Ardens can assist with drug monitoring to ensure the correct tests are completed, including medications like ACE inhibitors, levothyroxine, anticoagulants, DMARDs and more.
For a summary of the drugs and monitoring tests, please see here.
For sulfasalazine monitoring, please see here.
1. Pop-Up Alerts on Record Retrieval
When opening a patient's record, a pop-up will appear if a patient is on a High Risk Drug (e.g. a DMARD) that has overdue tests and is under primary care monitoring. The overdue time interval is set at the longest recommended time for monitoring when the patient is stable on their medication, e.g. 12 weeks. The patient may require testing more regularly than this.
If you want to stop these pop-up alerts go to 'Setup > Workflow Support > Protocols > Ardens > Pop ups' and deselect the ‘Drug Monitoring Pop Up Warning’.
2. Templates for Consultations
To access the drug monitoring templates, go to 'Autoconsultations > ardens DRUG MONITORING'. If a patient is on a DMARD or an anticoagulant, they will also have a
icon under their name. Clicking this icon will also open the template. The medication must be on their repeat medication list to show the alert.
If the medication is under shared care, this can be recorded at the top of the template. If this is left blank, it will be presumed that the monitoring is done in primary care. As there is only one ‘High Risk Drug Monitoring – Primary Care’ read code, if a patient is on two or more high risk drugs it is assumed monitoring will be the same for each drug. For information about recording hospital medications, please see here.
On the template is also information about the what tests need doing and the warning thresholds. Click in the free text notes box & look to the right to see previous notes.
2. Reviewing Patients With Overdue Tests
To review patients on specific medications with overdue tests, go to Clinical Reporting > Ardens > Prescribing > Monitoring > Drugs | Annual / Anticoagulants / DMARDS / HRD. Here you can run find the report for the medication you are interested in, run the report and then review the patients record. Any medication that requires monitoring more frequently than annual, is classed as a high risk drug for the purposes of reporting, and can be found in the HRD folder, unless it is an anticoagulant or a DMARD.
On the specific drug monitoring template above is a link to the 'Drug Monitoring Letter' template with some useful pre-set text and letters.
3. Sending Reminder Invitations In Batch
To send a reminder invitation in a batch to all your patients who have overdue tests, go to Clinical Reporting > Ardens > Prescribing | Monitoring > 1 High risk monitoring | Primary Care reminders .... Here you will find a report to send a 1st letter to patients with overdue tests. After you have sent them all a letter, batch add the 'XaXwg - Medication monitoring first letter sent' Read code.
If the patient still has not had their blood tests done 1 month later, they will then appear in the '2nd Letter' due reports. You can then send them a further letter and batch add the 'XaXwh - Medication monitoring second letter sent' Read code.
Annual and Has QOF LTC/QOF or Best Practice LTC/legacy LTC/no QOF LTC - this means that the patient is due bloods for steroids or thyroid medications, for example, and also has a chronic illness. You would use these if you do not use the Ardens LTC Recall system. You must also use Annual and no LTC to ensure you capture your full population of bloods due patients in this instance. If you do use the recall system, you can ignore these as this population is picked up within that system.
Annual and No QOF LTC/No QOF or Best Practice LTC/No legacy LTC - this means that the patient is due for bloods, and does not have a chronic illness. If you do use the Ardens LTC Recall system you will be picking up patients who have a chronic illness and we will be prompting you to take their steriod/thyroid etc bloods at the same time as their diabetic bloods for example. Therefore, this population of patients will be outstanding so you must use these to capture everyone due bloods.
High risk - this will let you call in patients taking DMARD medications and any other medication requiring monitoring 6-monthly or more frequently.
4. Removing Patients From Monitoring
Patients can be removed from monitoring by ending the repeat or by coding the patient with 'High risk drug monitoring - secondary care 205811000000106'.
NB As drug monitoring carried out by secondary care at some point generally becomes the responsibility of primary care, the secondary care monitoring code above has to be reapplied every 6 months.
5. Frequency of Monitoring
The intervals for Ardens drug monitoring blood tests follow national guidance and cannot be altered by a practice or local area. The link at the top of this article, hosts a spreadsheet outlining the resource used to govern the blood tests and intervals suggested.
Generally these are British National Formulary, National Institute of Clinical Exel, Specialist Pharmacy Service or specialist groups like the British Society of Gastroenterologists. Where national guidance states to 'monitor regularly' we do not include these in our reports as setting a time frame would be adding interpretation to this.
There are a few drugs where national guidance suggests that monitoring can be extended in stable patients. For example, lithium, tacrolimus and ciclosporin. The monitoring templates for these drugs have a page where you can add codes simultaneously to adjust the frequency of invites.
If an individual patient needs increased frequency of monitoring for any other drugs, you can set up an additional recall on a case by case basis.
6. Locally Commissioned Services
There are numerous reports to assist with any contractual requirements that are needed. To find these reports, go to Clinical Reporting > Ardens > Contracts | 20xx xx | Local Contracts ....