If the patient is currently on the End of Life/Palliative Care register, the template can be accessed by clicking under the patient name and address.
Alternatively go to Auto-Consultation >ardens CONDITIONS FRAILTY and EOL
The template is split into several tabs across the top, to make it easer to navigate to the area you wish to complete:
The template has an initial Home page showing a summary of the patient's key information, such as resus status, Treatment Escalation Plan, record sharing information etc.
The top of this summary shows key information currently missing (with two green exclamation marks) - as shown in the screen shot below i.e. 'Consider Recording Preferred Place of Death'.
RED STAR = QOF coding
YELLOW STAR = LES requirements (audit trail linked to these)
To add the patient to the QOF register, select the most appropriate code from the Diagnosis drop down.
To set any Gold Standard Framework prognostic indicators, select from the GSF drop down.
Discussion - record any discussions with a patient making them aware of diagnosis/prognosis. Use the highlighted pencil icon to add any free text.
This page allows you to record a routine assessment on the patient.
History and Observations allows for free text and below, coding of any other symptoms affecting the patient with a link to the drug formularies for prescribing non-injectable meds and assessment of any holistic needs using the PEPSI COLA assessment or Responsive Need Tool.
Impression allows you to record the patients current condition and update their GSF status.
From here you can access the Injectable and Non-Injectable Formulary for prescribing anticipatory medication and producing the drug chart (also within the Care Plan section - see further down).
The Phlebotomy button allows you to view recent blood results with a link to Electronic Pathology Request for any new requests (i.e. ICE/tQuest etc.)
This page allows you to record a Care Plan review for the patient.
The Special Note and TEP sections allow for free text but also have preset notes available to the right
Select text from this list individually or multiple lines by pressing and holding the Ctrl button (on keyboard) and use the mouse to select required text, and then select OK.
Coding below allows recording of DNACPR Status with a link to your local form 'DNACPR form' which is auto-populated, alternatively 'RESPECT Plan' is also available if using in your area.
Anticipatory Drug Prescribing
The Care Plan page will allow you to create auto populated local drug charts (if using Ardens Plus or Pro) and prescribe these drugs using one click preset buttons.
Select the 'Injectable Formulary' icon within the Care Plan (or Assessment) tab.
Select the required section from Just In Case (JIC), Syringe Driver - Starting doses or other doses from Pain, Agitation, Nausea, Secretions, Steroids & Water.
To prescribe using the preset buttons
Click the button for the required medication, in the example above a choice of either 3 or 5 ampoules, this will add the prescription for that drug. Continue adding other medications as required, allowing the script to load before moving on to the next.
Each time a new drug is added - you will see the medications listed in the window at the bottom of the template (as shown in above screen shot for Morphine sulfate). The dose/number of ampoules may be amended by right clicking on the drug shown and selecting Amend Medication. Options for sending electronically or printing are in the bottom right-hand corner of the template. Please see the EOL Formulary - Sending via EPS guide.
Producing local Community Drug Chart
Once all required medications have been added, click the Community Drug Chart option located towards the bottom of the template.
This will open the drug chart, auto-populated with all prescribed medications. This can be printed/saved to the record. Please have a look at our other article about End of Life Drug Charts.
The End of Life Formularies on Ardens are pre-set with a choice to prescribe a quantity of either 3 or 5 ampoules for subcutaneous anticipatory prescriptions.
Why do Ardens recommend 3 ampoules?
In the majority of cases, anticipatory drugs are prescribed and are never used resulting in waste which can lead to:
- Shortage of end of life medication when a patient really needs it
- Increased quantities of controlled drugs in the community with risks concerning supervision of use and safe disposal.
- Unnecessary cost and expenses to the NHS
- Environmental impact of increased waste
End of Life drugs often come in a pack of 5. Whilst prescribing in a pack of 5 may be convenient for dispensing purposes, it often goes to waste and results in the issues above. By prescribing 3 ampoules for anticipatory medicines, every 15 ampoules supplies 5 patients with anticipatory medicine, rather than only 3 patients.
When should you prescribe more ampoules?
Whilst in the majority of cases End of Life medicines are prescribed in anticipation, in some cases a patient is sufficiently symptomatic to need immediate subcutaneous end of life treatment. If this is the case, then even 5 ampoules is likely to be insufficient and the patient is likely to need 10 or more ampoules prescribing.
When else should you prescribe more ampoules?
You may also consider increasing the number of ampoules prescribed to cover Out-Of-Hour periods over weekends and bank holidays.
How do I prescribe more ampoules?
If you wish to prescribe more than 3 or 5 ampoules, you can use the Ardens End of Life Formulary as normal but after clicking on a medication you can then right click the medication in the view at the bottom of the template and increase the number of ampoules to the quantity required.
Use this section to add any notes discussed during MDT meetings.
Practices can have SystmOne open on a large screen allowing direct input of notes at time of meeting rather than being added at a later time.
Add names of people present at the meeting. Clicking in to any section will allow you to see previously recorded information on the right side of the template.
Use the Notes section for any other free text.
Provides a list of useful website links that can be sent to a patient, carer or relative via SMS or email.
For more information see below video: