Ardens has designed Multi-morbidity templates to help manage patients with multiple long term conditions. These have recently been updated with input from the University of Bristol and the Year of Care Partnerships® .
There are two templates available:
- The Multi-Morbidity Initial Consultation template - we recommend to be completed by the HCAs. This will allow the HCAs to capture data on the initial examinations that has taken place before the patient sees either a Nurse or GP for their annual review.
- The Multi-Morbidity Annual Review template - to be used by the Nurses and GPs and includes elements for a full annual review.
Access the Multi-Morbidity templates in one of the following ways:
- Click on the Run Template option within the consultation.
- Click on Add > Data using Template option outside of a consultation.
Clicking on either of the options above will display the Template Picker screen. Search for the Multi-Morbidity templates using the search box provided or folder navigation pane. Select the template and click OK.
The Multi-Morbidity templates contain visibility rules and will only display certain pages in the template if the patient has been coded with the particular condition. For example - the below patient has Asthma, Hypertension and LD.
Multi-Morbidity Initial Consultation Template
Once accessed, the HCA will click on the relevant page on the left hand side of the template.
The Template Information page includes a tick box for 'Chronic disease initial assessment' we recommend selecting this field to record an initial consultation has taken place. Searches are available to identify patients that have had an initial consultation but not an annual review with the clinician, please click here for further information.
For each condition, options will be available to capture the initial examinations.
Please note - there could be elements of a examination required for several of the conditions (e.g. Blood Pressure), these elements can be captured in the Lifestyle and Screening page. Information displayed in red indicates this is a QOF requirement for the particular condition.
The following pages will be displayed for all patients and does not depend on a visibility rule:
- Lifestyle and screening page - allows the HCA to capture general information e.g. Blood pressure, height and weight, BMI, alcohol status, smoking status and more.
- Anxiety & Depression screening page - includes links to the anxiety and depression tools.
- Phlebotomy page - to be used to record the details of any phlebotomy procedures.
- Next steps page - includes a declined code for care planning and follow up plan options.
Complete the template using the required fields and ensure you save the information, using the Save Template option.
Multi-Morbidity Annual Review Template
Once accessed, the Nurse or GP will click on the relevant page on the left hand side of the template.
The Template Information page will display details of when the patient had been seen initially by the HCA (if relevant). Please note - the following template will include all options from the Multi-Morbidity Initial Consultation template if patient is not seen by an HCA.
Each condition page will contain the latest QOF requirements for the current financial year, and will either contain a green tick if that indicator has been achieved for the financial year, or a red cross to denote it is still outstanding. If you require to complete a full review of the condition, we recommend using the single Chronic Disease templates.
Information displayed in red indicates this is a contract requirement.
The template will display all the results from the HCAs initial consultation if taken place to the right of the data field.
Please note - there could be elements of an annual review required for several of the conditions (e.g. Blood Pressure), this data can be captured in the Lifestyle and Screening page.
The following pages will be displayed for all patients and does not depend on a visibility rule:
- Lifestyle and screening page - allows the clinician to capture general information e.g. Blood pressure, height and weight, BMI, alcohol status, smoking status and more.
- Anxiety & Depression screening page - includes links to the anxiety and depression tools.
- Bloods page - displays the most recent potentially relevant blood tests.
- Vaccinations page - displays the latest coded vaccinations.
- Medication Review page - allows the clinician to capture basic medication review information. Please note the Ardens Structured Medication Review template is available if required.
- Phlebotomy page - to be used to record the details of any phlebotomy procedures.
- Care & Support Planning page - includes options to update the patients care planning information. Please note the Ardens Future Care Planning template and Ardens Universal Care Planning template are available to complete further care planning details.
Where blood tests or further investigations are required you can use the Ardens Diary Recall system to add a reminder to follow patients up for these tests in the future . The Administration team will be prompted to send the patient an invitation text message, email or letter. There is more information about this here.
Complete the template using the required fields and ensure you save the information, using the Save Template option.
For further information on how Ardens can help you to streamline the recalling of long-term condition patients, click here.
If you require any further assistance on the process above, please contact Ardens support on: