patient needs contraceptive advice and is under 16 then competency assessment questions are shown, if they are older then they don't
The first section of this looks the same for every patient opened and has some information about the colour coding used within the template as well as links to our support site and to add development requests for future versions of the template:
If you have our enhanced package then any locally commissioned services are highlighted in purple within the template
Where there are important safety considerations, these are shown below the template guide, for example where a patient is on medications that mean they need notifying about sick day rules (and this hasn't been done in the last 12 months) the following box shows (if they have been told already it doesn't):
Previous exception reporting is also shown under here so that this can be undertaken at the time of review and not left to year end to complete:
If the patient has codes or drugs that would suggest a diagnosis that has not been appropriately coded, this is also flagged under here
Possible new diagnosis
Where this is the case, further details are shown in the possible new diagnosis page (there are over 30 areas that this covers and if you want to look at this prospectively rather than when seeing patients we provide the searches to be able to do this):
This makes sure that your patients get the care that they need by being enrolled on the appropriate registers. It will also increase your practice income for QOF
When dealing with QOF there are two pages that show you different information:
Relevant QOF disease areas: This shows you every QOF area that the patient is in and all of the elements of care needed for that QOF area - so that you can see what has been done and re-do everything if you want. If you have patients with singular diseases (e.g. just asthma) this is quite easy to digest and you can immediately see what you need to. If you have patients who have multimorbidity this can get a lot busier and it can be more difficult to separate what's needed from what's not
A simple patient with relevant QOF disease areas:
A more complex patient with Relevant QOF disease areas:
This is why we have the second QOF page: QOF Outstanding. This just shows you what's outstanding for this QOF year. So if we take the same patient as above, you can see that this makes it much easier to hone in on what needs doing:
Earlier in the year the "relevant QOF disease areas" tends to be more useful, because you can go through and tick off the things that need doing. Later in the year when you're just trying to mop up remaining QOF points the "QOF Outstanding" comes into it's own so you can just see what needs doing to finish up for QOF.
Don't forget all of this information is also in an easily digestible form in the OneMonitoring tool
Where a patient has multiple diseases where the same elements of care are needed (e.g. BP needed for both hypertension and CHD) these elements are pulled into the "Shared elements" page of the template:
Notice the level of detail in the information provided about the appropriate blood pressure targets which are patient specific and also highlighting whether or not these have been achieved. This kind of information allows for the devolvement of care to other team members - as everybody is clear what the targets for treatment are.
Where shared elements exist, these elements of care are removed from the disease areas - so in the example above the hypertension and CHD pages would both show but neither would have BP in them - this would be in the "Shared elements" page. There are red alerts to the need to look at the shared elements page where this is relevant for patients in each of the individual disease areas:
Where a patient is frail or has suggestions from codes or scores that they may be frail, we have a page that allows you to undertake a frailty assessment, record important information about information sharing and other important information. It also has all of the NICE multimorbidity guidance built into the page - so that if your patient is on any of the drugs that NICE identify as having limited evidence in frail patients then this is highlighted and the evidence for treatment shown to you. This can be really useful to review prior to nursing home rounds, during MDT discussions or at review with your clinical pharmacist.
Anticholinergic Burden calculator
Where patients are elderly or frail and have combinations of drugs that give them an anticholinergic burden score of more than 3, this is highlighted within the template.
- Tick this box and it tells you the score (8 for this patient)
- Drugs shown with a score of one
- Drugs shown with a score of two
- Drugs shown with a score of three
Individual disease area pages
These will show up if appropriate for the patient you are reviewing. As highlighted earlier each of the elements within the pages are also highly dynamic, we try to provide gold standard information which strikes a reasonable balance between giving the user enough relevant information, but also not being overwhelming. As with any change, some local discussion will be needed about how the tools are utilised and what the expectations are about how much information is completed versus the appointment duration given. Where our tools have been shown to have the maximum impact, they have been supported by funded schemes to account for the work required.
Wherever possible we provide information which you can copy and paste to AccuRx to make sure the patient remembers key information