Key Information Summary

 

GUIDANCE for PRACTICES

The Key Information Summary (KIS)  allows practices to compile a sharable summary of key Information for patients who are at risk of needing further care or emergency treatment ‘out of hours’. It will supplement or replace Anticipatory Care Plans (ACPs) and Special Notes sent to Out of Hours Organisations (OOHs).

A KIS can only be created within a GP practice system, and will be available as read only for clinicians who have access to the Emergency Care Summary (ECS). This includes all clinicians  working in A/E departments, Ambulance, OOHs and Acute receiving units.

Practices might choose to create a KIS for patients with Long Term Conditions, those in Nursing Homes or with a rare condition requiring particular instructions for care in case of deterioration. There is no age limit or restriction on who can have a KIS and children with complex neurological conditions or special needs might benefit from having one too.  KIS will encompass all of the functionality of the electronic Palliative Care Summary (ePCS) but improvements should make it easier to see what information is present, and whether it has been sent to the ECS store.

CONSENT

Clinicians must get consent from each patient or their carer, or choose to override consent if the patient is a frail adult, a vulnerable child or ‘at risk’ to themselves or others. If this is the case, a reason must be entered along with information about whether the patient and their family is aware. There are slight differences between the way this is displayed in vision and EMIS due to the way they record the information.

EMIS PRACTICES

When practices upgrade to version B they will find that any ePCS records will be transformed into KIS records. Practices should check their palliative care registers and ensure that any pre – existing ePCS records still have the correct data. Some critical user interface changes have been requested from EMIS and these will be included in release E which will be available after September, notably that when the box ‘add to palliative care register’ is ticked, the Read code is NOT added automatically. This is a bug which WILL be fixed.

VISION PRACTICES

VISION users will get KIS in the DLM 441 upgrade. It will not be switched on automatically and practices will need to ensure that all users are logged off for the system administrator to make the necessary changes on the practice system.

To create a KIS, start by clicking on ‘LIST’ on the top tool bar within a patient consultation. The first drop down option is ‘KIS management’ and clicking on this will open the KIS template. It takes a few seconds to load and you should click on the box in the top RH corner to expand the template to fit your screen.

The TRAFFIC LIGHTS at the top will show whether a KIS has been started (orange), completed and sent (green) or not yet begun (grey). To change these options, click ‘MORE’ which will open the consent choices.  Choose whether to tick ‘consent’ or ‘consent overridden’. If you are not ready to complete the KIS, information can be added, saved and sent at a future date.

When you are ready to send the KIS record from the practice, change the consent status so that either patient consent or consent override is ticked and the KIS traffic light is green.

If consent cannot be confirmed, Consent override can be used and in this case, a reason for override must be given. Once decision has been made to send, tick  the ‘send’ box.

CARER DETAILS will appear automatically if these are already in the system but if not, these can be added to the record in the usual way through ‘patient details tab’ or directly through the KIS screen. Use the patient contact list to add new carers, it takes a bit of fiddling about but is generally self-explanatory. Carers who are already patients in the practice can be found very easily and new non patients can be added but adding phone numbers using this pane is tricky.

The PAST MEDICAL HISTORY PRIORITY 1 CODES will appear in the box on the LHS of the screen. Open this  by clicking ‘EDIT’ and note that all priority 1 coded items are in the top pane and automatically checked. These can be deselected individually as required, or supplemented from the list of lower priority codes in the lower pane, or by adding new codes directly into the box  which will add the new item into the patient record in Vision . Adjust the choice of PMH codes to be displayed by changing the PMH items as required and all of the items which are ticked will appear in KIS.

This only needs to be done once unless a new diagnosis or coded entry is required.

‘SPECIAL NOTES’ on the bottom LHS of the screen  can take up to 2045 characters of free text, either by typing directly  or by copying  and pasting  from the clinical record (Highlight the items required, copy to clipboard by pressing control and C, then paste into KIS by pressing control and V)

The free text box is the only field which requires a review date to be added. This is the date of expiry of the information in the box, and the information will disappear once the date has passed. For enduring messages such as care instructions for long term conditions, a date well into the future is required and the default date is 2099. If a patient has opted out of ECS, special notes information can still be sent but ONLY the special notes information will go, the medications, adverse reaction and other KIS information WILL NOT BE SENT. This is to allow for ‘dangerous patient’ or ‘child at risk’ information to go to OOHs in cases where it is not advisable for the patient to know the details.

Most of the rest of the information on the KIS template is self-explanatory and only needs to be added if required. Users in OOHs will see only information that has been included, and empty boxes will not be displayed. All information will be date stamped.

DNACPR fields and information about patient wishes for preferred place of care and preferred place of death are shared with the original ePCS record and will be populated by an existing ePCS. KIS will pick up the latest date for any item so changes can be made within the GP record at any time.

KIS records will be sent from the practice and updated every few hours and the timings will vary between practices. This means that it may be several hours between entering the information and its arrival in the ECS store but should normally be within 6 hours and never more than 12.

Other agencies – drop down list

Access information – can add freetext

‘OOH information’ is a notepad entry, a type of NAC, and the date action to be taken will appear when red spot on top bar is clicked. It will also appear as ‘special note’ in journal view.

There is a 512 character limit for all entries apart from special notes. If you wish to add an important consultation, this can be done using a priority 1 code to code the consultation (provided it is less than 512 words) or by copying and pasting into the special note. To edit any freetext comments,  click on the item and choose ’edit’ from drop down list.

RESUSCITATION is always recorded as a read code, and the latest dated entry will be displayed on KIS. Options are;

Read codes for resuscitation, wishes to be resuscitated, or resuscitation unknown are all  IR..00

Does not wish to be resuscitated  IR1..

Traffic lights on top LHS of screen will display whether the record has been sent or not –the  date will  automatically be reset after each update.  NB this is  not date of arrival at ECS, only of sending.

SEARCH and REPORT tabs;

Click on REPORTS on top RHS of screen to see a list of all patients who have a KIS or to show individual KIS reports for the patient. These reports can be printed off but will only print information that is on KIS. If you wish to print the whole KIS template for a particular patient (eg to take on a home visit and show the blank fields) you would need to copy the snapshot onto a word document.

Contract searches will be provided (similar to the current MDT reports for ePCS)

If lost at any time, go back to KIS on top bar.

KIS display at bottom of guideline – click on heading to show details (apart from carers and problems)

Finally, double check the summary and click on the top RHS cross which will save and close the KIS. Please note that this is not the exit button but saves any information on the form.

ADASTRA

Adastra will have a flag to show when a patient has a KIS, and a pop up that the user will need to open so that they cannot fail to see the KIS record if one exists.