Rheumatoid Arthritis Template Guide 2014

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1 Rheumatoid Arthritis Template Guide

2 CEG produces a wide range of templates & guides All of these are available on our website!! Clinical Domain Clinical Domain 1 6 Week Check (Baby) 36 Mental Health Depot 2 Admin 37 Minor Surgery 3 Alcohol Misuse 38 NHS Health Check 4 Alcohol Screening 39 Obesity Monitoring 5 Antenatal Care 40 Oral Contraception 6 Anticoagulation 41 Oral Nutritional Supplements 7 Asthma 42 Osteoporosis Secondary 8 Atrial Fibrillation 43 Peripheral Arterial Disease 9 Bowel Cancer Screening 44 Palliative Care 10 Cancer 45 Pathology / Phlebotomy 11 Cervical Smear 46 Postnatal 12 CHD 47 PSA Monitoring 13 Child at Risk 48 Referrals 14 Child Imms 49 Severe Mental Illness 15 Chlamydia 50 Sexual Health 16 CKD 51 Shared Care Record 17 COPD 52 Smoking Cessation 18 Dementia 53 Stroke 19 Depression 54 Surgical Aftercare 20 Diabetes Annual Review 55 Tuberculosis 21 Diabetes Follow Up 22 Drug Misuse 56 Smoking History 23 Epilepsy 57 Ethnicity 24 Falls and Osteoporosis 58 GPPAQ 25 Flu and Pneumococcal Vaccination 59 Newly Diagnosed Diabetes Template 26 Heart Failure 27 Home Visiting of Vulnerable Patients 28 HPV 29 High Risk Drugs 30 Hypertension 31 Hypothyroid 32 Insulin Initiation 33 LARC 34 Learning Disabilities 35 Mammography 2

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4 Template Control Page National Rheumatoid Arthritis Template Guide Title Rheumatoid Arthritis Author CEG Version Description QOF Rheumatoid Arthritis Review (vr2) Status Active Date January 2014 DOCUMENT MANAGEMENT REVISION HISTORY Version Date Summary of Changes Vr 1 Jan 2014 Vr 2 April 2014 Revised in line with QOF vr 28. Removed fracture risk prompt. Removed Full med review prompt and replaced with info text regarding use Medication module to record full med reviews. Removed concept. AUTHORISATION Reviewed by Approved by Date Jayne Callaghan Dr Sally Hull 11/02/2014 Jo Tissier Dr Sally Hull April 2014 Library Items, protocols and concepts used by this template Library Items Smoking Status CEG 1.0 Alcohol CEG 1.0 Obesity Monitoring CEG 1.0 Ethnicity CEG 1.0 Concepts EMIS system concepts used by this template 4

5 Rheumatoid Arthritis Template Guide The template includes coded data entry for all the quality indicators for Rheumatoid Arthritis required by the GP GMS contract. These are marked with *. We have included a number of other items which monitor good practice. The contract requires practices to produce a register of all patients aged 16 or over with rheumatoid arthritis. We have deliberately not included the diagnosis code in the template, in case including it encourages multiple entries over time. RHEUMATOID ARTHRITIS MAIN PAGE Rheumatoid Arthritis Template *Signifies QOF indicator for this domain Prompt Code What does this prompt mean? EMISWeb Consultation Section Rheumatoid Arthritis Review An annual review should include: - Assess disease activity and damage, which may include CRP or ESR test - Measure functional ability (e.g. with HAQ) - Check for comorbidities such as hypertension, IHD, osteoporosis and depression - Check for complications such as vasculitis, and disease of the cervical spine, lung or eyes - Medication review including DMARDS - Carer review QOF Target Face to face review in preceding 12 mths * RA annual 66HB0 Tick box review Examination Blood Pressure 246 Enter value for Systolic and Diastolic Examination O/E height 229 Enter the value for height Examination O/E weight 22A Enter the value for weight Examination Body Mass Index 22K Automatically calculated Examination QRISK2 38DP Calculates the risk of developing CVD in the next 10 years. Investigations / Results Cholesterol 44P Value Result Assessment Haemoglobin 423 Value Result C reactive protein 44CS Value Results 5

6 ESR 42B6 Value Results Rheumatoid 43F Value Results factor Autoimmune 43GG Tick box Results profile Referrals Referred to 8H4B Tick box Rheumatologist Refer to 8H7J Tick box occupational therapy Refer to 8H77 Tick box physiotherapy Refer to podiatry 8H7X Tick box Assessment of needs Follow-Up RA annual review due 389 Tick box Tooltip: social work / care needs assessment Text line for further details QOF Target - Medication review every 15mths for patients prescribed repeat medication. Please use Medication module to code this. 66HB0 Diary entry for next review Assessment EXCEPTION REPORTING PAGE Exception info *Exception Reason Whole Register Exclusion Criteria rmed dissent means that a patient does not agree to investigation or treatment, and this is recorded in their medical records. Patient unsuitable means it is not appropriate to review the chronic disease parameters due to particular circumstances, e.g. terminal illness or other supervening condition, or extreme frailty. Patient unsuitable 9hR0 rmed dissent 9hR1 Text line HIGH RISK DRUGS PAGE HRD Monitoring HRD Monitoring 66P Tick box Text line - Date/Ref of 1st hospital letter: Based broadly on the National Patient Safety Agency Safe Practice Checklist, the High Risk Drugs Monitoring template has been produced to enable GPs to readily ensure the necessary blood results are available and patient education has occurred to facilitate safe prescribing of the following high-risk drugs: 6

7 Methotrexate Azathioprine Mercaptopurine Ciclosporin Dapsone Penicillamine Hydroxychloroqui ne Sulphasalazine Mycophenolate Oral Tacrolimus Hydroxycarbamide Cyclophosphamide Leflunomide Text Hospital initiated prescription 8B2D In the majority of cases these drugs are initiated in secondary care and GPs are asked to continue the prescribing of these for their patients. This may occasionally occur without the GP having access to up-to date blood test results. The purpose of this template is to improve safety by highlighting the monitoring, increasing access to important blood tests and ensuring the identification of gaps in monitoring when these occur. The name and indication for the high risk drug is: Tick box Tick if the high risk drug was initiated by a specialist. Free text the name of the hospital, the consultant and the contact details. Methotrexate should be taken weekly. Methotrexate should generally be prescribed as 2.5mg tablets. Please specify the date Methotrexate is meant to be taken and also the date in milligrams and number of tablets. e.g. Methotrexate 2.5mg tablets Take (5 mg) TWO TABLETS on Monday Investigations/Results Haemoglobin 423 Value Result White Blood 42H Value Result Cell Platelet 42P Value Result count MCV 42A Value Result Neutrophil 42J Value Result count Lymphocytes 42M Value Result Serum Urea 44J9 Value Result Serum 44J3 Value Result Creatinine Sodium 44I5 Value Result Potassium 44I4 Value Result Serum albumin 44M4 Value Result 7

8 ALP 44F Value Result ALT/SGPT 44G3 Value Result AST 44HB Value Result ESR 42B6 Value Result CRP 44CC Value Result Review Blood Pressure Drug monitoring up to date The patient does not attend the HRD clinic Med Counsel Given Patient Unhappy re. med? Adverse reaction 246 Value Enter for Systolic and Diastolic Examinatio n 8BIf Predefine d text Tick box Tooltip: This can be used if results do not arrive via lab links due to IT break downs/different hospitals or a letter arrives suggesting bloods are ok. If results and letters do not arrive please contact the High Risk Drugs Pharmacist or the specialist. Tick box Tooltip: The patient needs monitoring by GP if HRD is to continue. Consider liaising with Prescribing Team and/ or specialist. QOF Target - Medication review every 15mths for patients prescribed repeat medication. Please use Medication module to code this Tick box 8BIB HRD 66P Diary entry Counselling about High Risk Drugs, their side effects and the need for regular blood monitoring should be reiterated every year or whenever possible. Tick box Text line If the patient suffers from any of the following adverse drug reactions, the high risk drug therapy should be reviewed. Please contact the initiating specialist for advice as soon as possible: All High Risk Drugs - Erythematous rash - Recurrent sore throat - Fever - Abnormal Bruising or bleeding Methotrexate specific - Oral Ulceration - New or increasing dyspnoea or cough Azathioprine and mercaptopurine specific - Oral Ulceration - Upper abdominal or back pain Ciclosporin, mycophenolate, tacrolimus in renal transplant patients - Raised BP especially if diastolic BP > 90mmHg - Sickness & diarrhoea - Development of opportunistic infections. 8

9 Monitoring Due Prescribing Teams Locality Contacts City and Hackney Medicines rmation Management Medicines Management Team, Tel: Prescribing Advisor, Tel: Prescribing Advisor, Tel: Newham Bola Sotubo, Medicines Management Lead, Tel: Wajid Qureshi, Senior Prescribing Adviser, Tel: Maninder Kaur Singh, Senior Prescribing Adviser, Tel: Tower Hamlets Tower Hamlets Medicines Management team, Tel: Second floor, Alderney Building Mile End Hospital, London, E1 4DG CARER S DETAILS PAGE Carer s Details Who provides care? 8GEA Care from relatives 8GEB Care from friends 918F0 Has a paid carer ZV604 No able carer in household Multiselect Carer s details 9180 Tick box Text Carer s telephone / 918L Carer-mobile telephone number 918J Carer-home telephone number 918K Carer-work telephone number 918M Carer- address Multiselect Text: Preferred method of contact Carer s needs assessed 3892 Tick box Text Date prompt Social Social Social Assessment RESOURCES PAGE Resources for Patients RA leaflet by patient.co.uk DMARDS leaflet by patient.co.uk Hyperlink Hyperlink 9

10 Biological medicines leaflet by patient.co.uk Self-management info by arthritiscare Resources for Clinicians Health Assessment Questionnaire National Rheumatoid Arthritis Society Disease Activity Score Hyperlink Hyperlink Hyperlink Hyperlink Medicines-for-Rheumatoid-Arthritis.htm Resources/Selfmanagement/ ments/cm_docs/2011/h/health_assessment_que stionnaire_haq_13_june_2011.pdf NICE Guidelines Hyperlink Arthritiscare website Hyperlink CEG Website Hyperlink 10

11 CEG Primary Care support & development For assistance & guidance around Templates, Enhanced Services or QOF, CEG have a team of enthusiastic facilitators able to come out to your practice or speak to you over the phone Jo Tissier (Facilitation lead) Jayne Callaghan (Newham Primary Care Facilitator) Ana Gutierrez (Tower Hamlets Primary Care Facilitator) Katherine Nishikant (Newham & C&H Primary Care Facilitator) Luis Rivas (C&H Primary Care Facilitator) j.r.tissier@qmul.ac.uk j.callaghan@qmul.ac.uk a.gutierrez@qmul.ac.uk k.nishikant@qmul.ac.uk l.o.rivastaquias@qmul.ac.uk Telephone:

12 Visit the CEG Website We aim to promote equality of access to effective primary care through evidence based guidelines, practice facilitation, audit, service development and research Clinical Effectiveness Group Centre for Primary Care and Public Health Blizard Institute Barts and The London School of Medicine and Dentistry Yvonne Carter Building 58 Turner Street London E1 2AB Phone:

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