4.2 Visit Record Defer/Omit/Cease

Purpose: To show how to omit, defer or cease a protocol that a patient is on in Episoft. To do this a File Note needs to be created first. This will record in the Visit Details why the protocol/treatment has been modified.
Definitions
Defer/Delay – Treatment is delayed and appointment(s) are to be rescheduled. This can be a single appointment or series.
Omit – This refers to ceasing a day or multiple days within a cycle. All other treatment days and appointments are unchanged. Treatment is only cancelled for the omitted day.
Cease – The whole treatment cycle is cancelled.


Access function to Delay/omit/cease treatment by creating a visit record

• Open Episoft
• Search for the patient then click on patient’s name to open the patient’s record. You will be taken to the Record Summary screen.
• On Visit Details page select ‘Visit Record’.

On the Visit Record page tick the ‘Defer/omit/cease treatment’ box. This will open up further radio button options to ‘Delay cycle’, ‘Omit treatment for just this day’ or ‘Cease treatment’.





Defer treatment:
NB: The function in Visit Record is the preferred way to reschedule a treatment. You can also reschedule from the Appointment’s List and navigate to the Appointment record by clicking the appointment time. However, this way you will not have the option to only ‘Recalculate current cycle’ dates. An alternative is to go to Edit Protocol, where you can edit the appointment and select the preferred carry forward option.

Via Visit Record, Defer/Omit/Cease:
Select ‘Delay cycle’ radio button
Choose the protocol step to delay/defer from the drop-down list
In Protocol step to defer/omit field, select and confirm the correct cycle and day to defer -always choose to defer from an Appointment step, not a Medication step

EXCEPTION – if the cycle list presents up with a ‘Day before Day 1 Medication step, you will need to defer from this Medication step, otherwise the step will be left behind! Remember also to select the calendar date for the day BEFORE intended appointment to line up the appointment on the correct day.
Occasionally the protocol cycle list could contain more than one type of protocol. Check carefully to defer the correct protocol.

Example of cycle step list with Day before Day 1 set up

• Select a ‘Defer reason’ from drop-down list
• Enter free text in ‘Other details’ if required. For example write the reason for deferring treatment.
• Choose new date for appointment using the calendar icon. Note: you are not able to defer backwards ie to a date before today. Call the System Administrator if you need to do this.
• Click either ‘Recalculate current cycle’ or ‘Recalculate all future cycles’.

‘Recalculate all future cycles’ is the more common option used, so that all cycle days are rescheduled the same time, whilst maintaining the frequency set up between cycles.
‘Recalculate current cycle’ is less commonly used. It is generally used to move a cycle a day or two ahead to navigate around treatment falling on a public holiday for example, whilst maintaining the future cycles at previously set days. When using this function, ensure the cycle moved is not too close to the start of the next cycle

• Click ‘Save’ or ‘Save & Close’
• After deferring the cycle, the appointment(s) will go back to ‘Booking Request’ and will need to be re-booked on the new days.
• A record note is automatically created to log this action.

Omit a day of treatment:
Note: This function is used to omit an appointment for treatment within a cycle with multiple appointment days. For example a cycle has Day 1, 8 and 15 appointments for treatments, where Day 8 is to be omitted.
Do not use this function to omit a day in a cycle with only one treatment day, or for FOLFOX/FOLFIRI type protocols as this would keep the pump disconnect appointment when the chemotherapy treatment is omitted! Use the Cease function in this instance.

• In Visit Record, after ticking Defer/omit/cease treatment box, select ‘Omit treatment for just this day’ radio button.
• Select the protocol step to omit as in Step 2.2, from the drop-down list as
• Confirm the correct cycle and day to omit
• Always choose to omit from an Appointment step, not a Medication step
• EXCEPTION – For FOLFOX/FOLFIRI types of protocols where there is an associated pump disconnect appointment day for the cycle, use the Cease cycle function
• Select a ‘Defer reason’ from the drop-down list
• Enter Other Details if desired
• Click ‘Save’ or ‘Save & Close’
• A record note is automatically created to log this action.

Notes:

• You are able to omit multiple days in a cycle or other days in other cycles (e.g. omit Day 8 in this and all future copied cycles), by repeating the Defer/Omit/Cease action for each day to omit, (i.e. repeat step 1) for each action to omit the days
• Omitting the day will only delete the appointment and medications associated with the appointment day. If the day also has discharge medication steps that do not have appointments, these medications are not deleted.
• Omitting a day keeps the cycle in the ‘active’ protocol list and cycle number is maintained. You are unable to tell if any day of the cycles have been omitted by looking at the patient’s protocol cycle list

Cease treatment:

Note: This function is used to cease a cycle or all cycles in the future.

• In Visit Record, after ticking Defer/omit/cease treatment box, Select ‘Cease treatment’ radio button.
• Choose the protocol cycle to cease from the drop-down list. You will only be presented the cycle to cease, not individual appointment or medication steps
• Confirm the correct cycle to cease
• Select a ‘Reason ceased’ from the drop-down list
• Enter free text in the ‘Ceased Description’ if required
• Choose whether to ‘Cease just this cycle’ or ‘Cease all future’
• Click ‘Save’ or ‘Save & Close’
• A record note is automatically created to log this action.

Notes:

• The function can be used to ‘skip’ a treatment where consecutive cycle numbering is not that important. If consecutive cycle numbering is important e.g. treatment has a set total number of cycles, then the Delay function should be used.
• The cycle ceased becomes inactive and drops down to the Ceased cycles window in Patient Protocol Cycles.
• Use the Omit function if you only want to cease a day of treatment within a cycle.

General notes on Appointment management

• Delay/Defer sends all the new appointment request/s to ‘Booking Requests’ to be rebooked into Episoft.
• Omit and Cease cancels the appointment(s) and medications.
• Reactivating an appointment in the Appointments List that has been cancelled via the Omit or Cease function does not reactivate the medications
• Cancelling an appointment in the Appointments List does not cancel the medications on the protocols.

Impact on Pharmacy:

• Defer/omit/cease functions send an email alert to Pharmacists regarding any ordered drugs to notify them of changes