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NHS Pathways system update - clinical release note - release 42.2.0

Release 42.2.0 was made available to suppliers and providers on 26 March 2024.

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NHS Pathways make changes to content based on:

  • new or emerging clinical evidence
  • change requests
  • feedback from our providers or wider stakeholders

NHS Pathways identifies areas of content that would benefit from enhancement. The aim of these enhancements is to provide clarity for users, and to benefit both users’ and patients’ experiences, thus ensuring that triage is as safe, effective, and efficient as possible.

What we've changed

The enhancements to Main Telephony made by NHS Pathways for Release 42.2.0 are highlighted below.

Release 42.2.0 was made available to suppliers and providers on 26 March 2024.

Pharmacy First

Following work completed in Release 41, to support work being undertaken by the Common Conditions Service as Part of Pharmacy First, NHS Pathways were required to review the outcomes for patients with shingles, acute otitis media (earache) and impetigo.

The following changes have been made to the system to allow community pharmacists to dispense antibiotics if required, under strict protocols, via the community pharmacy consultation service (CPCS) which has been subsumed into the new Pharmacy First service.

Patients with the following symptoms can now be sent to a Pharmacy First Common Condition Service:
  • Non-pregnant adults over 18 with suspected uncomplicated shingles, that have appeared within the last 3 days.
  • Patients aged between 1-16 who present with acute otitis media (earache), where likely serious illness and complications of this condition have been excluded.
  • To align with work completed in Release 41 for adults and children with suspected non bullous impetigo (skin infection that starts with red sores), toddlers answering positively to ‘Are there spots or patches covered with honey-coloured scabs?’ and who have answered negatively to other rash interrogation can now also be sent to a Pharmacy First Common Condition Service.

Coronavirus (COVID-19)

NHS Pathways were required to make changes to the system following the COVID-19 pandemic.

The following changes have been made to the system following the COVID-19 pandemic to focus on the patient’s main presenting symptom:
  • Patients with a cough, fever, tiredness (fatigue) or with a loss of sense of smell or taste will no longer be asked additional questions that were COVID-19 focused as they can be safely assessed by their main presenting symptom pathway.
  • In the Predetermined management Plan pathway, the question ‘HAVE ANY OXYGEN READINGS BEEN DECLARED?’ has been added to the assessment.
  • Within the Predetermined management Plan pathway patients who reached a previous specific COVID-19 outcome will now reach ‘Speak to a Primary Care Service within 1 hour’.

Return Of Spontaneous Circulation (ROSC) (restart of the heart following a cardiac arrest) in children and adults

Following a stakeholder request, NHS Pathways were required to make changes to the system to ensure adults, children and toddlers who have had successful resuscitation for cardiac or respiratory arrest receive a Category 1 ambulance 
outcome.

What we changed
  • Following work completed in Release 40 for infants, patients who are conscious following successful resuscitation after cardiac or respiratory arrest will now receive a ‘Emergency Ambulance Response for Potential Cardiac Arrest (Category 1)’ outcome.
  • Further to this work, those who have drowned in the past hour with no other injuries who have received successful resuscitation now receive the outcome ‘Emergency Ambulance Response for Potential Cardiac Arrest (Category 1)’ which has replaced the previous category 2 ambulance response outcome.

Agitation and Asthma

Following external feedback NHS Pathways were required to make changes to 
help better identify an acute asthma attack.

What we changed
  • In the Pathways relating to non-trauma emergencies the question ‘Are they confused or drowsy?’ has been replaced with ‘Are they confused, agitated or drowsy?’ to aid better identification of an acute asthma attack in adults and children.

Trans-Ischaemic Attacks (TIA) and Driving

As part of the management of strokes, NHS Pathways were required to make 
changes to driving advice for patients who may have had a Trans-Ischaemic Attack (TIA) (mini stroke).

We made the following change
  • New care advice to ‘Seek medical advice before driving’ has been added to the system where assessment suggests the patient may have TIA symptoms, UNLESS other care advice presents giving the instruction not to drive i.e. visual loss/dizziness/fainting.

Breathing Problems

Following internal review, changes were made to enhance assessment in the Breathing Problems and Chest Pain pathways.

We made the following change
  • In some parts of the Breathing Problems pathways, the presence of pulmonary embolism (when a blood clot blocks a blood vessel in the lungs), or pneumothorax (collapsed lung) risk factors did not change the outcome for callers who were well at the time of assessment. NHS Pathways were therefore able to shorten sections of the triage assessment so that people who have no functional impairment do not get asked about risk factors, to improve the user’s experience.

Attend Incident

Following stakeholder feedback, NHS Pathways were required to make changes to the Attend Incident module (999 services only).

NHS Pathways has made enhancements to the system to better allow Health Advisors using Attend Incident to select the appropriate dispatch category. This has resulted in the following changes:
  • A new question ‘Is this a suicide attempt or risk of suicide?’ has been added.
Following a request for additional instructions for those trapped in high rise buildings, NHS Pathways have made the following changes:
  • A new question has been created ‘IS THE CALLER TRAPPED IN A HIGH RISE BUILDING?’.
  • For patients who are trapped in high rise buildings, new care advice; ‘Safety, fire - trapped in high rise building’ has been created.
  • To enhance the Attend Incident module, ‘Emergency Ambulance Response for Accidental Poisoning (Category 3)’ and ‘Emergency Ambulance Response for Risk of Suicide (Category 3)’ outcomes have been added to the module. These outcomes are already accessible for callers to 111 and 999.

Scratches, Grazes and Minor Wounds Pathway

Following internal review, NHS Pathways were required to make changes to the Scratches, Grazes and Minor Wounds pathway.

We made the following change
  • An additional fever question has been added for children (infants) under 1 year of age so any signs of a fever with severe pain will reach the outcome ‘Speak to a Primary Care Service within 1 hour’

Coughed Blood Consistency

Following review, changes were required in the adult Chest and Upper Back Pain pathways to provide consistency across the system.

We made the following change
  • Within the adult Pathway patients who answer positively to the coughing up blood question will now receive a ‘To Contact a Primary Care Service within 6 hours’ outcome, to ensure consistency between the adult and child Chest and Upper Back Pain pathways.

Conflicting Ice Pack Care Advice

To ensure the system is in line with the latest guidance, NHS Pathways were required to make changes to all ice pack related advice.

We made the following changes
  • To ensure consistency throughout the system all care advice relating to timescales for using ice packs has been amended to 15 to 20 minutes.

Ebola Question in Headache Pathway

Following internal review, NHS Pathways were required to make changes to the Headache pathway to identify whether the patient may have Ebola.

We made the following changes
  • The Ebola question ‘Have you been in a country affected by the Ebola outbreak, IN THE LAST 4 WEEKS?’ has been added to the Headache pathway for adults only. The Ebola assessment question is included or not included dependant on advice from UKHSA

Last edited: 17 May 2024 9:59 am