OPAT Review Field

[michaeledwardmarks]

Based on current Clinical Advice Modal

Subfields a. Date b. Type of R/V (Look up list) c. Discussion d. OPAT Plan d. Next Planned Review

Consider ??Auditable outcomes as check boxes – similar to current clinical advice modal

[GabPoll]

Is the plan for OPAT to enter their clinical entries (i.e. outpatient notes) straight on OPAT via an equivalent of the clinical advice modal?

I ask because many of these patients' "journeys" begins as inpatient via micro advice / ID liaison advice. Presumably the outpatient setting will be a different episode, but when flicking to the inpatient episode, the OPAT view on elCID should would also show up clinical advice received as an inpatient.

[7575colli]

This field will need to differentiate between a nurse/medical review. The nursing review would need to include a field for the following:

• Recording physiological observations - Blood pressure (.../...mm Hg), Pulse (...BPM), RR (...BPM), SpO2 (...% on ...L O2) Temp (... Degrees C), Height (...cm), Weight (...kg). There should be an option to record this information on every review and also to record it multiple times during each attendance. Sometimes we might check the patients BP a few times during one visit.
• Assessment of the intravascular access device 'line' This would need to access the same information as #180 'lines' field. This is the time that we would note any complications/dressing changes/VIP scores/or change the line. It should also have a filed to note when the next line assessment is due - this could be a calendar. Can all of the calendars that enter a date also enter the DAY as well... It would make life easier :) Il add to this list later

[michaeledwardmarks]

Specific box for Line review as part of OPAT Review is excellent suggestion.

I think recording all the observations is part of later development when we start to build the ICP into OPAT - but agree this will ultimately be helpful.

Broadly an important divider for us currently is that we have funds to replace list functionality and add a few extra features but integrating all of the ICP into the system will require more funding/time.

[7575colli]

Is it possible to have a section for the nurse clinic review?

Ideally it would have fields for the icp components. Maybe a free text area to record obs could be used? I hasten to add the the lengthy icp that I gave to you would not need to be incorporated... Only the smaller one that basically has single a4 review pages. I was of the impression that our nursing records would be entered onto eLCID and the printed after to our review for filing to comply with record keeping regs. Maybe we should have a chat to discuss expectations. You can call me on the number bellow whenever is convenient. If I can't answer leave a voicemail and il get back to you.

Kind regards,

Steve Collins

OPAT Lead Clinical Nurse Specialist Hospital for Tropical Diseases UCLH 2nd Floor Mortimer Market Capper St WC1E 6JB

07535327416 steve.collins@uclh.nhs.uk

On 22 Mar 2014, at 22:17, "Michael Marks" notifications@github.com wrote:

Specific box for Line review as part of OPAT Review is excellent suggestion.

I think recording all the observations is part of later development when we start to build the ICP into OPAT - but agree this will ultimately be helpful.

Broadly an important divider for us currently is that we have funds to replace list functionality and add a few extra features but integrating all of the ICP into the system will require more funding/time.

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[michaeledwardmarks]

@7575colli I agree we should capture nurse reviews - perhaps helpful to circulate the single page review sheet so we know what that consists of. I'll leave @davidmiller to look at that and comment on what is realistic to achieve within the currently agreed funding.

[7575colli]

@davidmiller; i have lost your email address, could you kindly email me with it - steve.collins@uclh.nhs.uk cheers, Steve

[michaeledwardmarks]

Completely agree with @7575colli that we want to record obs etc and capture nursing review - this is clearly key as much of OPAT is nurse led. Not my intention to suggest we wouldn't do this but more to think about how and why as this impacts on development.

As @davidmiller has said elsewhere how this is done can range from very simple to very complicated: e.g write in the observations as free text vs. capturing multiple observations in an ordered format, recognising trends etc - for example having an option to record temperature and time it was taken 5 times in a clinic setting is quite a tricky thing

Suggestions: 1) I think helpful for us to consider aims of capturing this information. If the aim is to be able to record the information as a broad record something happened (e.g I took the temperature) then we may not need a very complex data capture system. On the other hand if you want to be able to interrogate specific questions (e.g of all people with a temp over 38 how many of them did we take their line out) then we need to capture that data in a much more systematic way.

@7575colli and @jonnylambourne thoughts on this (again remember we might have immediate aims whilst also knowing that we want to be able to do more in 12 months time - don't need perfection up front)

2) I think the second consideration here is about Primary vs Secondary documentation. At the moment elCID is very clearly secondary documentation. Making it a form of primary documentation (e.g the only place we record information) has significant time/governance implications - not just for OPAT but for the whole elCID project. I think this is the direction we are headed in but as with our work on the ward it is likely to be achieved in a number of small steps rather than in one go. So I think that needs to be considered, for example with recording of observations (primary documentation) - how does that end up in the patients records in a way that is accessible to other users?

@7575colli do you have a copy of the single page review you could circulate - it will make discussion much easier - it may well turn out that what you are suggesting is a lot less work than it sounds to me - in which case we try and achieve more of it up front.

[michaeledwardmarks]

Update summary of this field with comments from taken from @jonnylambourne comments on another Issue (now closed) and @7575colli above.

This modal should have:

Subfields a. Date

b. Type of R/V (Look up list)

• phone call
• clinic visit (nurse)
• clinic visit (Dr)
• MDT discussion

c. Who did the consult/was present

d. Observations (as per @7575colli above) Free text in first iteration

e. Discussion

f. OPAT Plan

g. Next Planned Review

[davidmiller]

More types of review (Where we capture outcome data #190):

• End of IV treatment visit
• End of treatment
• Follow up

[davidmiller]

Nursing review Extra fields:

• For every line currently in place
  • add a VIP score
• Dressing intact tick box
• Lumen flush OK ? tick box
• Drawback of blood seen tick box
• CM from exit site
• Date of next dressing change
• Date of next bung change

In this review

• Dressing changed Tick box
• Bung changed Tick Box

Text boxes

• Comments
• Obs
• Medication administered

Were there any adverse events Yes/No/Not Filled in

• Adverse events

Display should include timestamp of creation.

[7575colli]

Re above: 'VIP' should be written in full 'Visual Infusion Phlebitis Score' and have a drop down box of 0-5.

[davidmiller]

I'm going to close this - I think we have everything here in the OPAT review.

I'm going to open a new issue for:

• Nurse Clinic Review as it's own field
• Adding obs data to Nurse/OPAT review.

[davidmiller]

The relevant issues are #386 && #387