OneTemplate Prescriber
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 chronic disease areas covered are:
- Asthma
- Atrial Fibrillation
- Cancer
- CHD
- CKD
- Coeliac
- COPD
- Dementia
- Depression
- Diabetes
- Eating disorder
- Epilepsy
- Gout
- Heart Failure
- High risk drug monitoring
- Homeless or Regugee
- Hypertension
- Hyposplenism
- Learning Disabilities
- Menopause
- SMI
- NDH
- New Baby Check
- Oral or other contraceptive
- Osteoporosis
- Peripheral arterial disease
- Palliative Care
- Post natal 6 week check
- Rheumatoid arthritis
- Stroke and TIA
Introduction Page
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:
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):
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
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
Blood Pressure and Smoking Status
Blood Pressure
When conducting any long term condition reviews, users should use the Blood Pressure page in order to see patient specific information about blood pressure control. PCIT separate this out so that information about blood pressure is not repeated in multiple different pages within the template:
Smoking Status
The Smoking Status page should be used for reviewing patient specific information about smoking when undertaking long term condition reviews. In keeping with the blood pressure page, this information is in a singular page so that repetition within the different pages is not needed. Users need to remember to use this page for all patients:
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
For example:
and:
Page visibility
Each page for a long term condition is governed by a visibility rule. These do not always use the QOF registers. Below are listed some of the behaviours which might deviate from the expected QOF register:
- Asthma - the page will display for children under the age of 6 with an unresolved asthma diagnosis. The page will also display for any patient with an unresolved asthma diagnosis who has not received an issue of medication in the last 12 months - you will be prompted to resolve the asthma at the top of the page.
- Learning Disabilities - the page will display for children under the age of 14. While QOF only maintains an LD register, there are also LESs and IIF which target patients aged 14 or older.
- Diabetes - the page will display for children under the age of 17.
- Homeless/refugee/asylum seekers - as noted above, these pages will not automatically show unless an appropriate code exists on the record.
- Mental health - patients whose condition has been coded 'in remission' remain on the QOF register, but are not eligible for the QOF indicators. The page will display a note at the top advising of a condition which is in remission.
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