Worcestershire EPaCCS. User Guide for GP Practices

Transcription

1 Worcestershire EPaCCS User Guide for GP Practices

2 Contents Introduction... 2 Introduction to the software... 2 Purpose of this guide... 2 How to Enable the EMIS Partner API and Set up Users... 3 How to Install the Pyrusium Browser Software... 5 How to Create and Amend Patient EPaCCS Records Create a new record Amend an existing record Manage deceased patients Logging out of Pyrusium How to View Changes and Update the Local Record How to Create Special Notes Support Appendix A How to download Chrome Appendix B How to create a desktop shortcut icon Appendix C Special Notes Patients on the Proactive Care Register Appendix D Patient Leaflet Appendix E EPaCCS Template and Readcodes Note this guide is up to date at date of publication. Some illustrations may differ slightly if there are any subsequent upgrades applied to the software, but any significant changes will be communicated to users, and new guides distributed. Please make sure you are always referring to the most up to date version. EPaCCS GP User Guide v1.0 Page 1 of 45

3 Introduction Introduction to the software The Worcestershire EPaCCS (Electronic Palliative Care Co-ordination System) software has been developed by Black Pear and is hosted by AIMES. Part of the software developed by Black Pear has the brand name Pyrusium. The system works on the principles of interoperability where the repository for data is held in a central EPaCCS database with a complete record also held on the GP clinical system. The system will hold an EPaCCS record for all patients in Worcestershire who are considered to be in the last year of their life, and who have consented to have an EPaCCS record created for them and for this to be shared with clinical staff. Once an EPaCCS record has been created it is then available to: Worcestershire Acute Hospitals Worcestershire Health & Care Trust St Richards Hospice Hospice Day Centres CareUK Out of Hours (Primary Care OOH) 111 Services via special notes on CareUK Adastra Instance West Midlands Ambulance Service (999 Service) - initially via auto . The process by which a patient s EPaCCS record is created and managed depends on the location where this is undertaken. GPs and Practice based staff will create the record using a Black Pear application running in Pyrusium, which integrates with the EMIS API to auto-populate the EPaCCS record and write back information to the EMIS record. Outside of general practice (Hospices, Acute and Community settings) the EPaCCS record will be created and managed using a web link to the Black Pear application. There is no write back from Black Pear direct into the GP system; all externally generated EPaCCS/amendments are saved and a notification of the changed record is sent to the practice via . Within the Pyrusium dashboard, practices can review and accept changed records; this will generate a new PDF for entry into the patient record. Updating of an EPaCCS record can be undertaken by any Clinician who is party to a patient altering their previously declared wishes or aware of other changes e.g. change of carer, etc. System Management to enable users to be set up on the EPaCCS system will be on a devolved basis. This means that within each organisation (GP Practice, Hospice, Acute and Community Trusts) there will designated Managers who can set users up/suspend accounts, etc. These Managers will have the responsibility to ensure that only bona fide users are set up and they have the correct level of access. Purpose of this guide The following user guide is intended for staff at GP Practices who are responsible for viewing, creating and updating EPaCCS records as integrated into EMIS Web, and Black Pear Organisation Administrators at the Practice who are responsible for setting up and configuring their organisation and users. A brief introduction to each section will define the target audience. EPaCCS GP User Guide v1.0 Page 2 of 45

4 How to Enable the EMIS Partner API and Set up Users The first activity that will need to be done is to activate and enable the Partner API in EMIS Web. This will be done once only, usually by the staff member at the GP Practice assigned the role of administrator. Log in to EMIS Web. Navigate to System Tools and EMAS Manager. Select Partner API on the left hand pane. Scroll down the list to MyHealthFile and click on it. Click the Activate Application button on the ribbon. EPaCCS GP User Guide v1.0 Page 3 of 45

5 Next you will need to set up the users who will need access to the application. This will also need to be done as new users join the Practice and are given access to EMIS Web. With MyHealthFile selected, click on the Edit Users button on the ribbon. In the User Configuration screen tick the boxes next to the users names. Enter a password for the user as prompted and click OK, and then OK again on the User Configuration screen. With MyHealthFile selected, click on the Login Access button on the ribbon. On the Application Login Access screen, for each user who requires access tick the Auto Login and Allow Login boxes, and click OK. EPaCCS GP User Guide v1.0 Page 4 of 45

6 How to Install the Pyrusium Browser Software Although logged in to EMIS Web the End of Life plans are accessed from the Pyrusium browser, so this must be installed on every workstation first beforehand. This will only need to be done once on every workstation, usually by the GP Practice staff member assigned the role of administrator. A licence for the practice has already been set up within the Black Pear licensing tool. Note that if the installer detects missing Windows files (Microsoft.NET or VC 2012x 86 redistributable package) the installer will automatically guide you through the installation of these files. The following are instructions on how to install the core Pyrusium browser. Open the following URL in your browser: Click Run. Depending on your configuration you may see the following message click Run. EPaCCS GP User Guide v1.0 Page 5 of 45

7 Tick the licence terms and conditions checkbox to agree to the licence, and then Next. In the Configuration dropdown select pyrusapps, and in the Licence code field type your practice s ODS code (this usually starts with M followed by 5 digits), then Next. For the System type select the clinical system used in your practice (this will be EMIS Web). EPaCCS GP User Guide v1.0 Page 6 of 45

8 In the Organisation code field type in your practice CDB number (this is the practice EMIS code), then Install. Depending how your system is configured you may get the following warning message click Yes. Wait for the installation to complete. EPaCCS GP User Guide v1.0 Page 7 of 45

9 When complete, click Close. When installing for the first time make sure the Black Pear Partner API has been set up in EMIS Web (see page 3). Note a user will see the following screen when opening Pyrusium for the first time on a newly installed PC. Enter your EMIS Web username and password, and click Activate Product. EPaCCS GP User Guide v1.0 Page 8 of 45

10 Once installed you may wish to create a shortcut somewhere on your desktop or in the start menu so that you can quickly open the Pyrusium browser when you come to view and create patient records via EMIS Web (this step is optional). Click on the Start button and All Programs, then navigate to Black Pear Software > Pyrusium. Right click on Pyrusium and you then have options to Pin to Taskbar or Pin to Start menu. Example of Pyrusium icon in Taskbar for quick launch Should you require them, instructions on how to create a shortcut icon on your desktop screen are included in Appendix B (page 35). EPaCCS GP User Guide v1.0 Page 9 of 45

11 How to Create and Amend Patient EPaCCS Records Create a new record This will be done by users who need to add End of Life Care information to patient records. It may be done direct into the system by clinical staff who have contact with the patient, or added afterwards by administration staff. For a patient who does not have an existing record, first find the patient in EMIS Web, then open the patient s EMIS Web record. Example of patient record in EMIS Web ready to add a new consultation With EMIS Web open, access the Pyrusium browser (this should already have been installed on the workstation you are using see page 5 for how to install the browser). You may have already created a quick launch icon or shortcut on your desktop (see pages 9 and 35), but if not, go to the Start menu > All Programs > Black Pear Software > Pyrusium. The log in screen will open. If it is the first time you have logged in, you will be prompted to enter your Black Pear username and password. Subsequently it will recognise your log in credentials, and after a few seconds will load. EPaCCS GP User Guide v1.0 Page 10 of 45

12 Note if you are using the software for the first time on a PC it will prompt you to activate the EMIS Web Partner API, so you will need to enter your EMIS Web log in details first (see page 8). Wait a few seconds for the patient to load. The screen will then bring up the current patient from EMIS Web. You can use the control buttons on the top right of the browser window to maximise the screen to full size if required (and also minimise when needed). EPaCCS GP User Guide v1.0 Page 11 of 45

13 Click the Create patient record button. Confirm you have the correct patient. When the patient record has been created, click the Create button next to Worcester End of Life. This opens an esp (electronic shared plan) record pre-populated as much as possible with patient information from EMIS Web. EPaCCS GP User Guide v1.0 Page 12 of 45

14 New WWW EPACCS (ESP) form ready to complete Note the Cancel button on the bottom left you can use this to go back if you are just viewing and do not wish to save anything. The Done button on the right is for when you have entered/amended information, as this will then take you on to the next screen where you can save the record. You can now enter as much information as is required in the blank fields. The following steps will guide you through each of the sections with examples of how to enter information. o Patient Consent Click on the dropdown arrow to choose from the list. EPaCCS GP User Guide v1.0 Page 13 of 45

15 EPaCCS form Click on the calendar button to bring up a calendar to enter the Date of next review. Patient Details and Patient s GP Details These details have pulled through from EMIS Web. EPaCCS GP User Guide v1.0 Page 14 of 45

16 Functional status, disability and communication A black arrow on the right of a section indicates there is a further sub-form which can be opened to add information. Click on the arrow to open up the sub-form. Type any text into the free text fields, tick any relevant checkboxes and click the dropdown arrow to indicate whether the patient needs an interpreter. Click Done to save when finished, or Cancel to go back to the previous page without saving. (Note this takes you back to the main form, it only saves the sub-form, not the whole record.) EPaCCS GP User Guide v1.0 Page 15 of 45

17 Back on the main screen you will see a tick in a green circle if data has been entered in a sub-form, and you can click on it to quickly preview the information. Click off the box to close it. o Carers Click on the arrow to open up the sub-form. Scroll down to access all the fields, then click Done to save. EPaCCS GP User Guide v1.0 Page 16 of 45

18 o Clinical summary The tick indicates that the GP Summary has pre-populated from EMIS Web. Click on the arrow to bring up the sub-form and fill in any other information as required, then Done. EPaCCS GP User Guide v1.0 Page 17 of 45

19 If all the entries in the GP summary are not visible, you can either use the scroll bar, or grab the bottom right corner of the text box (indicated by the two diagonal lines as in the illustration above) and pull the box down to enlarge it. Complete the remaining sections in the same way. The following are examples from each section. Note - Not all fields are mandatory, but you will be prompted with an error message in red to complete a mandatory field if you try to proceed without completing it. o Anticipatory Medication EPaCCS GP User Guide v1.0 Page 18 of 45

20 o Advanced statement, Places of Care o DNACPR decision EPaCCS GP User Guide v1.0 Page 19 of 45

21 o Advance decision to refuse treatment o Lasting Power of Attorney o Other relevant issues or preferences about provision of care o Remove patient record (eg. patient deceased, incorrect record etc.) EPaCCS GP User Guide v1.0 Page 20 of 45

22 When you have finished filling in the form click Done, then Save. Wait a few seconds for the record to post to the pyruscloud and to EMIS Web. You will see the progress in the blue and green messages. When the record has been successfully saved, click Back to active session, and wait for the current patient record to load. Back on the main Pyrusium screen you will see that the patient now has a record. Go back into EMIS Web (either click the Minimise control button on the top right of the Pyrusium browser if you have gone full screen or the active EMIS Web button in the task bar on your desktop, or click back onto the EMIS Web screen if you can see it open behind the Pyrusium browser window). EPaCCS GP User Guide v1.0 Page 21 of 45

23 A yellow alert bar will display informing you the record has been updated. Click the bar to write back to EMIS Web and update the record with the new data and codes. You will then see all the EPaCCS information that has been entered is now present in the EMIS Web record, along with all the relevant codes. Example of Consultation screen showing EPaCCS information A PDF file has also been created and will show as an attachment in EMIS Web. You can access this document from any screen in EMIS Web where you would usually access documents. You can Print and Export as you would any other document. EPaCCS GP User Guide v1.0 Page 22 of 45

24 Example of EPaCCS PDF document in EMIS Web The Ambulance Service has been notified and the information is also available for Adastra and the 111 Service. The information is also available to other Health Care Professionals with appropriate access rights in other local health care settings such as community health, hospitals and hospices via a regular web browser. Amend an existing record To edit or update an existing record, first find the patient in EMIS Web. If you do not already have Pyrusium open, log in and ensure you have the correct patient loaded. You will not need to enter your credentials again, as the system will remember them (as long as you used the X to close previously rather than the Logout button see page 25). Wait a few seconds for the screen to load. Click Start> All Programs > Black Pear Software > Pyrusium, or click the quick launch icon If Pyrusium is already open, and is still showing a previous patient, click the Refresh button on the right to load the required patient. EPaCCS GP User Guide v1.0 Page 23 of 45

25 Click the Update button. This will open the existing record. Navigate to the section you wish to update or edit. When you have finished amending, click Done and Save, and wait for the record to save successfully (see page 21). Back in EMIS Web, click the yellow alert bar to refresh the updated record (see page 22). The changes will now be recorded in EMIS Web, with codes added and a new updated PDF document, and changes made available to the appropriate external parties (Ambulance, 111, etc.). Note the old version of the PDF will still be present in the patient s documents in EMIS Web, so make sure you are always looking at the most recent copy, especially if you have updated a document on the same day. EPaCCS GP User Guide v1.0 Page 24 of 45

26 Manage deceased patients Follow the steps in the previous section, Amend an existing record, to open the patient s record and navigate to the section Remove patient record. Tick the Record closed box. Select the reason of patient died. Complete the date of death and actual place of death if known. This will have the effect of: 1) removing the patient completely from the EPaCCS register so that the record can no longer be retrieved 2) sending an ambulance notification to inform WMAS that the patient has died 3) entering an updated PDF into the EMIS patient record to reflect the changes. It will not do any of the administration within EMIS Web associated with a patient death. The practice will still have to mark the patient as deceased and deduct them using the usual processes. Logging out of Pyrusium When you are ready to exit, it can be done by clicking the cross on the top right of the Pyrusium browser screen. If you click on the Logout button within the application this will terminate your single sign on, meaning that the next time you log in it will prompt you for your username and password again rather than remember your credentials and take you straight in to the system. EPaCCS GP User Guide v1.0 Page 25 of 45

27 How to View Changes and Update the Local Record Once you have created a patient EPaCCS record, other Health Care Professionals may update it outside of the GP Surgery. You will receive an notification to the address you gave to Black Pear. You can then access the Dashboard in Pyrusium to see the records which have been updated, and accept any changes to update the local EMIS Web record. With the Pyrusium browser open, click on the Dashboard link on the top right. This will display any records that have been updated. To view changes, click the Review button to the right of the patient s name. This will open the form. Changes are indicated in blue text, and a tick in a blue circle. EPaCCS GP User Guide v1.0 Page 26 of 45

28 Click Done and then Accept to save. Wait for the record to post back to the pyruscloud and EMIS Web, and then back in EMIS Web reload the patient from the prompt on the alert bar to see the changes take effect. A new PDF will be created and data and codes updated. Click Back to Dashboard to review any other records, or log out. EPaCCS GP User Guide v1.0 Page 27 of 45

29 How to Create Special Notes The Special Notes form has a free text box to enter generic free text for Practices to enter anything of note to 111/OOH/WMAS regarding any non-palliative care patient. This can cover information such as child/adult/healthcare worker at risk, long term conditions, mental health, substance abuse, frequent caller, communication barriers, and special access instructions. Create a Special Note: Open the patient record in EMIS Web and retrieve the pyruscloud record for the patient. If a pyruscloud record does not already exist you will first need to create one by clicking the Create patient record button (see page 12 for details). Once the record has been created or existing record retrieved, click on the Create button next to Non-Palliative Care Special Notes. The special note form will pre-populate itself with as much information from EMIS Web as it can, ie. demographics and practice details. EPaCCS GP User Guide v1.0 Page 28 of 45

30 Scroll down to the Special patient note section and type into the box as required. Click Done. Example of non-palliative care patient special note Click Save and wait for the record to post, and the data, a PDF and code will be posted back to EMIS Web. It will also save to the central repository so the information is available to the external organisations. EPaCCS GP User Guide v1.0 Page 29 of 45

31 Example of special note posted back into the EMIS Web record To amend a special note which has already been added, open the patient record and click on the Update button. EPaCCS GP User Guide v1.0 Page 30 of 45

32 Support For queries on Pyrusium and the esp records, Black Pear at Any problems with the software should be reported to Please include your Practice ODS code and a contact telephone number with a brief description of the problem. You can access support from Black Pear by clicking on the Support link when logged in to Pyrusium. You can also click on the Documentation link for user guides, FAQs and release notes. The following are links to instructional video clips: o Pyrusium installation: o EPaCCS form: o EPaCCS integration with Adastra: o Non Palliative Care Special Note integration with Adastra: Any problems or issues with EMIS Web should be reported to EMIS Health Support via the usual methods. There is also a set of Quick Reference Guides to accompany this User Guide. EPaCCS GP User Guide v1.0 Page 31 of 45

33 Appendix A How to download Chrome To access the Black Pear License Manager you will need Internet Explorer 10 or higher. If you do not have a modern browser you can download one from the internet. There are several popular and effective browsers, such as Firefox and Opera, which you can download direct from their websites. The following are instructions on how to download Google Chrome. You will need administrator rights on the PC you are using contact your local IT Administrator or Helpdesk if you have any problems. Open the following URL in your browser: Click on Download Chrome. When you have read the terms of service, click on Accept and Install. Note make sure you untick the Set Google Chrome as my default browser box (unless you wish to use it as your main browser), as this may interfere with other applications you use on that workstation which have been configured to use Internet Explorer as a default. EPaCCS GP User Guide v1.0 Page 32 of 45

34 Click Run. Wait for the download and installation to complete. The Chrome set up screen will then load. Click on No thanks to bypass setting up a Google account (unless you wish to do so). EPaCCS GP User Guide v1.0 Page 33 of 45

35 A new tab will then open so you can start browsing straight away. If you are unfamiliar with Chrome and would like to learn some of the basics, click on the Getting Started tab. EPaCCS GP User Guide v1.0 Page 34 of 45

36 Appendix B How to create a desktop shortcut icon The quickest way to create a shortcut is to drag the Pyrusium icon from the Start menu and drop it on the desktop. If there is no entry in the Start menu you will need to follow these instructions to create the shortcut: Open the Black Pear Pyrusium properties to find where the files are stored on the PC: Start > All Programs > Black Pear Software > Pyrusium right click on Pyrusium and select Properties. Keep this window open on your desktop. EPaCCS GP User Guide v1.0 Page 35 of 45

37 Right click on a blank area of your desktop screen and select New and Shortcut. In the Type the location of the item box, copy what is in the Target field of the Shortcut tab of the Pyrusium Properties box (select the text, right click and then paste). Click Next in the Create Shortcut box. Type a name for the shortcut (Pyrusium), and Finish. You will now see the shortcut on your desktop. You can now close the Pyrusium Properties box. EPaCCS GP User Guide v1.0 Page 36 of 45

38 Appendix C Special Notes Patients on the Proactive Care Register The following is information for Practices with patients on the Proactive Register (2% AUDES Frailty), on how to flag notes on Pyrusium and EMIS Web: Aims: o To highlight awareness of patients vulnerability to unplanned hospital admission and to reduce the rate of inappropriate admissions o To reduce duplication and promote an integrated approach to care o To encourage review of any advance care planning decisions that have already been made o To encourage contact with the Care Coordinator to discuss options Objectives: o To ensure that other organisations with access to Pyrusium are aware that the patient is on the Proactive Care register (OOH Acute Trust Community Hospitals WMAS Clinical Contact Centre Community Teams) and that care plans should be available to them regarding patient priorities for care o To ensure that other organisations using EMIS community ( eg Community Teams and Clinical Call Centre) are aware that the patient is on the Proactive Care register to enable them to review notes and find care plans and any advance care planning discussions Create a special note, as instructed on page 28, and enter the following text in the free text field: Patient is on GP Proactive Care Register. Assessment and Care Planning undertaken and Care and Support Plan available. Advanced assessment required prior to transfer. If possible add the main diagnosis, eg. Frailty/Asthma/COPD etc. Add a warning message onto the patient s EMIS Web record open the patient s Registration tab, and click on Patient Warnings. Click Add, and type in Patient is on GP Proactive Care Register. Tick the Sharing box. OK and Close. EPaCCS GP User Guide v1.0 Page 37 of 45

39 Appendix D Patient Leaflet The following page is information available for patients about their EPaCCS record. It is available to download as a PDF file from the Documentation link within Pyrusium, and also available as an EMIS Web Document Template file (EWDT) to import direct into EMIS Web. This can then be coded and printed from EMIS Web straight from the patient s record. EPaCCS GP User Guide v1.0 Page 38 of 45

40 Worcestershire Electronic Palliative Care Coordination System A guide for Patients Introduction This leaflet provides you with details about Worcestershire s Electronic Palliative Care Co-ordination System which is often shortened to EPaCCS. This is an electronic system that contains information about your illness, your important contacts and any medication you may need if your condition changes (so called anticipatory medication). The information we collect and why We ask you for information to improve the quality, efficiency and safety of the care you receive without having to repeatedly ask you the same questions. Information includes: Information about you i.e Your date of birth, name and address, preferred place of care, next of kin and your NHS number. Details of health professionals involved in your care and their contact details. Information about any anticipatory medications that have been prescribed to you. How your records are used Providing good care towards the end of an illness requires a number of health professionals and services to act in a co-ordinated way and our new EPaCCS communicates this information with health and social care professionals from a variety of services. This information is kept on a computer system that can be accessed by your doctor, nurse or other healthcare professionals within Worcestershire at any time of the day or night seven days a week. In addition, we use the information within EPaCCS to inform us whether we have been successful or not in providing good care and the impact on the broader health services. This is done by combining the information with other sources such as hospital use and is done anonymously and doesn t include any identifiable information. This means we can improve our services based on having a good understanding of what we are doing. Who can see EPaCCS and how we protect your information? EPaCCS can be accessed by health and social care professionals involved in your care and they will only be able to see information appropriate to their role. This may include your GP, district nurse, the out of hours GP service, the ambulance service, the local hospice and the hospital. This information will only be collated and shared with your permission and all these organisations operate strict confidentiality agreements. The system has the same level of security as all NHS records. Your GP practice supports this initiative. Practice Name:... Your information will NOT be shared with other organisations or companies and is only for use by approved Health Care providers in Worcestershire. primrose hospice centre of care EPaCCS GP User Guide v1.0 Page 39 of 45 SW Healthcare stay well in south worcestershire

41 Appendix E EPaCCS Template and Readcodes The following information is available from the Documentation link within Pyrusium. It shows which readcodes are used and which information is pulled through from the EMIS Web record. Where possible, fields are pre-populated on first creation of the record. These are highlighted in green in the tables below. Where a readcode is shown, on first creating the record these will be picked up from the EMIS record. On every save, where present in the form these codes will be written back to the EMIS record. Section Field Readcode Patient Consent Consent given for sharing end of life care 9Nu6. coordination record Consent given by appointed person with 9Nu90 lasting power of attorney for personal welfare (Mental Capacity Act 2005) for sharing end of life care coordination record Best interest decision taken (Mental Capacity Act 2005) for sharing end of life care coordination record 9Nu8. Section Field Readcode EPaCCS form Date EPaCCS form created Created on Last amended by: of: Date of next review Section Field Readcode Patient Details Forename Preferred name Surname NHS Number Date of Birth Gender Home Address Home Telephone Mobile EPaCCS GP User Guide v1.0 Page 40 of 45

42 Usual address if different Section Field Readcode Patient s GP Details Prepopulated Name Practice Practice Address Telephone Practice code Section Field Readcode Functional status, Functional status disability and communication Disability Visual impairment Cognitive impairment 28E3. Impaired ability to recognise safety risks Hearing impairment Difficulty communicating Unable to summon help in emergency Other Communication Preferred Spoken Language Does the patient need an interpreter: - Interpreter needed - Interpreter not needed Section Field Readcode Carers Key worker (if not usual GP) Name of key worker Telephone number Main informal carer Does not have an informal carer Has informal carer support u. Availability Home Address Tel no Is main informal carer aware of diagnosis Other informal carers Carer 2 Name Carer 2 Telephone Number Carer 3 Name Carer 3 Telephone Number Formal Carers Carer 1 Name Carer 1 Professional Group Carer 1 Telephone Number Carer 2 Name Carer 2 Professional Group EPaCCS GP User Guide v1.0 Page 41 of 45

43 Carer 2 Telephone Number Carer 3 Name Carer 3 Professional Group Carer 3 Telephone Number Section Field Readcode Clinical Summary Diagnosis Readcoded Pre-populated Past Medical History GP Summary Other relevant clinical issues Allergies/Adverse Drug Reactions Section Field Readcode Just in Case Box Anticipatory medicines have been 8BMM. prescribed Anticipatory medicines not appropriate Patient has Just in case box Where are these medicines kept? Anticipatory medicines Analgesics Antiemetic McKinley Syringe Pump Chart Completed Anxiolytics Antisecretory Section Field Readcode Advanced Statement, Places of Care Has an End of Life Care Plan AMBER care bundle Preferred Place of Care First choice: - Person s own home 8Ce0. - Hospital 8Ce3. - Care home 8Ce4. - NHS hospice 8Ce1. - Voluntary hospice 8Ce1. - Other Name of treatment Centre Second choice: as above Third choice: as above Preferred Place of Death First choice: - Person s own home - Hospital - Care home - NHS hospice - Voluntary hospice - Other Second choice: as above Third choice: as above 8Ce0. 8Ce3. 8Ce4. 8Ce1. 8Ce1. EPaCCS GP User Guide v1.0 Page 42 of 45

44 Section Field Readcode DNACPR decision Is DNACPR in place? - Yes 1R00. - No 1R10. Is the patient aware? If no, reason the patient is not aware? - Patient does not have capacity - Harmful to patient Is the family aware? If no, reason the family is not aware? - Patient request - Awaiting discussion - Not possible e.g. unable to contact the family DNACPR decision review Date DNACPR decision made Location of documentation Date of next DNACPR review Section Field Readcode Advance decision to Has ADRT (advance decision to refuse 9NgG. refuse treatment treatment)(mental Capacity Act 2005) Information about decision Date the decision was made Location of the documentation Section Field Readcode Lasting power of attorney - No power of attorney appointed - Without authority to make life sustaining decisions - With authority to make life sustaining decisions Power of attorney Name Address Telephone Number Person the patient wants to be involved in decisions about their care Name Address Telephone Number Section Field Readcode Other relevant issues or preferences about provision of care State other preferences Is there further information available to ambulance crews? If yes, further information EPaCCS GP User Guide v1.0 Page 43 of 45

45 Section Field Readcode Remove patient record Reason for removal Patient died Patient recovered Patient moved out of area Withdrawal of consent for sharing end of life care coordination record Form created in error Details of death Incorrect information recorded Date of death Actual place of death: - Person s own home - Hospital - Care home - NHS hospice - Voluntary hospice - Other HG.. 949D. 949A. 949A. EPaCCS GP User Guide v1.0 Page 44 of 45