TIARA EPR & PROCESS GUIDEFOR DIETIETC TEAMS PHC/PHCP/MLD – VERSION 1
For advice on how to use EPR – also refer to the handouts given to you by your EPR trainer they will act as a useful memory aid (especially for staff new to TIARA EPR).
TODAY vs CASELOAD Remember TODAY is for your booked clinics/dom telephone assessments/Groups. If you are updating your clinic a day later you may need to enter the date it was held to find the clinic you need to enter (overdue clinics don’t always appear when you login).
CASELOAD is for recording your ad-hoc contacts e.g. unplanned telephone contacts,inpatient contacts and is where you can lookat episode details and access other tasks e.g. discharging inpatients.
TODAY SCREEN
DNA’s (You must not proceed to contact entry. DO NOT SELECT ‘CONTACT ENTRY’ OR DNA/DISCHARGE. SELECT DNA from your drop down list and follow processes for discharging/DNA letters as per your team guidance. CAUTION Click off [X ]any boxes that pop-up asking if you want to return the patient to the waiting list (they don’t work as you would expect and it is not PHC/P process).
DEMOGRAPHICS SCREEN
CHECK PATIENTS ADDRESS AND GP PRACTICE DETAILS AT EVERY CONTACT. You can UPDATE patient’s demographics if you need to and add in the patients preferred name. If you update the patients address YOU MUST TICK THE ‘MOVE’ BOX to bring up a new blank fieldto type into and retain address history. NEVERbackspace/delete the information in the address field and/or overtype it. If you are not confident in doing this correctly email the CBAO office with the new details and they will amend for you. Email Subject: CHANGE TO PATIENT DETAILS
OVERVIEW SCREEN
You will automatically be taken to this screen before you input any contact information – this gives you the opportunity to quickly review any previous contact history and to see if the last entry displays in a white field denoting either a general note has been recorded (non-clinical information) OR that a document has been scanned on by admin (this may be a letter received about your patient which you should read / or it could be another referral we have received for the patient). If the patient is NEW but you can see contact information in a pale yellow field you will be aware that a pre-appointment clinical contact has taken place (common with Paeds and Doms).
GENERAL NOTES
You access this via the OVERVIEW screen to enter details of any non-clinical contacts you need to record in GENERAL NOTES FIELD. If using patient search don’t select OVERVIEW from the drop down on the search screen. Select EPISODE first and then select OVERVIEW from the Care Episode History screen. Prefix your entry with Date / Time this occurred as this may not necessarily be the same as when you are entering it. Examples include: school phoned with ‘weights’ for the patient / after speaking with health visitor we agreed appointment was no longer necessary / care home staff said patient had moved to another home. Anything made as a general note will appear in a white text box.
CONTACT SET-UPSCREEN
CONTACTOR INDIRECT – You will make this selection on Contact Setup screen. NOTE that a contact is still a contact even if you gave the advice to a carer/parent/relative – this is not indirect.
NEVER SELECT CASE NOTE. You can also select your CARE TEAM on this screen e.g. PHC DOM team, PHC inpatient team – this will help you to find your patients more easily if you need to access them in CASELOAD to enter ad-hoc contacts or to review appointment or episode history. Times should be entered as follows e.g. 1030 the field does not accept the following - . , : ; punctuation marks.
INTERVENTION SCREEN
INTERVENTION CODES – at least one appropriate intervention code should be selected at every patient contact or indirect contact recorded.
MAIN PATIENT RECORD – This EPR form should be completed for ALL ‘NEW’ patient contacts, i.e. first contact for new referral/new episode. The mandatory fields should be completed as a minimum for patients attending group sessions. This should not be used for subsequent contacts (Exceptions: This may have beenpartially completed by a dietitian recording details of advice given before your new patient first appointment and you may need to complete the remaining required information at this contact.)
SUMMARY NOTES FIELDshould be used to enter details of your follow-up contacts (the main record card should not be used). If you have written lots of information into comments sections within EPR forms/Care Plans – make a cross-reference by typing:- ‘See notes in’ ?? Form on ?? date.
EPR FORMS – use these if and when appropriate. Some patients will never require additional EPR forms to be used. If using more than one EPR form select only one at a time.
SAVE SAVE SAVE as you work on forms that are taking a long time to complete
TICK YELLOW BOX TO START A NEW BLANK EPR FORM
READING AN EPR FORM – Select the number at the end
ADDING TO AN EPR FORM – Click the underline – complete SAVE NEW AND CLOSE
PICKED WRONG EPR FORM/OR WANT TO CREATE ANEW VERSION – SELECT CANCEL
INTERVENTION DETAILS SCREEN
WAITING OUTCOME (clock stopping) this is MANDATORY at first contact only. The code you should use is 30 START OF FIRST DEFINITIVE TREATMENT.
CLINICAL DIAGNOSIS – (first contact) select an appropriate code from LNDS 1CD10 code list
END TIME: Change this only if you have changed the START TIME on your booked clinics.
TT (timed) UNITS – record length of clinical time only (not travelling or admin)
ACTIVITY TYPE is always 03 (clinical intervention)
AVOIDING ‘NO MANS LAND’ FOR COMMUNTY AND OPD PATIENTS
Patients who don’t already have an appointment booked should be on a WAITING LIST or DISCHARGED.
Make your selection whilst on the Intervention Details Screen. Generally PHC/P don’t book their own patient appointments.
ADD TO WAITING LIST SCREEN
FOLLOW-UP LIST -CBAO will write to your patient when they are due according to the ‘not before date’.
REVIEW PATIENT*- CBAO do not write to patients on this list. Give the patient the contact number for CBAO or hand them a card with our contact details
*Review list is where you will add your patients with an open appointment for 12 months for OPD and
3 months for Doms – these patients will be discharged by CBAO if they do not contact us within the agreed timescale. This list is useful for patients who are undecided whether they need a further dietetic appointment (e.g. depending on test results/other information).
DISCHARGE SCREEN
Complete your OUTCOME fields. Complete Reason Phase Closed. Tick the tiny box at the end of the screen Discharge Care Episode and repeat with the selection used for Phase Closed.
OUTCOME CODES (patient and therapist)
Add these when you discharge your patient they are:- 100 / 75 / 50/ 25 per cent, died or not known.
Add to notes field when adding to waiting list – CBAO will complete if they discharge the patient in the future due to ‘no contact’.
LOOKING BACK –Select OVERVIEW(other options available e.g. summaries and phase EPR - see your EPR training handouts for details if required).
NOTE:- if using patient search don’t select OVERVIEW from the drop down on the search screen you MUST select EPISODE first and then select OVERVIEW from the Care Episode History screen.
VIEWING EXTERNAL DOCUMENTS AND LETTER HISTORY
Use either drop down menus or the GO tab to access External Documents (which are copies of your scanned referrals and external correspondence). Go to Letter History to view service generated letters.
LETTERSFROM THE SERVICE
Generating Letters – if the letter is taking a long time to type or you get interrupted click CONFIRM
Followed by [edit text] when you want to proceed again to keep the letter active on the system. It is a good idea to keep the letter on the screen after you have printed it (instead of selecting NEXT). If you find any mistakes you can [edit text] to correct and print again.
LETTER HISTORY – letters generated in OAM will say ‘viewed’ when they have actually been printed. Do not be confused by the terminology. Letters that do say ‘printed’ were generated in GUI
TIPS FOR GENERATING AND POSTING LETTERS
TIARA GENERATED ONLY - Do not revert to using word versions of letters (the letters must be system generated).
TICK BOXES - As tick box fields are not accessible in TIARA you are advised to mention in your summary notes /general notes which option you will be selecting. This will not be necessary for informing referrers regarding Discharge due to DNA as we will know from the RN
COPYING PEOPLE IN – Make sure you have the correct address information for your cc’s. If sending copies to more than one person make sure there are 9 returns between recipients (for enveloping purposes) OR use the STD COPY TO SHEET which is spaced accordingly.
COPY TO SHEET - in the first field type the date and the name of the letter/literature/food diary you are sending. Complete the remaining fields 1 for each recipient if you get to the last box and require more – use 9 returns between each and type remaining recipients in this field.
The ‘copy to’ sheet should be pinned to the back of the main recipients letter but will be pinned to the front of the ‘copied in’ to enable this to be folded accordingly into the window envelopes.
ENVELOPING LETTERS – Use window envelopes only for letters containing patient identifiable information (PII). Place a small TICK next to the copied in recipients name as you place it into the envelope – this will assist us in knowing which recipient has not received it in the event a ‘copied in persons’ letter is returned.
COPIES FOR FILE – generally there is no need to print letters for your paper-lite file so avoid this unless it is absolutely essential that you have a copy e.g. working offline.
LETTERS/CORREPSONDENCE TO THE SERVICE – SCANNED ON
Admin team will scan on correspondence received for a ‘current patient’. You will see an indication that this has happened when you look at your OVERVIEW screen pre-contact. There will be a white field giving the date/time/name of admin person. This will be your cue to look at the external document especially if it is the last TIARA entry since the last contact.
GENERAL GUIDANCE
INTERNET – GOOGLE CHROME – don’t use TIARA via GOOGLE CHROME
BACK BUTTON – use the green back arrow in TIARA (which will display if going BACK is an option). The use of Internet back buttons may throw you out of TIARA
SYSTEM LOCKDOWN – Don’t start recording information for a patient that you cannot complete before the current LOCKDOWN time of midnight.
MISTAKES - If you have made an error or generated the wrong letter/EPR form against a patient use standard format shown below to draw other users attention to this by typing in GENERAL NOTES
e.g.ERROR MSG: Name of Letter /Form created or ‘entry made’ on (date) by(whom) was entered/generated in error and is not for this patient or correct for this patient please disregard.
TODAY SCREEN CONTACTS – MADE ON DIFFERENT DATES THAN SCHEDULED
e.g. Dom call made day earlier/later. The date will be corrected to what you entered on contact entry, however YOU MUST remember to change the time of the contact if this is different. E.g. Original time was 14:00 new time is 10:30 – CHANGE THE END TIME ALSO ON INTERVENTION DETAILS SCREEN
INPATIENTS – for all inpatients who will require ongoing monitoring a ‘Patient Front Sheet’ should be printed from the letter suite and the referral (which will not be scanned on) should be stapled to it. If the patient is discharged following first contact the referral can be filed with DX written across the front.
GROUPS – don’t forget to complete the Mandatory fields on the main patient record card – further details about advice given at the group can go into summary notes (copy and paste for each patient).
PRE-APPOINTMENT CONTACT (CLINICAL) – complete the mandatory fields on the main patient record (and other fields if appropriate at this stage. Complete the waiting outcome field to stop the clock. If you know the patient has an appointment you can select FINISH at the interventions details screen.
CHECKING IF SOMEONE HAS AN APPOINTMENT OR THEIR APPOINTMENT HISTORY
On the pull down menu in TODAY or CASELOAD select Appointments option to see details of cancellations, wait listing and past / future appointments.
EMAILS TO/FROM PATIENTS - If you want to enter text from Emails sent to/from/about patients you should copy and paste the text as follows:
-If clinical paste into the Free Text Summary - Remember to select appropriate Consultant Medium option.
-If non-clinical – paste into general notes
OFFLINE USERS – don’t forget to enter your timed units before you FINISH and if this was a clinic don’t forget your do your letters and wait listing when you upload.
TIARA QUICK TIPS:-
1)NEW PATIENTS – MUST REMEMBER TO:-
-Complete the Main Patient Record Card
-Select at least one intervention code
-Complete Clinical Diagnosis IDC10
-Waiting Outcome – Start of First Definitive Treatment (30)
2)FOLLOW-UPS
-Use summary notes
-Select at least one intervention code
-Click on underlines on EPR forms if you need to add additional information into
3)DNA PROCESS
-DNA’S (includes domiciliary patients where the contact does not take place)
-Always send a discharge letter to the GP/Referrer
-Complete the discharge process on TIARA – close Phase and Episode.
-PAEDS missedfirst appointment – send a DNA letter to the parents
4)WAITING LISTS:
-When Follow-up is selected the activity type you should select refers to the default length of time for follow-ups in your particular clinic e.g. 15 MINUTES.
-Select SITE, a clinic location and a NOT BEFORE DATE
-Use notes field to advice of longer durations required – but these requests should be kept to a minimum. Do not use the duration field.
-Notes field should include outcome codes.
-When Review is selected – you don’t get a clinic location option - select ANY PHC/P resource (don’t select community review list option)
-Not before dates should be 12 Months OPD and 3 months Doms
-Give patient contact details for CBAO
-Notes field should denote the clinic location and outcome codes.
5)OPD AND COMMUNITY PATIENTS (PHC/P) SHOULD BE:
-In a booked appointment slot
-On a waiting list
-Discharged
6)LOCATION CODES FOR TELEPHONE CONTACTS:
-ATtelephone call to patients residence – includes speaking to carers/relatives (DIRECT)
-3Ptelephone call to a third party e.g. GP/HV about the patient care (INDIRECT)
This code can also be used for attendance at a MDT meeting
VERSION 1 – log of minor amendments
Date / Page / Amendment29/12/15 / 5 / Additional information added to waiting lists - point (4) about duration
1TIARA EPR & PROCESS GUIDE FOR DIETETIC TEAMS PHC PHCP MLD version 1 - updated 291215 27 October 2015 – updated 29/12/15