Ardens has created a variety of resources to assist with identifying patients who may have chronic kidney disease, and to support the patient's ongoing management once diagnosed. 


Recording Information on the Management of CKD Patients

The Ardens Chronic Kidney Disease – CKD clinical template has been designed to standardise consultations, ensuring clinicians are following the latest national guidelines and recording accurate coding of data. 

 

To locate the Ardens CKD Template, access the relevant patient record. Open a new consultation and select the Run Template option (if not in a open consultation, click on the Add button on the EMIS ribbon, followed by Data Using Template option).

 

This will open the Template Picker screen. If you have accessed any templates before, these will display to the left of the screen. Search for the template by typing “CKD” in the search box.

 

 

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This will return the Chronic Kidney Disease - CKD (Ardens) template (alternatively select the Ardens > Chronic disease templates folder to the right of the screen).

 

All the Ardens Chronic Disease Templates follow the latest NICE guidance and best practice information. They include a QOF page for capturing QOF requirements and Review pages to complete a structured review.

 

Any information displayed in red relates to payment purposes such as QOF, PCN DES or local payment. Please note - if the information is relevant for the current financial year, you do not need to duplicate this information. 

 

The Review pages include sections to record information around the review appointment, examination, lifestyle, investigation and monitoring. The hyperlinks will direct you to useful external websites and NICE guidance:

 

 

The Review and Recall page ensures coding is captured to record that the CKD annual review has been completed, as well as enabling you to add a follow up date to the patients diary for renal function tests. This follow up diary entry will link with the Ardens Diary Recall System.

 

The Initial Diagnosis page can be used for patients without a confirmed diagnosis of CKD. This page enables you to record incidental findings and gives information on risk factors. CKD is often asymptomatic in the early stages and the clinical features of CKD can be non-specific and diverse, therefore the Clinical features section ensures you are recording general symptoms such as lethargy, breathlessness, cramps (often worse at night), sleep disturbance, bone pain, or loss of appetite, vomiting, weight loss, and taste.  There is a section to record advice given to the patient. 

Please note the appropriate diagnosis codes for CKD can be found within the QOF page.

 

 


The Initial investigations page gives guidance on investigations you may want to consider, sections for you to record results, view the latest recorded results as well as guidance around interpreting the results: 

 

 

The template contains many helpful links and information including links to NICE guidance within the Management Guidance page and leaflets for your patients within the Patient Resources page.

 

Please note – for patients presenting with multiple long term conditions, you may wish to use the Ardens Multi-Morbidity Templates.

 

Ardens Clinical Safety Alerts

The Ardens resources includes Clinical Safety Alerts to flag in real-time important MHRA drug safety and NICE guidance information that maybe missed. The alerts are triggered automatically by certain activity entered in the patient record e.g. entering a particular code or prescribing specific drugs.  Further information on the Clinical Safety Alerts included can be found here


A clinical safety warning will display, if your CKD patient is on an ACE inhibitor and you are recording a gastro-like illness:

 

 

 

If issuing metformin to patients with a low eGFR the following clinical safety alert will display:

 

Ardens CKD Searches 

Ardens has provided various searches which may be useful to support practices with the care of CKD patients.  The searches can be accessed via the Population Reporting module > Ardens Searches folder.


1.1 Chronic Disease (QOF) Recall Syst

This is a month of birth recall system, designed to recall a patient for multiple conditions at once.  CKD patients are not included in the main Invitation searches as CKD patients do not need to be recalled annually.  However, within the 2. Detailed Review Searches > 2.3 Interim Review (CKD & DM) > CKD folder, are searches to support practices in identifying those CKD patients that may require an interim review at intervals appropriate to their level of CKD:

 

 

 

For more information, please see our dedicated support article.

 

1.2 Ardens Diary Recall Searches

The Ardens Diary Recall System allows practice staff to easily manage diary recalls for ad-hoc tests, including blood tests and interim reviews.  These can be used to ensure your CKD patients are called back for any blood or urine tests required:

 

 

 

For more information, please see our dedicated support article.

 

1.4 Ardens Clinical Safety Searches

Ardens has created medication related searches to support practices with identifying patients on medication that may need extra care or monitoring.  For your CKD patients who are issued with Metformin, within the Medication Related Searches > Metformin with renal failure folder, a search will display patients who have been issued Metformin in the last 3 months and their latest eGFR is below 30.  You may wish to use the Population Included tab to review these patients:

 

 

 

1.7 Ardens COVID19 Searches

Within the Miscellaneous COVID19 Searches folder, Ardens has created additional searches for practices that wish to monitor further COVID activity.  These include a search displaying your CKD 5 patients that have not been coded as high risk of developing complications from COVID19.  You may wish to review the patients records and add the code:

 

 

 

5.0 Ardens Case Finders

Ardens has provided a suite of searches to support practices to improve data quality and ensure QOF payments are correctly calculated for your CKD patients.  These can be accessed via the Population Reporting module > Ardens Searches > 5.0 Ardens Case Finders > CKD folder:

 

The searches are reporting on patients that fulfil certain criteria which indicates the patient potentially could be included in the CKD QOF register but are not recorded with the correct diagnostic code. For more information, please see our dedicated Support Article.

 

If you require any further assistance on the process above, please contact Ardens support on:

 support-emis@ardens.org.uk