NHS Forth Valley Near Patient Testing Monitoring EMIS Templates

Purpose of templates

To support safe near patient testing systems in practices

To help collect data for the FV LES consistently using codes which can be searched

Important points

– Commencement of high risk drug treatment and duration of treatment can be displayed on the problems

summary list, which is important for safe practice – when initiating high risk drug treatment, a GP

needs to use the template in consultation manager (F6) and save the problem as significant and

permanent to ensure this.

– The template allows for recording of patient reported side effects, which could be captured by the

phlebotomist. Again, using in consultation mode ensures that the information is recorded in the

consultation history.

– Bundle data is asterisked on the relevant screens (required for methotrexate and azathioprine).

– A linked advice template for the drugs give specific advice on treatment, side effects, and the Forth

Valley monitoring schedule

– The most recent blood results are displayed and when results are reviewed there is a checkbox to record

whether these are normal or abnormal, with a freetext box to record appropriate action taken.

– Hyperlinks are provided to the Arthritis UK patient information booklet, the Web Mentor / EMIS

Reference patient leaflet

Initiation of high risk drug treatment

To record that a patient is starting on a high risk drug and display this (with duration) on the

problem summary (F11):

In Consultation manager (F6), select the FV ES NPT Index template

Click FV NPT and then the button for high risk treatment started (contains the ESCRO codes)

Select the drug which

is to be started (e.g.

sulfasalazine)

The drug name will be

added automatically.

Enter the expected

duration using freetext

box.

Click ok on this and

the FV ES NPT screen

In the FV ES NPT

index screen, click the

button for the relevant

drug

Discuss possible side

effects with the

patient, give Mentor

or Arthritis UK

patient leaflet

Check the box for

medication counselling

on the index screen

(top left as shown)

Ok all screens before

closing

The problem list should show the following problem:

Monitoring high risk drugs

The template can be used when taking the monitoring blood samples, and also after checking the results to

re-authorise the next prescription.

When saving the

consultation there will

be a new problem.

The problem should

appear as significant –

if not change it to

significant and click

finish (if saved as

minor, the problem

will drop off the active

problem list after 28

days)

When blood is

being taken by the

phlebotomist, the

template can be

used to record

that the test

request has been

sent, and also

whether the

patient has

experienced any

side effects.

The monitoring

schedule can be

checked before a

diary entry made

for inviting a

patient for a blood

test.

Reviewing blood results

When reviewing blood

results, the GP can

access these via the

NPT index screen.

Record whether the

results are normal or,

if abnormal,

Enter appropriate action

in the freetext box and

diary date for patient

recall.

If results are normal,

re-authorise the drug

(for 1 or 2 months as

appropriate).

Click ok and save

consultation (F8)

Access the advice

screen if required

See button on left

side index list

APPENDIX: NHS Forth Valley Near Patient Testing LES data requirements

LES requirements

(Bundles in bold)

Data entry required Preferred code Comments

Develop and

maintain a register of

patients on LES NPT

drugs

Patient on drugs register:

could be done by search

for patient on specific

drugs but best to code

patient on high risk drug

as will show on problem

summary

High risk drug started 66P5

High risk drug stopped 66P6

Need to save as significant permanent

problem to show on summary / active

problem list.

Include duration as extension.

Drug name automatically added from

drug screen.

1. Appropriate tests

are carried out in

correct time scale

(B)

Has there been a full

blood count in the past 12

weeks (AZA) or 8 weeks

(MTX) as per local

guidance

FBC 424

Automatically in system via lab import

and last results displayed on screen

2. Appropriate

action are taken

and documented for

any abnormal

results in previous

12 weeks (B)

If any significantly abnormal results occurred in the previous 12 weeks has action been recorded in the consultation record?

Lab test result abnormal 419 Use freetext box on template and save in consultation record

3. Conduct

appropriate review

of blood test prior

to issuing of

Patients’ blood tests are reviewed prior to a prescription of high-risk drugs being issued

Lab test result normal 418

Lab test result abnormal 419

Needs checked when GP checks test results – could be done when first see results or when drug is re-authorised

prescription (B)

4. Provide

appropriate

vaccination (B)

Pneumococcal vaccine

and a flu vaccination

Flu 65ED

Pneumococcal 6572

Flu declined 8I3Q

Pneumococcal declined 9OX5

Provide patient

education

The practice should offer

the patient with written

education about their drug

and record that this has

taken place in the notes

annually.

Medication counseling 6774

This could be done by phlebotomist

5. Side effects (B)

Is it documented that the

patient was asked about

any new or recent side

effects the last time blood

was taken for drug

monitoring?

Drug side effects checked 8BIZ

This could be done by phlebotomist and

GP notified if any side effects present