Ardens CQC Clinical Searches for GP Practices
Explore how Ardens CQC clinical searches aid GP practices in identifying potential clinical risks, ensuring safety and effective care delivery. Discover the purpose, background, and access information of these searches developed in response to the COVID pandemic, all aimed to enhance quality improvement and consistency in approach.
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Presentation Transcript
CQC Clinical Searches Wednesday 22 June Dr Janet Hall, National Professional Advisor General Practice Dr Tim Ballard, National Professional Advisor General Practice Dr Robert Greville-Heygate, Chief Executive, Ardens Dr Merlin Dunlop, Medical Director, Ardens 1
Meet the webinar team Dr Janet Hall, National Professional Advisor General Practice Dr Tim Ballard, National Professional Advisor General Practice Dr Robert Greville-Heygate, Chief Executive, Ardens Dr Merlin Dunlop, Medical Director, Ardens David Gwyther, Communication and Engagement Manager Lisa Lloyd, Communication and Engagement Manager 3
What we will cover today Background Purpose of searches Ardens The business rules Accessing the searches EMIS Web SystmOne Vision The searches Other areas covered in CQC GP interview Any Questions 4
Background Developed in response to COVID pandemic Used in both onsite and offsite inspections Suite of clinical searches routinely used for inspections of GP practices Based on - Safe prescribing - Monitoring high risk drugs and DMARDs - Identifying potential missed diagnosis - Reviewing MHRA alerts - Long term condition management treatment - Care in line with evidence based practice Freely available for all practices to access at any point in time Business rules publicly available to ensure transparency
Purpose of Searches To identify potential clinical risk predominantly in relation to delivery of safety and effective care To have a degree of tolerance to identify significant outliers Consistency of approach Promote quality improvement Providers will have access to the searches at any time NOT to substitute existing GP Practice s own governance system NOT to be used for managing care on a daily basis
Ardens CQC are not experts in configuring searches on clinical systems Ardens was selected as a partner to provide this expertise Relationship is a partnership as part of a 12-month pilot Searches are available for free for all EMIS Web & SystmOne practices Cegedim Healthcare have been given the business rules and are creating the searches for Vision practices. These are due to be launched towards the end June 22.
Business Rules Publicly accessible Includes rules and code-sets www.ardens.live/cqc
EMIS Web Downloading Searches To download the searches from the portal: 1. Go to www.ardens.live/portal 2. Select practice where importing searches to 3. Select "CQC Searches" followed by the download link 4. Save the folder of searches to your desktop Please note First-time users will need to create a free account and register for the practices where they work. Please do not share the downloaded searches with other GP practices as the Ardens Portal records which version of the searches you have downloaded for your GP practice so that we can contact you (if needed) when updates are released.
EMIS Web Installing Searches 1. Go to EMIS > Population Reporting 2. Create a new folder called "CQC" and import the downloaded file here
EMIS Web Searches viewing results Highlight the line you want to Auto-report and click on the lightning bolt
EMIS Web How to import searches Ardens EMIS - CQC Inspection Searches - GP Practice Access on Vimeo
SystmOne Join group To join the open access organisation group: 1. Go to Setup > Users & Policies > Organisation Groups 2. Untick top left box Only show groups this organisation has joined (red box) 3. Go to Wiltshire > CQC Inspection Searches (green box) 4. Right click > Join Group (yellow box) 5. Turn SystmOne off and back on again Please note Your organisation can only be a member of 25 groups. If you have exceeded this number, you will need to leave another first. The SPA need to have System Administrator rights to join the group For further information, please see this support article
SystmOne Accessing Searches Go to Reporting > Clinical Reporting > CQC Inspection Searches
SystmOne How to access the searches Ardens SystmOne - CQC Inspection Searches (vimeo.com)
Vision Downloading searches Downloading: 1. Click chevron at bottom left screen in system tray (green box) 2. Select Download Web Files (red box) 3. Select CQC Clinical Searches 4. Download searches if not showing as up to date by: check download box (yellow box) > select download button (purple box) 5. Vision searches available by end of June 22
Vision Running searches Running searches: 1. Click chevron at bottom left screen in system tray (green box) 2. Select Practice Reports (red box) 3. Select Practice Lists 4. Select Other and type CQC into search box (orange boxes) 5. Click on CQC Clinical Searches and choose Run now (purple box) 6. Click on any of the +symbols next to the category headings to see results
Acknowledgements The CQC and Ardens acknowledge the support provided by EMIS Health, TPP (SystmOne) and Cegedim Healthcare Solutions (Vision) during the initial conceptual discussions, for advice during the development of the reports and to Cegedim Healthcare for building the reports.
How the searches will be used The CQC SpA will run all the searches from the following domains and select searches to review according to perceived risk: At least one search from each of the following domains: - DMARDs Review a random sample of at least 5 patient clinical records for each search selected. - High Risk Drugs - Medication Review A sample of patient records will also be reviewed for at least one search in a domain even if all searches report as zero to ensure robust monitoring recall processes are in place - Medicines Usage - Missed Diagnosis - Safety Alerts All searches from this domain: - Long Term Conditions DNACPR: Choose 5 patient identifiers for the inspector to review:
Searches DMARDS Azathioprine in last 6m - Check FBC/U+E/LFT as none in last 6m (should be 12w) Leflunomide in last 6m - Check FBC/U+E/LFT as none in last 6m (should be 12w) Methotrexate in last 6m - Check FBC/U+E/LFT as none in last 6m (should be 12w) DNACPR DNACPR or ReSPECT - Review if recorded appropriately in last 1y: alive DNACPR or ReSPECT - Review if recorded appropriately in last 1y: deceased
High-risk drug Searches Medicine Search criteria ACEi or ARB Check U+E as none in last 18m (should be every 12m) Amiodarone Check U+E/LFT/TFT as none in last 6m DOAC Check CrCl as not done in last 1y Check CrCl as never done Check FBC + LFT as none in last 15m (should be every 12m) Check U+E as none in last 1y + CrCl >=60 Check U+E as none in last 3m + CrCl <30 Check U+E as none in last 6m + CrCl 30-59 Contraindicated as CrCl <30 or <15 Review as Hb <9g/dl in last 1y Lithium Check lithium levels as none in last 6m (should be every 3m) Check U+E/TFT/Calcium as none in last 9m (should be every 6m) Potasssium-sparing diuretic (aldosterone antagonists) Check U+E as not done in last 6m Warfarin Check INR as none in last 3m + not INR self-monitoring in last 1y Review as 2x INRs >5 or 1x INR >8 in last 6m 22
Searches Long Term Conditions Asthma - Review as 2 or more courses prednisolone in last 12m (+ no COPD) CKD 4-5 or CKD + latest eGFR <30 - Check U+E as none in last 9m (should be 3-6m) Diabetes - Review as diabetic retinopathy + latest HbA1c >74 Hypothyroidism - Check TSH as none in last 18m (should be every 12m) Hypothyroidism - Check TSH as none in last 18m and last TSH <0.3 or >7.0 Missed Diagnosis Possible CKD 3-5 - 2 or more eGFR <60 in the last 2y (including latest) Possible DM - 2 or more HBA1c >=48 (exc. GDM & steroid-DM in last 1y or Hb-opathy)
Searches Medication Reviews Medication review in last 3m - Check quality of review - age >75y Medication review in last 3m - Check quality of review - any age Medication Usage Asthma - Review as 12 or more SABA inhalers in last 12m (+ no COPD) Benzodiazepines +/or Z-drugs >=10 in last 1y - Review due to risk of dependence Gabapentin or pregabalin >=3 in last 6m - For medication review as none last 1y
MHRA Searches Medicine Hydrochlorothiazide in last 6m MHRA safety alert reason to review Review due to risk of skin cancer Citalopram 40mg or Escitalopram 20mg Reduce dose as age >65y Clopidogrel Review as also on omeprazole or esomeprazole DOAC Consider warfarin as mechanical cardiac valve Febuxostat Review as has CVD Fentanyl patch Review as started and no other opiates in preceding 3m Mirabegron Check BP as none in last 1y Potassium-sparing diuretic + ACEi or ARB Check U+E as none in last 6m Renin-Angiotensin System Drugs (ACE, ARB, RI) Review as on 2 or more SGLT-2 inhibitor Review if Fournier's gangrene and DKA advice given Simvastatin 40mg or 80mg Review as on amlodipine, diltiazem or verapamil Teratogenic drugs in childbearing age Review on Valproate/Carbimazole/Modafinil/Pregabalin 25
Areas covered in GP Interview Non-medical clinicians: scope of practice, competency, supervision, training Leadership: governance, successes, challenges, innovations, workforce Consent and capacity: DNACPR, MCA, Gillick/Fraser chaperones Care and treatment: evidence-based practice, care pathways, health promotion Record keeping: Comprehensive Hx, Ex, Ix, Mx, safety netting, follow up, shared decisions Continuous improvement: LEA, SEA, audit, quality improvement, competency checks, benchmarking Referrals and A+G: timely, appropriate, sufficient detail, 2ww Safeguarding: register, meetings, alerts, coding, household members, policies System working: transfer info between service, coordination care, PCN Workflow: lab results, correspondence, tasks Registers and care plans: call/recall, LTC Mx, how assess needs different groups 26
Questions??? 27
More information If you have any queries about how the searches have been constructed or identify any glitches, please see the FAQs on the Ardens website: www.ardens.org.uk/cqc Or if any queries about the search criteria please contact: cqcclinicalsearches@cqc.org.uk Please do not contact EMIS Web or TPP SystmOne directly regarding the clinical searches unless it relates to a technical problem directly associated with the functioning of your clinical system. 28
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