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You are here: Home / Resources / SystmOne Resource Centre / Medicine Management / Safety & Reviews

Safety & Reviews

The CDRC has a suite of resources to support with General Safety Considerations and Specific Safety Issues, including:

Medication Prescribed Elsewhere

We strongly recommend that all medication being taken regularly by patients is included on a repeat template.  This allows the system to ‘see’ which medication the patient is taking. 

For medication where you need to ensure more careful control of issues (e.g. opiates, antidepressants at initiation), the Maximum Issues function can be used to ensure clinical oversight is applied before further issues are allowed 

Machine generated alternative text:
Medication stan 
Drug prescribed 
Script type 
Dose 
Total quantty 
Script notes 
hu 30 Jul 2020 
i Fluoxetine 20mg capsules 
Times 8 Doses 
@ NHS Issue 
o 
Private Issue 
take one daily 
@ Number 2B 
C) Packs 
Free Text 
o 
Instalment Dispensed Issue 
dée 
capsule 
Administrative notes 
Issue duration 
End date 27 Aug 2020 
Days 
Automatically create a Repeat Template based on this Issue 
Llse review date 
30 Jan 2021 
Synchronise all review dates to this 
Synchronise all maximum issue counts 
use maximum issues I 
Patient can intiate issues 
Irregularly issued template Repeat template can be reauthorised

For medication that is prescribed elsewhere (e.g. transplant immunosuppression, biologics) the same function can be used with additional precautions: 

  1. Add free text to indicate the medication is for hospital issue only 
  2. Set the minimum quantity possible. 
  3. Set the maximum number of issues to 1 
  4. Disable the Patient can initiate issues and Repeat template can be reauthorised functions 

This would make it very unlikely that a prescription will be issued and if it is issued it is very unlikely to be dispensed, and even if it is dispensed only a very small quantity will be dispensed. (We are lobbying TPP to allow the maximum number of issues to be set to 0) 

Machine generated alternative text:
Medication stan 
Drug prescribed 
Script type 
Dose 
hu 30 Jul 2020 
i Neoral 10mg capsules (Novartis Pharmaceuticals LIK Ltd) 
@ NHS Issue 
o 
o 
Private Issue 
Instalment Dispensed Issue 
one daily (ISSUED BY HOSPITAL ONLY) 
dée 
Times 8 Doses 
capsule 
Synchronise all review dates to this 
Total quantty @ Number 
C) Packs 
Free Text 
Script notes 
Administrative notes 
Issue duration 
30/01/2021 
Llse review date 
use maximum issues 
Patient can intiate issues 
Repeat template can be reauthorised 
Irregularly issued template

The following symbols will then be displayed in the repeat medication screen 

Renal – Sick Day Rules

CDRC has an automated warning system to try and prevent dehydration induced acute kidney injury with nephrotoxic medication. 

For patients taking metformin, NSAIDs, diuretics, renin-angiotensin system, if free text including the words ‘vomit’, ‘sick’, ‘diarrh’ or Read codes for vomiting and diarrhoea are added to the record, a warning will be displayed. 

Negative free text such as ‘no diarrhoea’, ‘not vomiting’ will not trigger the alert. 

Question 
Medicine Sick Day Rules: 
This patient is taking ACE, ARS's, NSAID's, Diuretics or 
Mettormin. 
Consider advising them to STOP taking medication listed 
above during periods ot diarrhoea or vomiting. 
Restart when they are well (after 24/48 hours ot eating and 
drinking normally). 
Print PIL 
Finish 
Pause

Clicking on Print PIL will print an information leaflet to give to patients. 

Medicine 
sick day rules 
North Durham 
Clinical Commissioning Group 
Durham Dales, Easington and Sedgefield 
Clinical Commissioning Group 
When you are unwell with any of the following: 
• Vomiting or diarrhoea (unless only minor) 
• Fevers, sweats and shaking 
Then STOP taking the medicines listed overleaf. 
Restart when you are well (after 24-48 hours of eating and 
drinking normally). 
If you are in any doubt, contact your pharmacist, 
GP or nurse. 
Medicines to stop on sick days 
ACE inhibitors: medicine names ending in "pril" 
ARBs: 
NSAlDs: 
Diuretics: 
Metformin: 
eg. lisinopril, perindopril, ramipril 
medicine names ending in "sartan" 
eg. losartan, candesartan, valsartan 
anti-inflammatory pain killers 
eg. ibuprofen, diclofenac, naproxen 
sometimes called "water pills" 
eg. furosemide, spircnolactone, 
indapamide, bendroflumethiazide 
a medicine for diabetes

NB., 

Only repeat templates of metformin, renin-angiotensin drugs and diuretics will trigger the alert. 

Repeat templates or acute issues in the last month of NSAIDs will trigger the alert. 

STOPP Tool

North Durham CCG commissioned the creation of a STOPP tool to help with care of frail elderly patients.  This tool facilitates a polypharmacy review of patients over 65 using a set of evidence based criteria. The tool could be used for patients who are not frail. 

The tool is based on work by Paul Johnson, a clinician from Devon, and I am indebted to him for sharing his work. 

Patient Status Alert 

The CDRC system now has a patient status alert (icon) that shows any patient over 65 who has a potential medication issue according to the STOPP criteria.  The icon is the capsule shown in the diagram below. 

Clicking on the icon will launch the STOPP tool.  Once the STOPP tool has been run the icon will disappear for 11 months.  After this time, it will reappear to prompt you to reconsider the issue. 

If you find this patient status alert intrusive, you can turn it off in the usual manner.  However the advantage of the alert is that you will know which patients need to have the tool applied. 

The STOPP Tool 

The STOPP tool can be launched in a number of ways: 

  • By clicking on the STOPP patient status alert 
  • By putting the STOPP protocol on your S1 toolbar 
  • By putting the STOPP protocol on your clinical tree 
  • From a template 
  • By putting the STOPP Medication Review CDRC view in your clinical tree 

The STOPP template shows any currently identified issues in the top panel. 

The middle panel displays previous STOPP issues recorded (along with any comments added). 

The Run STOPP Algorithm button will record any current STOPP issues in the record with today’s date.  This also removes the STOPP icon from the top of the record for 11 months. 

Uffformatio 
STOPP 
Current STOPP Issues Identified 
F2 Treatment dose PPI on repeat 
Previously rcorded 
polypharmacy comments 
18Apr2016 
Notes 
16 May 2016 
Notes 
Notes 
(risk of acute exacerbation of glaucoma), or chronic prostatism (risk of urinary retention) 
Polypharmacy medication review [XaaCQ) 
STOPP Alert use of regular (as distinct from PRN) opioids without concomitant laxative (risk of 
severe constipation) 
Polypharmacy medication review IXaaCQ) 
STOPP Alert use of regular (as distinct from PRN) opioids without concomitant laxative (risk of 
severe constipation) 
using opiates for diarrhoea 
STOPP - Screening Tool of Older Person's Prescriptions [XaeCm) 
PPI for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage 
for > 8 weeks (dose reduction or earlier discontinuation indicatedX NEEDS PPIS FOR GU 
STOPP Medication Review Summary (todaVs entries) 
Run STOPP Algorithm 
To add comments: right click, 
choose Amendments-Amend 
Notes 
Information 
print 
Suspend 
Cancel 
Show Incomplete Fields

 If you want to add a comment to the STOPP alert information: 

  • Right click on the relevant alert 
  • Choose amend notes  
  • Add any free text comments to the end of the STOPP message 

This will allow you to record why the medication is being given if you think it should be continued.  This will help the next time the STOPP protocol is run.  To see previous STOPP messages and comments simply click on the STOPP capsule above the STOPP recommendations.  This will launch another screen showing previous STOPP alerts and comments 

STOPP Reports 

If you would prefer to look at all the patients with a particular STOPP indicator you can view the relevant report in the CDRC Quality > STOPP folder.  Each report has a, hopefully, self-explanatory title e.g.: 

.C02 Aspirin AND peptic ulcer disease WITHOUTppi 

NB. These reports are not limited to patients over 65 which is officially where the STOPP criteria apply. However, most of the indicators would be applicable to younger patients. 

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