Patient Safety Queries

DMARDs, Warfarin and Triple Whammy Version 1.0 – 4th July 2017

User Guide for GP Practices

SPIRE Local (v1.2.54)

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Contents 1 Introduction ........................................................................................................................... 3

1.1 Patient Safety Queries ............................................................................................................ 3

1.2 Frequency ................................................................................................................................ 3

1.3 Criteria ..................................................................................................................................... 3

1.4 Eligibility .................................................................................................................................. 3

1.5 Output ..................................................................................................................................... 3

1.6 ‘At risk’ health condition ......................................................................................................... 3

2 SPIRE Local Homepage ........................................................................................................... 4

2.1 New Schedules ........................................................................................................................ 4

3 My Schedules ......................................................................................................................... 5

3.1 Rationale ................................................................................................................................. 6

3.2 Run History .............................................................................................................................. 7

3.3 Requesting a Query Run ......................................................................................................... 8

4 Query Viewer ......................................................................................................................... 9

4.1 Patients List ........................................................................................................................... 10

4.2 Clinical Events ....................................................................................................................... 13

4.3 Patient Summary ................................................................................................................... 15

4.4 Demographics ....................................................................................................................... 16

4.5 Patient Changes .................................................................................................................... 17

4.6 Rationale ............................................................................................................................... 19

4.7 Baseline Date Selection ......................................................................................................... 19

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1 Introduction 1.1 Patient Safety Queries There are three patient safety queries available for practice use.

DMARDs, Warfarin and Triple Whammy queries have all been designed to ‘Improve the monitoring of patients on medicines with high risk of adverse drug effects by providing data which highlights patients at risk’ and output a list of patients meeting the following requirements:

For DMARDs - Patients prescribed Methotrexate and Azathioprine in the last six months who have not had a Full Blood Count done in the past three months.

For Warfarin – Patients prescribed medication containing Warfarin in the last six months without a record of INR having been measured in the past four months.

For Triple Whammy – Patients aged 65 and over prescribed Oral non-steroidal anti-inflammatory drug (NSAID) who are currently prescribed a Diuretic and an Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) (the ‘Triple Whammy’).

Note: these queries will only be available in SPIRE Local (in the Practice).

NO DATA WILL BE EXTRACTED by National Services Scotland.

1.2 Frequency These queries are set to run monthly in practice.

1.3 Criteria The following patient types are included in these queries:

Registered, permanent, temporary, private or non-GMS patients

1.4 Eligibility DMARDs and Warfarin applies to patients of all ages, Triple Whammy to those aged 65 years and over.

1.5 Output Patients List

1.6 ‘At risk’ health condition Please refer to the Rationale within My Schedules (as detailed on page 6 of this manual).

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2 SPIRE Local Homepage

Fig 2.1 – SPIRE Local Homepage

2.1 New Schedules

How do I know if new schedules (queries/reports/extracts) have arrived?

The envelope icon and circled number alerts you to the presence of messages informing you of new queries/extracts. Select the Ms Icon to view messages that are listed in the ‘New Schedules’ upper window.

Figure 2.2 – Notification of New Schedule

My Schedules module allows you to see which queries are running at your practice.

The Patient Safety queries will be presented here. There is no requirement to opt in or opt out as no data will be returned to NSS for these particular queries

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3 My Schedules

Select ‘My Schedules’ from the SPIRE Local Homepage.

The patient safety queries will show in the ‘New Schedules’ section of this module. The following screenshots apply specifically to the ‘Patient Safety DMARDS’ query but the same principles apply to Warfarin and Triple Whammy.

Fig 3.1 – New Schedules Screen

In this list highlight the query named: ‘Patient Safety DMARDS’ by clicking on the row. Note that the name of this query may change slightly if a new version is published by NSS.

Information on the Query Name, Type of Query, Query Start/End Dates and Schedule Details are detailed on this row.

In your practice the patient safety queries are set to run on the 1st of the month from 01/07/2017 to 01/06/2018.

To view schedule details click on the ellipses button (with 3 horizontal dots) in the ‘Details’ column as highlighted by the red circle shown in Fig 3.1 above.

The following information will be shown in a pop-up window (as highlighted in Fig 3.2 below):

Fig 3.2 – DMARDs Query Details Summary

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3.1 Rationale

All information on the Rationale and Read Codes that are included in the selected query can be accessed through My Schedules

Fig 3.3 – My Schedules – View Rationale

Select the ‘View Rationale’ button as highlighted by the red rectangle in Fig 3.3 above.

The following pop-up window (Figs 3.4 and 3.5 below) will appear providing further information on the Rationale and Read Codes used for the DMARDs Query:

Fig 3.4 – DMARDs – Rationale Details

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Fig 3.5 – DMARDs – Rationale Details

Further information can be found by selecting the ‘Link to rationale’ hyperlinks within this screen which will take you to the Rationale and Read Codes for ‘Patient Safety DMARDS’ Query.

3.2 Run History

Run History shows the status of any selected query.

To view the status of the ‘Patient Safety DMARDS’ query, select the query from the list, this will highlight in blue.

Select the ‘Run History’ button on the right hand side of the page, highlighted by the red rectangle in Fig 3.6 below:

Fig 3.6 – My Schedules – Run History

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This will open the following window:

Fig 3.7 - Run History Screen

Any completed, failed and in progress runs will appear in the list.

Future runs will not show until the date on which they are scheduled to run.

3.3 Requesting a Query Run

If you wish to run any query in between scheduled runs you can select the ‘Request New Run’ button shown in Fig 3.7 above. This will run the query for the current date.

A failed run of a query is indicated in the status box with the text ‘Failed at Query Stage’ as shown in Fig 3.8 below:

Figure 3.8 – Failed Query Run Status

If, for any reason, a query has failed to run, the ‘Request Re-run’ option becomes available as shown in Fig 3.9 below:

Select the row for the failed to run query and then select ‘Request Re-run’

Figure 3.9 – Query ‘Request Re-Run’ Selection

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Fig 3.10 – View Results

From the Run History screen select the row you wish to view results for, this will highlight in blue. Selecting the ‘View Results’ button as shown in Fig 3.10 above, will open Query Viewer to view the results for ‘Patient Safety DMARDS’ (See Section 4 for further information).

4 Query Viewer

There are two separate ways to access the results for any query in SPIRE Local

1) Through ‘View Results’ in Run History as detailed in Section 3.2 OR

2) Select Query Viewer from the SPIRE Local Homepage (Fig 4.1 below)

Both options will access the results for DMARDs and the other patient safety queries.

Fig 4.1 – Query Viewer – SPIRE Local Homepage

When accessing through the Query Viewer Icon from SPIRE Local Homepage you will be required to select the query you wish to view results for, as shown in Fig 4.2 below:

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All queries are shown in alphabetical order.

Fig 4.2 – Query Selection – Query Viewer Homepage

Select the drop down menu and then select ‘Patient Safety DMARDS’ to view the results for this query which will show results for the latest run date.

As default, the patient list shown on the right hand side shows all the patients analysed for ‘Patient Safety DMARDS’ Query – Patients on Methotrexate or Azathioprine within 6 months.

4.1 Patients List

Results for queries within Query Viewer will always produce a Patient List as shown in Fig 4.3

Fig 4.3 – Query Viewer – Patients List - DMARDs

Details of the number of patients who have been returned for this query are detailed as shown in Fig 4.3. In the example above there are 8,017 patients returned. These are patients who are registered, and either permanent, private, temporary or Non-GMS patients.

From the list on the Left Hand Side, select ‘Patients with a record of FBC within 3 months’.

Fig 4.4 – Query details – Patients with a record of Full Blood Count within 3 months

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A patient list will be generated on the Right Hand Side screen for all patients in this category, as shown in Fig 4.5

Fig 4.5 – Patients List – Patients with a record of Full Blood Count within 3 months

Select the next query in the list to show ‘Patients with no record of FBC within 3 months’ as shown in Fig 4.6 below

All patients for this query will be generated on the Patient List tab on the Right Hand Side:

Fig 4.6 – Patients with no record of FBC within 3 months

The Patients List generated for the Warfarin query will show patients on Warfarin within 6 months and underneath it patients with a record of International Normalised Ratio (INR) within 4 months and a second list of patients with no record of an INR within 4 months. See Fig 4.7 below

Fig 4.7 – Query Viewer – Patient List - Warfarin

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The Patients List generated for the Triple Whammy query gives a list of patients aged 65 years and older and underneath it a list of those prescribed the Triple Whammy drug combination. See Fig 4.8 below.

Fig 4.8 – Query Viewer – Patient List –Triple Whammy

All patient lists can be sorted as follows:

Sort by Patient ‘Opt-out Status’ Sort by ‘Registration Status’

Sort by ‘Deregistered on the baseline date’ Sort by ‘Patient Type’

Fig 4.9 – Patient List Functions

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Fig 4.10 – Patient List Functions

Functions of the buttons at the top of this page are outlined below.

To print the patient list, select this button:

To export the patient list in CSV format, select this button:

To perform a mail merge, select the following button:

4.2 Clinical Events

Clinical events for all patients relating to all the patient safety queries can be accessed within Query Viewer without returning to the Clinical System – EMIS or Vision.

To view the clinical event(s) that brought the patient into the DMARDs search, select the patient by

clicking on their row and then select the following button as shown within the red rectangle in Fig 4.11 below:

Fig 4.11 – Clinical Events Functions

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All Relevant Clinical Events will be shown for the selected patient as shown in Fig 4.12 below:

Fig 4.12 – ‘View Relevant Clinical Events’

To view ALL Clinical Events for Patient

Select the following button: as shown in Fig 4.11

All clinical events will be shown for the selected patient in a pop-up window:

Fig 4.13 – ‘View All Clinical Events for Patient’

All Clinical Events will be shown for the patient in reverse date order (latest first).

The information can be sorted for specific date ranges as required.

Select and enter the date range required and select apply (as shown in Fig 4.13) to return All Clinical Events for the time period selected.

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4.3 Patient Summary

Use Patient Summary tab to:

View information on the number of patients for each category To exclude specific patients from the Patients List tab

By default, all patients who have fulfilled the criteria for the selected query will be shown in the Patients List tab.

All patient list information can be filtered as required.

Select Patient Summary tab as shown in Fig 4.14 below.

Untick the selection from the right hand side of the screen to remove these patients from the Patients List tab.

Fig 4.14 – Patient Summary

N.B. – Query Viewer filters that have been applied will be reset to default settings when you exit this module.

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4.4 Demographics

The Demographics tab shows a breakdown of all patients returned for the selected query by age group and gender. These are shown in a Bar Graph, a Table of Results and a Patients List.

Select Demographics tab as shown in Fig 4.15 below:

Fig 4.15 – Demographics Tab – Males aged 45-54 selected

By clicking on any bar in the bar graph the corresponding number appears in the Table of Results below. It will be highlighted in blue and the corresponding patient list will also be shown at the bottom of the screen.

Patient lists can be sorted as required (e.g. by Name or CHI) and you can view clinical results for the selected patient, see section 4.2 for further detail.

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4.5 Patient Changes

The Patient Changes tab shows patients who have been removed or added to the results of ‘Patient Safety DMARDS’ query from the initial baseline date, allowing you to monitor changes in patients in the practice.

Select Patient Changes tab as shown in Fig 4.16 below:

Fig 4.16 – Patient Changes Tab

Patient Changes are shown in the line graph on the Right Hand Side of your screen.

By selecting each query from the Query list, details are provided of all patient changes between the baseline date and when the query was last run.

Fig 4.17 – Patient Changes Tab – Patients Removed

Patients changes are shown for each baseline run date e.g. in this case 31/03/2016.

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By selecting a patient from the Patients Removed tab as shown in Fig 4.17 the patient changes between baseline run dates will be shown on the line graph.

There has only been one patient removed in the example shown above and the line graph may appear to be horizontal, suggesting no changes, if we look more closely at the line we can see there has been a change. This is confirmed by looking at the Patients Removed tab where 1 patient has been removed. The changes in the graph will be more obvious with increased numbers of patient removed.

Fig 4.18 – Patient Changes Tab – Patients Added

By selecting a patient from the Patients Added tab as shown in Fig 4.18 the patient changes between baseline run dates will be shown on the line graph. Again the line appears horizontal but does slope upwards showing a patient has been added, changes in the graph will be more obvious with increased numbers of patients added.

Any patient who is detailed in the Patients Added or Patients Removed tabs, you can drill down into clinical events for the selected patient as detailed in section 4.2.

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4.6 Rationale

Information on the Rationale and Read Codes for the selected query will be shown under the Rationale Tab.

Select the Rationale tab as shown in Fig 4.19 below:

Fig 4.19 – Rationale Tab

4.7 Baseline Date Selection

All results for completed runs of ‘Patient Safety DMARDS’ Query can be selected without returning to the Run History screen within My Schedules.

To view results for other baseline run dates, select the drop down menu as detailed in Fig 4.20 below:

Fig 4.20 – Baseline Date Selection

All data will be refreshed through Query Viewer to generate results for the selected Baseline Date.