audit

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INVESTIGATION OF DEATHS IN EPILEPSYAudit ToolsContents ListAUDIT OF PRIMARY AND SECONDARY CARE1 Primary Care Audit Tool 1: non-referred patients2 Primarudit Tool 2: ref3 Secondary Care Audit ToolAUDIT OF THE INVESTIGATION OF DEATH4 Pathology Audit Tool 5 Doctor Certified Deaths Audit Tool SERVICE QUESTIONNAIRES6 Service Questionnaire: Pathologists7 Ser Primary Care8 Ser Secondary CareNational Sentinel Clinical Audit - Epilepsy Deaths1 Primary Care Casenotes Audit Tool 1For use where there is no secondary care or the GP did not referCase No Age Sex Date of death (for reference only)1 What was the date of the first possible/putative seizure? If the epilepsey was diagnosed in the last five years, continue below. If not, go to Q152 Is there evidence that the patient contacted any branch of the health service about that episode? Yes NoIf yes, continue below. If no, go to Q53 If yes, which branch of the health service was first contacted?a GP b A&Ec NHS Direct d Ambulance Service e Other (please state)f State the date of that first contact4 How long, in days, between f above and the date the patient saw a GP about this episode?5 When was the patient first seen by the GP after the first possible/putative seizure? 6 How many seizures had the patient experienced before being seen for the first time by the GP?7 Has the GP written a description of a seizure in the notes or in a ...

Informations

• Publié par: Nepher
• Nombre de lectures: 22
• Langue: English

Extrait

INVESTIGATION OF DEATHS IN EPILEPSY Audit Tools

Contents List

AUDIT OF PRIMARY AND SECONDARY CARE

1 Primary Care Audit Tool 1: non-referred patients 2 Primary Care Audit Tool 2: referred patients 3 Secondary Care Audit Tool

AUDIT OF THE INVESTIGATION OF DEATH

4 Pathology Audit Tool 5 Doctor Certified Deaths Audit Tool

SERVICE QUESTIONNAIRES

6 Service Questionnaire: Pathologists 7 Service Questionnaire: Primary Care 8 Service Questionnaire: Secondary Care

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10If yes, on what evidence was that diagnosis made?

9Is there evidence that the GP made the diagnosis of epilepsy?

No

Yes

8State the reason why the GP did not refer the patient to a specialist

Yes

7Has the GP written a description of a seizure in the notes or in a letter? If yes, summarize the account on paper or tape

No

Yes

No

Case No Age Sex Date of death(for reference only)

1What was the date of the first possible/putative seizure? If the epilepsey was diagnosed in the last five years, continue below. If not, go to Q15 2Is there evidence that the patient contacted any branch of the health service about that episode? If yes, continue below. If no, go to Q5 3If yes, which branch of the health service was first contacted? aGP bA&E cNHS Direct dAmbulance Service eOther (please state) fState the date of that first contact 4How long, in days, betweenfabove and the date the patient saw a GP about this episode?

5When was the patient first seen by the GP after the first possible/putative seizure?

6How many seizures had the patient experienced before being seen for the first time by the GP?

1

1

For use where there is no secondary care or the GP did not refer

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ABOUT INVESTIGATIONS WHICH AID DIAGNOSIS 11Are there any investigations initiated by the GP to clarify the differential diagnosis of epilepsy? If yes, complete table A, then continue below. If no, go to Q13 12Is there evidence that the patient was awaiting any GP initiated investigations at time of death? 13Is there in the notes a clearly stated cause of the epilepsy (e.g. antenatal or birth-related brain injury, head injury, meningitis, brain tumour, stroke, genetic or chromosomal disorder)? If yes, continue below. If no, go to Q15 14What was the cause?

MANAGING & REVIEWING THE EPILEPSY 15In the last year was the seizure frequency documented in the GPs notes or correspondence? If yes, continue below. If no, go to Q17 16Record the seizure frequency as it is described by the GP

17Is there any evidence of increase in seizure frequency in the 12 months preceding death? 18Give details, as contained in the notes, of aSeizure type bTrigger factors for epilepsy 19Is there a management plan in the GPs own notes during the 5 years prior to death? 20Is there evidence of other specialist advice being sought by the GP? If yes, record who was consulted and what the advice was

21Who reviewed the patient’s epilepsy at the last review prior to death?(Tick any that apply) aGP bSpecialist nurse cPractice nurse dNo review recorded eDate of last review(if applicable) 22Did the deceased see any GP in the 28 days prior to death? If yes, continue below. If no, go to Q24 23If yes, when and for what?

Yes Yes Yes

Yes

Yes

Yes Yes

Yes

No No No

No

No

No No

No

24Is there evidence that the patient was receiving any of the therapies listed below?: aAlternative therapist bBiofeedback cDietary restriction dPsychological therapies eOther - please state fNone of these

ABOUT MEDICATION 25Is there evidence that the GP had in the last five years checked blood for therapeutic AED levels? If yes, complete table B, inserting the most recent test only for all AEDs done. Complete Table C 26Does the repeat prescription record indicate good compliance? (Within seven days either way of expiry of last prescription) State E, T or L or Unknown. Calculate this as follows: Find the date of the prescription before last. Note how many days supply of tablets had been prescribed. Find the date of the last prescription. Work out if the number of days between prescriptions is lesser, the same as or greater than the number of days tablets previously prescribed. If it is lesser, state E. If it is the same, state T, or if it is greater state L. 27Is there any record of non-compliance with medication in the GPs own notes? 28If yes, what action was taken as a result?

29List any other medication commenced over the last year stating doses and commencement date. Include the date of last prescription for each item.

ABOUT OTHER HEALTH PROBLEMS 30Is there evidence in the notes of any of the health problems below?(tick any that apply) aLearning disability bDrug misuse cAlcohol misuse dNone of these 31Was the patient pregnant?

ABOUT INFORMATION GIVEN 32Is there documented evidence in the notes about whether the deceased and/or family had been provided with information about epilepsy? If yes dictate details of information given and to whom. If no, go to Q34.

Yes

Yes No

Yes No

No N/A

Yes No

33Who provided this information? aGP bPractice nurse cSpecialist nurse dOther - please state

34Is there evidence of discussion of hazards of seizures?

35Is there any evidence that there had been discussion about epilepsy causing death?

36Is there evidence that there has been contact by the GP to support the family after the death?

36aIs there evidence of an invitation by the GP to the family to meet to discuss the death?

37Is there evidence that the GP was present at the terminal event? If yes, continue below. If not, go to Q38a

38If yes, record the description of what happened and any treatment given.

WHERE THE GP CERTIFIED THE DEATH 38aIs there any evidence that the certifying GP has reported the death to the Coroner? If yes, record what is written in the medical record

38bIs there anything in the notes describing the cause and/or circumstances of death? If yes, record what is written in the medical record

Table A – tests done by GP to clarify the differential diagnosis of epilepsy

Type of test

Date ordered

Date done

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

Table B - Record only the last result for each AED prescribed at the time of death, and do not go back more than five years

AED name

Date blood Reason for taken testing

Date received Date tested Date reported Date result Action taken in lab received by GP

Table C – List of antiepileptic drugs the patient was prescribed at the time of death

AED Name

Dose

Dosage

Date started

Reason started

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45Has the GP made a description of a seizure in the notes or in a letter? If yes, summarize the account on paper or tape

No

43What was the date the patient was first seen by the GP after the first possible/putative seizure?

44How many seizures had the patient experienced before being seen for the first time by the GP?

Case No Age Sex Date of death(for reference only)

39What was the date of the first possible/putative seizure? If the epilepsy was diagnosed inlast five years, continue below. If not, go to Q58 40Is there evidence that the patient contacted any branch of the health service about that episode? If yes, continue below. If no, go to Q43 41If yes, which branch of the health service was first contacted? aGP bA&E cNHS Direct dAmbulance Service eOther(please state) fState the date of that first contact 42How long, in days, betweenfabove and the date the patient saw a GP about this episode?

49Was the referral by: aPhone? bFax? cLetter? dOther(please state)

ABOUT REFERRING THE PATIENT 46What was the date of the referral? 47What is the time difference between Q43 and Q46?CALCULATE BY FORMULA

Yes

Yes

No

 toTuAid

2

48To which speciality was the referral made?(tick one or more) aNeurology bGeneral medicine cMedicine for the elderly dPaediatrics ePaediatric neurology fPsychiatry gLearning disability hA&E iOther(please state)

For use where the GP referred a patient to secondary care

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50What was the date of the first appointment with the specialist? 51How long from first consultation with the GP about the first seizure to appointment with specialist?CALCULATED BY FORMULA 52Is there evidence that a more urgent referral was requested? 53Had the patient been re-referred to a speciality or referred to a new speciality because of epilepsy If yes, continue below. If no, go to Q58 54What was the date of re-referral? 55What was the date of the subsequent appointment? 56What is the time gap in days between Q43 & Q55?CALCULATE BY FORMULA

57Why was the patient re-referred?(tick one or more) aConsider stopping anti-epileptic medication bChange in seizure frequency or pattern? cFor reassessment of AEDs due to side effects? dChange in life event e.g. pregnancy, contraception eReconsider diagnosis fSecond opinion gOther -please state 58Is there a letter or a note of a phone call from the specialist in which the specialist confirms the diagnosis of epilepsy? If yes, continue below. If no, go to Q60 59If yes, what is the date on that letter or of that call? Now go to Q60

ABOUT INVESTIGATIONS WHICH AID DIAGNOSIS 60Are there any investigations initiated by the GP to aid the diagnosis of epilepsy? If yes, complete table A, then continue below. If no, go to Q62 61Is there evidence that the patient was awaiting any GP initiated investigations at time of death? 62Who reviewed the patient’s epilepsy at the last review prior to death?(Tick any that apply) aSpecialist bGP cSpecialist Nurse dPractice Nurse eNo review recorded 63What was the date of the last review (if one was carried out)? 64Did the deceased see any GP in the 28 days prior to death? If yes, continue below. If no, go to Q66 65If yes for what?

Yes Yes

Yes

Yes Yes

Yes

No No

No

No No

No

ABOUT MEDICATION 66Is there evidence that in the last five years the GP had checked blood for therapeutic AED levels? If yes, complete table B, inserting the most recent test only for all AEDs done. Complete table C 67Does the repeat prescription record indicate good compliance? (Within seven days either way of expiry of last prescription) State E,T,L or Unknown. Calculate this as follows: Find the date of the prescription before last. Note how many days supply of tablets had been prescribed. Find the date of the last prescription. Work out if the number of days between prescriptions is lesser, the same as or greatert than the number of days tablets previously prescribed. If it is lesser, state E. If it is the same, state T, or if it is greater state L. 68Is there any record of non-compliance with medication in the GPs own notes? 69List any other medication commenced over the last year stating doses and commencement date. Include the date of last prescription for each item.

ABOUT OTHER HEALTH PROBLEMS 70Is there evidence in the notes of any of the health problems below?(tick any that apply) aIschaemic Heart Disease bRespiratory conditions cLearning disability dDrug misuse eAlcohol misuse fTrauma gPhysical disability hNeurological illness iNone of the above If yes, go to Q71. If no, go to Q72 71Has the GP told the specialist about all items ticked in 70 above before the referral appointment takes place? 72Is there evidence in the notes of any of the following coronary risk factors? aSmoking bHaving a BMI of 28 or more cDiabetes dA BP of 150/90 or a statement of hypertension eFamily history of stroke or heart attack under age of 60 years gNone of the above 73Was the patient pregnant? If yes, continue below. If not, go to Q76 74Is there evidence that the obstetrician had been told of the patient’s epilepsy? 75Is there evidence of a management plan during pregnancy? 76Is there evidence that the patient was receiving any of the therapies listed below: aVagal Nerve Stimulation bAlternative therapist cBiofeedback dDietary restriction ePsychological therapies fOther - please state gNone of the above

Yes No

Yes No

Yes No

Yes No N/A Yes No Yes No

77Is there any evidence in the last 3 months preceding death of a change in seizures, trigger factors or note of life event ? If yes, continue below. If no, go to Q79 78If yes, give details:

ABOUT INFORMATION GIVEN 79Is there documented evidence in the notes about whether the deceased and/or family had been provided with information about epilepsy? If yes dictate details of information given and to whom. If no, go to Q81

80Who provided this information? aGP bSpecialist cPractice nurse dSpecialist nurse eOther - please state 81Is there any evidence that there had been discussion between the GP and the patient/relative/carer about epilepsycausing death? 82Is there evidence of a letter from the GP to the family after the death? 83Is there evidence of an invitation by the GP to the family to meet to discuss the death? 84Is there evidence that the GP was present at the terminal event? If yes, continue below. If not, go to Q85a 85If yes, record the description of what happened and any treatment given.

WHERE THE GP CERTIFIED THE DEATH 85aIs there any evidence that the certifying GP has reported the death to the Coroner? If yes, record what is written in the medical record

85bIs there anything in the notes describing the cause and/or circumstances of death? If yes, record what is written in the medical record

Yes

Yes

Yes Yes Yes Yes

Yes

Yes

No

No

No No No No

No

No

Table A – tests done by GP to clarify the differential diagnosis of epilepsy

Type of test

Date ordered

Table B - Record only the last result for each AED prescribed at the time of death, and do not go back more than five years

AED name

Date blood Reason for taken testing

Date done

Date received Date tested Date reported Date result Action taken in lab received by GP