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You are here: Home / Resource Support & Frequently Asked Questions / SystmOne Support Centre / Medicine Management / Drugs Requiring Monitoring System

Drugs Requiring Monitoring System

The CDRC has a comprehensive system for ensuring medication is appropriately monitored and safely administered, based on information in the BNF, national and local guidelines. 

Medication is divided into three basic categories with respect to monitoring: 

  1. Medication that is almost always prescribed in secondary care (e.g. biologics) 
    • Medications are taken into consideration when looking at factors such as drug interactions or immunosuppression 
    • An assumption is made that appropriate monitoring is the responsibility of the prescriber – they are not included in the monitoring system 
  2. Medication that might be prescribed in primary care or elsewhere (e.g. DMARD at initiation, antipsychotics) 
    • Medications are taken into consideration when looking at factors such as drug interactions or immunosuppression 
    • These medications are included in the monitoring system if they are on repeat prescription AND the medication has been issued from primary care recently (usually in the last three months) 
  3. Medication that is almost always prescribed in primary care (e.g. ACE inhibitors, anticoagulants) 
    • Medications are taken into consideration when looking at factors such as drug interactions or immunosuppression 
    • These medications are included in the monitoring system if they are on repeat prescription irrespective of recent issues.  (There are separate systems in place to detect important medication on repeat that is not being issued).  

In general, only medication on repeat templates are included in the monitoring system with a few exceptions such as people receiving repeated NSAIDs. We strongly recommend that all medication which is being taken regularly by the patient is included in a repeat template. Medication that is not being issued in primary care can be set so that it is extremely unlikely that it can be issued (see Medication Prescribed Elsewhere).

Reports

A comprehensive set of reports is available to identify patients who are due or overdue drug monitoring: 

*ORM and any test due # 
*ORM and any test due (1 monthly tests) # 
*ORM and any test due (2 or 3 monthly tests) # 
*ORM and any test due (6 monthly tests) unless test needed more often # 
*ORM and any test due (6 monthly tests) without L TC needing 6m check # 
*ORM and any test due (annual or less frequent tests) # 
*ORM and any test due (annual or less frequent tests) without L TC (Common Ones) # 
*ORM and any test overdue # 
*ORM and any test overdue (1 monthly tests) # 
*ORM and any test overdue (2 or 3 monthly tests) # 
*ORM and any test overdue (annual or less frequent tests) # 
*ORM and any test overdue (annual or less frequent tests) without L TC (Common Ones) # 
*ORM and any test overdue (six monthly tests) unless test needed more often # 
*ORM and any test overdue (six monthly tests) without L TC needing 6m check # 
*ORM and any test significantly overdue # 
*ORM and any test significantly overdue (2 or 3 monthly tests) # 
*ORM and any test very significantly overdue (6 or 12 monthly tests) # 
*ORM and any test very significantly overdue (6 or 12 monthly tests) without L TC (Common Ones) # 
*ORM L TC Conditions (Common Ones)

Reports are also available for individual drugs:

SIGUANIOES tests due # 
SIGUANIOES tests overdue # 
BIGLIANIDES tests significantly overdue # 
BIGLIANIDES tests very significantly overdue # 
Carbimazole (here) tests DI-IE # 
Carbimazole (here) tests OVERDUE # 
carbimazole (here) tests SIGNIFICANTLY OVERDUE # 
carbimazole (here) tests very SIGNIFICANTLY OVERDUE # 
Ciclosporin (here) and tests due # 
Ciclosporin (here) and tests overdue # 
Ciclosporin (here) and tests significantly overdue # 
Cinacalcet (here) and tests due # 
Cinacalcet (here) and tests overdue # 
Cinacalcet (here) and tests significantly overdue # 
Conicosteroids (here) (adults) and tests due # 
Conicosteroids (here) (adults) and tests overdue # 
Conicosteroids (here) (adults) and tests significantly overdue # 
Conicosteroids (here) (adults) and tests very significantly overdue # 
Digoxin tests due # 
Digoxin tests overdue # 
Digoxin tests signficantly overdue # 
Digoxin tests very signficantly overdue # 
DOAC (on repeat) and tests due # 
DOAC (on repeat) and tests overdue # 
DOAC (on repeat) and tests significantly overdue # 
DOAC (on repeat) and tests very significantly overdue # 
Dronedarone tests

The following time periods are generally used to define monitoring status: 

Usual Monitoring Frequency Due Overdue Significantly overdue Very significantly overdue 
Monthly 21d 28d 35d N/A 
2 monthly 49d 56d 63d N/A 
3 monthly 77d 84d 91d N/A 
6 monthly 5m 6m 7m 9m 
Annually or longer 11m Or 1m before 12m or equivalent 13m Or 1m after 18m Or 6m after 

Patient Status Alerts 

Patients who are on a drug that needs monitoring will have the follow icon if the monitoring is up to date: 

and this icon if the monitoring is due: 

Templates 

How to Access

In the lower left hand corner use the search bar, type in ‘Drugs Requiring Monitoring’ and select the following template:

Alternatively, press F12 and search for ‘Drugs Requiring Monitoring’, this will open the aforementioned template.

Clicking on the icon above will open the DRM template showing which medication(s) the patient is on and which tests are due/overdue.  

Drugs Requiring Monitoring 
Mental Health 
O Atomoxetine 
Melatonin 
Methylphenidate 
O Lithium 
cytotoxics DMARDS 
Azathioprine 
Ciclosporin 
Hydroxycarbamide 
Hydroxychloroquine 
Leflunomide 
O Mercaptopurine 
O Methotrexate 
Mycophenolate 
Penicillamine 
Neurology 
Apormorphine 
Modafanil 
Riluzole 
Endocrinology 
Cinacalcet 
Steroids 
Cardiovascular 
Amiodarone 
Anticoagulation 
Dronedarone 
Current DRM Repeats 
On antiepileptics (enzyme inducing) 
On ciclosporin 
On methotrexate 
! BP due ! 
! FBC due ! 
! due ! 
! LFTs due ! 
! LIPIDS due 
- Considerations Durina Covidlg Pandemic 
Sodium aurothiomalate 
Sulfasalazine 
Near patient testing enhanced services administration 
Slood sample taken

There are links to more detailed information about each medication on separate pages, for example:

The monitoring issues are also shown on the LTC Management Template alongside any other tests that are needed for the long term condition review ……. 

Core Data 3ntry% 
aronchiectasis 
copo 
Pulm Fibrosis 
Hean Failure 
BP Hypertension 
PAD OCS 
Stroke Dcs 
Year of Care 
Diabetes 
High Risk of DM 
Hypothyroidism 
O CKD 
NAFLD 
Epilepsy 
Dementia 
a Mental Heath 
C Palliative Care 
Fraity 
Is a Carer 
Check 
Check Hba lc 
Tests Needed (Generic) 
DCS Interventions view has no data for patienl 
Potential Interventions

……. And the Medication Review Tool template. 

Medication Review Tool 
Med Rev Safetf Tools Consider Medication Stan Checklists Page 1 
Current Repeats 
Colecalciferol 25,000units/1 ml oral solution unit dose ampoules sugar free 10 Jul 2020 
Medication Timeline 
New Acute 
New Repeat 
Expand this box > 
Medication Concordance 
Medication Side Effects 
Lisinopril 10mg tablets 
Tamsulosin 400microgram modified-release capsules 
Lansoprazole 1 5mg gastro-resistant capsules 
Docusate 100mg capsules 
Bisoprolol 2fmg tablets 
Apixaban 5mg tablets 
Alendronic acid 70mg tablets 
Metformin 500mg tablets 
Prednisolone 5mg tablets 
Atorvastatin 20mg tablets 
Recent Acutes 
Docusate 50mg/5ml oral solution sugar free 
21 Jul 2020 
21 Jul 2020 
21 Jul 2020 
17 Aug 2020 
21 Jul 2020 
21 Jul 2020 
30 Jun 2020 
21 Jul 2020 
21 Jul 2020 
1 monthly 
take one daily 
take one daily 
take one once 
Take one daily 
take one daily 
Take one twic4 
take one weekl„ 
To be taken Tw 
2 daily 
21 Jul 2020, Issue one daily ( 
10mls once daily 
Prescribing Safety Tools 
Drugs Requiring Montoring 
Consider Medication Stans/Switches 
Medication Checklists 
Medication review done 
Not Asked 
Not Asked 
! due ! 
! due ! 
on ACEi or A2RB 
On corticosteroids 
24 Jul 2020 Medication review done (XaF8d) 
1 ampoule 
7 tablet 
7 capsule 
7 capsule 
7 capsule 
7 tablet 
14 tablet 
4 tablet 
M4 tablet 
14 tablet 
7 tablet 
08 dun 2020 
Expand 
Expand 
Expand 
Expand 
Expand

For some medications the monitoring frequency can be customised from the medication specific link e.g. default methotrexate monitoring is monthly but this can be amended to 2 or 3 monthly once stable in line with local guidelines. 

Using the System to Call Patients

The system is designed to integrate with long term condition management, so patients are not brought unnecessarily for separate drug monitoring and LTC review appointments.  It is also designed to allow units to customise the system for their own requirements. 

At the simplest level the ! *DRM and any test due # will show the patients who will be due to have a monitoring test in the near future.  ! *DRM and any test overdue # shows those patients who have become due today. 

For 6 monthly tests there is a separate report which shows only patients who would not be called for a 6 monthly LTC review. 

For annual or less frequent tests there is a separate report to show only patients who do not have one of the common LTCs. 

Local Customisation

Individual units can combine the available reports for their own requirements. An example is shown below. 

Join to reports 
Select report(s) 
Remove report(s) 
Repon information 
Name 
*ORM and any test due (2 or 3 monthly tests) # 
*ORM and any test overdue (1 monthly tests) # 
*ORM and any test overdue (annual or less frequent tests) 
without L TC (Leadgate) # 
*ORM and any test overdue (six monthly tests) without LTC 
needing 6m check* 
Category 
OCS Quality/ Drugs requirin 
OCS Quality/ Drugs requirim 
OCS Quality/ Drugs requirim 
OCS Quality/ Drugs requirim
  1. Appointments for monthly tests are assumed, in this unit, to be booked at the previous appointment so only those who are overdue are added to the call list (as a backstop, rather than for initial call) 
  2. Patients needing 2 or 3 monthly monitoring tests are included in the list a week before their test is due to ensure they can be invited or already have an appointment 
  3. Patients needing 6 monthly tests are invited on the day the test becomes due unless they have a long term condition which means they will be invited for a 6 month review anyway 
  4. Patients needing annual tests are invited on the day the test becomes due unless they have a long term condition which means they will be invited for an annual review anyway. 
  5. There is then a ‘backstop’ report which shows patients with or without an LTC whose monitoring is very significantly overdue – ! *DRM and any test very significantly overdue (6 or 12 monthly tests) # 

Further customisation can be achieved with some technical experience. For example by creating a local copy of the ! *DRM LTC Conditions (Common Ones) report to include all the conditions which have LTC reviews at that unit and then a local copy of the linked reports. 

Creating More Complex Outputs

It is possible, with some extra work, to create more complex outputs showing information such as: 

  • Future appointments 
  • Which tests are due 

An example is shown below: 

  1. Create a report with the customised combination of due/overdue/significantly overdue reports such as the example above 
  2. Create a report joining report 1. to future appointments and test due reports like this: 
*ORM Leadgate report and join 
[3 Add report to favourtes 
Category 
sub category Drugs requiring monitoring 
Demographics 
Registration 
Administration 
Child Heath 
Risk Factors 
Clinical 
Report Joining 
Join to one report 
Join to two reports 
Join to more than two reports 
New Sub-category 
oin to more than two reports 
Join to reports 
Select report(s) 
Remove report(s) 
Repon information 
Join type 
Percentage calculation 
Name 
*ORM Leadgate - to recall 
ORM and any test due 
Has future appointment 
Category 
OCS Quality/ Drugs requirin 
OCS Quality/ Drugs requirim 
OCS / Recall New 
Repon on patients found in any of 
the selected reports 
• use organisation captation to calculate this repots percentage 
o 
Has future appointment (OCS Recall New) 
C) •DRM Leadgate - to recall (OCS Quality Drugs requiring montoring) 
C) DRM and any test due (OCS Quality Drugs requiring montoring)
  1. Create a report joining reports 1. and 2. like this: 
Amend Report 
Name 
Category 
Sub category 
*ORM *Leadgate 
Drugs requiring monitoring 
Z] Add report to favourtes 
New Sub-category 
Join to two reports 
Demographics 
Registration 
Administration 
Child Heath 
Risk Factors 
Clinical 
Report Joining 
Join to one report 
Join to two reports 
Join to more than two reports 
Join to report one 
Select report one 
Clear report 
Repon information 
00 
Join to report two 
Select report two 
Clear report 
Repon information 
Join type 
Percentage calculation 
IN Repon I 
IN Repon 2 
! •ORM Leadgate - to recall 
OCS Qualty Drugs requiring montoring 
IN Report 3 
IN Repon I 
! •ORM Leadgate report and join 
DCS Quality Drugs requiring montoring 
IN Report 3 
Repon on patients fo 
the selected reports 
• use organisation captation to calculate this repots percentage

Run report 3 then use the breakdown options to select the features you wish to highlight. E.g. to see which patients need a potassium test: 

DRM and due Potassium # (DCS Quality Drugs requiring montoring) 
Patient Count 
Current Referrals In 
Demographics 
Record Sharing 
Relationship 
Strategic Reporting ID (I) 
Z] Patient ID 
Patient ID (Oriainal format)

To see future appointments: 

Has future appointment (DCS Recall New) 
Patient Count 
Appointments (2) 
Appointment arrival time 
Appointment booked date 
Appointment branch 
Appointment cancellation date 
Z] Appointment date 
Appointment duration (actual) 
[3 Appointment duration (booked) 
Appointment flags 
[3 Appointment location 
Appointment status 
[3 Appointment time 
Appointment wating time (absolute) 
[3 Appointment wating time (calculated) 
Booked by 
Clinician 
e-ReferraI Service appointment 
Rota end date

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