Psychiatric Sample Database
From Ajexus
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Sample configurations
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Note: Ajexus is suitable for any healthcare provider. The sample databases provided show how Ajexus might be configured to meet specific needs. If you have different requirements, remember that in Ajexus you define the information that is to be recorded therefore Ajexus can easily be tailored to your needs.
The psychiatric sample database supplied with Ajexus covers the fictitious organisation 'CareWays Health Centre'. This organisation currently provides healthcare services in the area of mental health, and are looking at expanding into additional services in the future.
For a good example of a complete medical record for a patient, select 'John Brown'. For information on selecting records refer to Select a Patient Record in the Patient Record section in the User Guide.
Logins available
The following User Names are available in the sample database:
- 'administrator' has full rights to all information, as well as rights to the Data Dictionary
- 'justint' has full rights, except no rights to the Data Dictionary
- 'maryo' has rights to most elements, but has no rights to access staff information, and no rights to most reports
The Password for all the users in the sample database is 'password'.
For information on logging into Ajexus refer to Getting Started in the Operation section in the User Guide.
Episodes - Continuum of care
CareWays Health Centre have carried out a process mapping exercise and have identified a continuum of care they provide their patients. They have set up episodes within Ajexus to cover this continuum of care.
The continuum of care covers four key stages. It should be noted that where an organisation provides a range of services (such as a large hospital), a patient may have more than one continuum of care active at any one time. For instance, they may be having an orthopaedic episode following a broken hip, and may concurrently be having a mental health episode.
Referral
This is when a patient is first referred to the service, and the referral is triaged to decide whether CareWays Health Centre is able to assist. If so, the referral will be accepted, and the patient will pass to the assessment stage. If not, the referral will be declined, and the patient will possibly be referred on to a more appropriate service.
Assessment
This is when investigations, tests and assessments are carried out on the patient, with the objective being to arrive at a suitable diagnosis, and to create a care or treatment plan for the patient.
Treatment
This is where interventions according to the care plan are carried out with the intention of reaching the outcome goals identified. Treatment may include drug therapy, physiotherapy, and so forth. For organisations providing other services, it could include, for example, surgical intervention.
Discharge
This stage covers the tasks involved with the discharge of the patient. The patient may be deceased, may be referred on to another service, or to their own resources. Diagnosis on discharge can be recorded, and an evaluation made on whether the outcome goals identified in the Treatment phase were reached (or exceeded).
Elements
Within the episodes outlined above, CareWays Health Centre have identified what information they wish to collect.
Note:these elements are only one possibility, and Ajexus users are able to create a set of elements appropriate to their service.
These elements are:
Alert/Warning
This is used to record any alerts or warnings for the patient. These may range from allergies (such as penicillin) to psychiatric alerts. At CareWays, alerts can be entered in any stage of the care process.
Assessment
This is used to record the various assessments that are carried out on a patient, following the acceptance of the referral, and movement to the assessment stage. In the case of CareWays, these cover areas related to mental health, however Ajexus may be configured to cover almost any assessment. The parent element is used to record the assessment itself, while sub-elements are used to record the individual assessment elements. These have been designated as appointment elements, so that CareWays staff may use the scheduling capabilities of Ajexus to diary them.
Assign
Generally, patients are implicitly assigned to the various health professionals by the entering of elements with these people, for example, an assessment by a psychiatrist has this person designated as their psychiatrist. However, there are times when there is a need to explicitly assign a particular person, and this is done with the assign element. Assign elements can be entered at any stage of the care process.
Care Plan
At the conclusion of the assessment process, a diagnosis is arrived at, and a care or treatment plan is formulated. There may be one or more care plans, and these can be selected from a standard list and then modified to suit individual requirements. Sub-elements are used to record the individual care plan elements, and these can be checked off as they are completed.
Contact (Intervention)
During the treatment process the patient may have one or more contacts. These may be sessions, for example, with a psychiatrist or psychologist. These have been designated as appointment elements, so that CareWays staff may use the scheduling capabilities of Ajexus to diary them.
Diagnosis
At the conclusion of the assessment process an initial (working) diagnosis may be made along with one or more alternate diagnosis. At CareWays, sub-elements are used to record these as DSM IV codes, however, the structure of Ajexus allows practically any coding system to be used, such as ICD-10, READ or an in-house system. Diagnosis can be recorded at the assessment, treatment, or discharge stages.
Discharge
This records the actual discharge of the patient. Generally patients are discharged when deceased, treatment is complete, or they are better served by another service. Patients can also request that they be discharged (subject to any applicable laws). The date and reasons for discharge along with any other details can be recorded.
Inpatient Admission
CareWays offers residential facilities, that is to say it deals with in patients who occupy a bed, as well as outpatients and day patients. The inpatient admission element is used to record the assignment of a bed. This element is designated as an equipment element, therefore the equipment scheduling capabilities of Ajexus can be utilised. In addition, equipment such as beds are assigned from an equipment list, and can only be assigned to one person at one time (although they can be booked in advance). Inpatient admission can be entered in the assessment or treatment stages of care.
Inpatient Discharge
This is a companion element to the inpatient admission, and records the patients discharge for a bed. This is not to be confused with a discharge from the service, as, for instance, their status may be changing to that of a day patient or an outpatient. The workflow capabilities of Ajexus are used to automatically assign an outcome to the inpatient admission element when the inpatient discharge element is entered.
Investigation
This element records what investigation is undertaken on a patient, and contains detail that allows the user to select a standard test that may be used as part of the investigation and diagnosis process.
Letters
Letter templates can be created using the report writer function as any other element report. When a new letter is entered, the template takes information from Ajexus, formats it according to the template, and displays this information on screen from the preview toolbar option. CareWays use this facility to create and record all their letters sent to patients and health providers involved in the patient's care.
Loan Issue
This records the issue of any loan equipment from CareWays to the patient, for example, wheel chairs, books, and self help material. Equipment issued in this way is recorded against their inventory list, and the same item cannot be issued to more than one patient at the same time. Items may be issued at any stage of the patients care.
Loan Return
This records the return of loan equipment to CareWays from the patient. Workflow planning is used to mark the original issue element as returned, and the item may now be issued to another patient.
Medical Record
Ultimately, CareWays intend to only maintain an electronic record, but for historical and legal reasons it continues to maintain a paper record. This element is used to record the request, issue, and return of medical record(s) relating to a patient. This allows the location of the medical record to be tracked and known at all times. Medical record elements may be entered at any stage of the patients care.
Medication
Medication information is an important part of the patients record. CareWays is able to record the existing medications, any medications newly prescribed during care, together with any medications discontinued, by entering a medication element. The dispensing of medication is also recorded by using dispense sub-elements. Medication elements may be entered during any part of the patients care.
Mental Health Act
As CareWays provides mental health services, a number of it's patients are subject to mental health and legal justice requirements for assessment, treatment, and containment. Due to very specific rules, it is important to track the patients legal status closely to ensure that CareWays is complying with these requirements. Elements are used to accomplish this, and Ajexus capabilities such as workflow and automatic review dates are used assist in this process. These elements may be entered at any stage of the patients care.
Referral In
This records the receipt of a referral for the patient. Automation is used to start a new referral episode. The referral may be declined, and the patient referred on, or it may be accepted and the patient moved to the assessment stage. It is possible that a patient may have more that one episode active at any one time, that is, they may be in the treatment phase for one service, and in the assessment phase of another. This is especially true for organisations that provide a wide range of health care services.
Referral On
CareWays use this to record any referrals that are made on the patients behalf to other services. These may be different services provided by the same organisation (internal referral on), or services provided by outside services (external referral on). A referral does not necessarily indicate the end of the episode of care; the patient may be referred on for assistance as part of their assessment or treatment programme, or alternatively, a unrelated problem may be identified as part of their care which requires separate care from another organisation or service.
Review
A review is similar to an assessment, except rather than attempting to ascertain the cause of the problems the patient is experiencing, it is designed to determine how effective the treatment is in combating the problem. The outcome of a review may be for treatment to be concluded, and the patient moved to the discharge stage, for treatment to be continued, for treatment to be altered and a new care plan put in place, or for the patient to be returned to the assessment stage. Review elements can be entered in the treatment stage of the episode.
Treatment Outcome
At the conclusion of the treatment stage, a treatment outcome element is entered to indicate how successful the treatment plan has been. The patient may have fully recovered, their condition may have improved, remained constant, deteriorated, or they may be deceased. A worsening condition does not necessary mean that treatment was unsuccessful; for a terminal cancer patient the treatment goal may have been to minimize pain and this was achieved even though the patient died. Treatment outcomes are entered in the treatment stage of the episode.
Waiting List
Ultimately, CareWays would like to not have waiting lists, however this is not currently possible. Patients may be waiting for assessment, a bed, to go on a group therapy program, and so forth. Urgency is recorded in Ajexus, and waiting times derived.
Note: this is only an example of the different elements that may be set up within Ajexus to record patient details. Practically any information can be stored in the patients record.
Patient Element Lists
As the various elements and sub-elements detailed above are entered in the patients record, a large patient record of information builds up. To simplify the viewing of the patient record, it is possible to create element lists that filter, order, and group the information. This results in only the information of interest being shown.
Any element list can be setup in Ajexus, and CareWays have settled on the following:
Alerts and Warnings
This element list shows any alerts or warnings entered for the patient. It has been designated by the CareWays Ajexus administrator as the alerts element list. This allows it to be selected via the separate alerts menu item. In addition if the patient has an alert set, a label with a red caption ("This record has ALERTS") will appear on the patient's demographics screen to highlight this to the Ajexus user.
Assessments & Reviews
This shows all the assessments and reviews that have been undertaken with the patient. This element list is useful for clinicians to see what investigations have already been carried out as they plan further care.
Contacts
Displays the contacts that the patient has had scheduled with their psychiatrist, psychologist, case worker or social worker for 'talking' therapy. Generally, a series of contacts are scheduled using the recurring element capabilities of Ajexus. This element list displays the outcomes, including whether the patient did not arrive, arrived late, or the session was cancelled for any reason. This element list allows a picture of the length and success of the contact series to be examined.
Diagnosis (DSM IV)
This displays the current diagnosis recorded for the patient. In the case of CareWays DSM IV is used, although practically any coding system can be supported. This element list could be combined with 'Assessments and Reviews' above to give an overall picture of the investigation and conclusion into the patients problems.
Full Record (Grouped by date)
This shows the complete medical record for the patient, grouped in strict (reverse) chronological order. This element list could be useful for someone wishing to fully acquaint themselves with the medical history, such as a new clinician taking over the case. Over time this element list can become unwieldy as a large amount of information accumulates.
Full Record (Grouped by episode)
Similar to the element list above, but now the record has been grouped by episodes. In the case of CareWays, episodes are used not only to distinguish the service, but also the stage of care within that episode. This element list is also useful for someone that wishes to acquaint themselves fully with the patients record, but again can become unmanageable as the volume of information grows.
Inpatient Events
Letters
This element list is used to show all the correspondence that has been generated using the element report capability of Ajexus. Letters can also be displayed using the preview menu option. The letters element list is very useful for clinicians, as reading the last element list letters can give a good summary of the patients recent condition and treatment.
Loan Equipment
This element list shows any equipment that is currently on loan to the patient. This is useful for administration staff that need to see at a glance whether any equipment is issued to the patient, and if so at what status.
Medical Record (Paper)
Over time, the need for paper records will diminish as Ajexus fulfils this function. Prior to the implementation of Ajexus, paper records were used extensively at CareWays, and these remain in use. In addition, information is still received from outside agencies in paper form. Overtime, more information from outside agencies will be sent in electronic form and less in paper form. Additionally, CareWays intend to scan the most important historical information to store electronically.
Medications
This element list shows all medications that are currently prescribed for the patient. Clinicians consult this when reviewing treatment options and making alterations to medication.
Mental Health Legal Status
Where patients assessment and treatment is subject to applicable laws, orders and legal requirements, this element list can be used to show the process undertaken to meet any prerequisites.
Organ donation
Highlights any undertakings that the patient may have made in regards to organ donation. A check of this element list will remove the possibility of administrative staff asking a patient the same question again.
Test Results
This element list displays any test results that are in the patients record. Review of these is useful as a clinician assesses and treats the patient, and also reduces the problem of a test being unnecessarily re-ordered.
Treatment Plans
This element list shows any treatment or care plans that may have been formulated for the patient. It is possible to have multiple care plans that each relate to different disciplines involved in patient care.
Summary Reports
*All Information
Displays all elements recorded against all patients and staff.
Accidents /Incidents
Displays any accidents or incidents recorded. Accidents and incidents may involve staff and/or patients, and include needle stick wounds, falls, skin tears, and so forth.
Accidents /Incidents Last Week
Displays any accidents or incidents recorded in the previous week. Accidents and incidents may involve staff and/or patients, and include needle stick wounds, falls, skin tears, and so forth.
Alerts Or Warnings (By Person)
Displays a list of all people that have alerts or warnings entered against them.
Appointments - Community for Today by Staff Member
This is a sample appointment list to show community appointments for staff scheduled for today. Normally, when selecting this report, the particular staff member whose appointments are required is also selected from the element summary screen.
Appointments - Community For Tomorrow By Staff Member
Similar to above, but displays all community appointments scheduled for tomorrow. Again the particular staff member of interest can be selected.
Appointments - All For Tomorrow By Staff Member
Similar to above but showing all appointments scheduled for tomorrow. Again the staff member of interest can be selected.
Appointments - All For Today By Staff Member
Similar to above but showing all appointments scheduled for today. Again the staff member of interest can be selected.
Appointments - Outpatients For Today By Staff
Similar to above but showing all outpatient appointments scheduled for today. Again the staff member of interest can be selected.
Appointments - Outpatients For Tomorrow By Staff
Similar to above but showing all outpatient appointments scheduled for tomorrow. Again the staff member of interest can be selected.
Assessments - Overdue
Shows any assessments that should have been carried out by a defined point, but have not. Where a patient is subject to legal proceedings, it is particularly important that assessments are carried out within the prescribed time frame.
Assessments - Due This Week
Shows any assessments that are due this week.
Assessments - Due Today
Shows any assessments that are due today.
Beds In Use
Shows all beds in use, that is, those that are occupied by a patient. Note: the equipment planner also has this functionality.
Consents - Outstanding
It is often required to obtain a consent for treatment, either from the patient themselves, or from someone with the authority to consent on the patients behalf. This summary displays any consents that are required but have not yet been given (or declined).
Deceased Last Month
Displays the patients who were discharged last month for the reason that they are deceased.
Inpatient Admissions - By Location
Displays a list of current inpatients, sorted by the location of the admission.
Inpatient Admissions - By Date
Displays a list of the current inpatients, sorted by the date on which they were admitted as an inpatient.
Letters
Provides a list of all recent correspondence.
Loan Equipment
Provides a list of all equipment that is currently out on loan. This is useful to ascertain who has what equipment and for how long.
Medical Record Requests - Outstanding
This provides a list of all (paper) medical records that have been requested and the request is still outstanding. At CareWays this is used by the medical records department staff to process requests for records..
Medical Records In Use
Provides a list of all (paper) medical records that are currently issued. Again, the medical records department staff use this list to ascertain the whereabouts of medical records that are requested and on issue.
Outpatient Letters - Not Sent
This summary provides a list of correspondence that has been generated, and is awaiting approval.
Referrals In - All Outstanding
When a referral is received, a triage process is carried out as to whether or not the referral is appropriate for CareWays to deal with. This summary provides a list of referrals that have been received, and are awaiting a decision as to accept or not accept the referral.
Referrals In - Received Today
This summary provides a the list of all referrals received today. Generally, CareWays aim to turn around non-urgent referrals within a day, and urgent referrals within an hour.
Referrals Out - All Outstanding
At CareWays, patients are often referred to other services. These services may be operated by CareWays itself, or by other organisations. Sometimes the referral will be for assistance as part of the patients care at CareWays, and at other times the referral out will mark the completion of that care. Once a referral out is made, confirmation is requested that the referral has been actioned satisfactorily. This summary provides a list of all referrals out that have been made, and for which appropriate confirmation has been received.
Reviews - Due This Week
This summary provides a list of any reviews due this week.
Reviews - Due Today
This summary provides a list of any reviews due today.
Reviews - Outstanding
Shows any reviews that should of been carried out by now but have not. Where a patient is subject to legal proceedings it is particularly important that reviews are carried out within the prescribed time frame.
Staff Employment
Displays a list of all staff employment elements. This is an example of a report for staff.
Waiting List - Inpatient Admission
Provides a list of all patients on the waiting list for an inpatient admission.
Total Reports
There are also various total reports available. These reports are similar to the summary reports, but return totals of the information, rather than the actual elements.
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