Skip to main content

NHS Pathways system update - clinical release note - release 43.2.0

Release 43.2.0 was made available to suppliers and providers on 21 May 2024.

Page contents

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 43.2.0 are highlighted below.

Release 43.2.0 was made available to suppliers and providers on 21 May 2024.

Pharmacy First

Following work completed in Releases 41 and 42, 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 sinusitis, infected insect bite, and sore throat.

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:
  • Patients over the age of 12 years with declared sinusitis (sinus infection) and symptoms similar to a previous episode, with a fever for over 3 days or fever that has come back or had symptoms for more than 1 week.
  • Patients over the age of 1 year who have a suspected uncomplicated infected insect bite, who do not have a fever.
  • Patients aged 5 years of age and above who presented with a sore throat for more than 1 week and have had likely serious illness and complications of this condition excluded.

Peritoneal Dialysis

Following internal review changes were required to enhance the assessment of peritoneal dialysis (procedure to remove waste products and excess fluid from the blood using the inside lining of the abdomen as a filter when the kidneys stop working properly) in the Tube and Drain Problems pathway. 

The following changes have been made to the Tube and Drain Problems pathway:
  • All ages (except those under 16 weeks old) who have a fever will now receive a 6 hour Primary Care outcome to ensure an appropriate level of care is achieved.
  • Changes were made to the answer options for the question ‘Is the tube one of the following?’ 
  • The first answer option has been amended to include a PICC (peripherally inserted central catheter) line in addition to a central and Hickman line. This is to make it more specific by including all relevant methods used to access the bloodstream through the vein.
  • The fifth answer option has been amended to include the word ‘peritoneal’ in front of dialysis tube (tube in your tummy).

Major Bleeding from a Central Venous Access Device

Following a request for change, NHS Pathways were required to enhance the assessment for patients who have major bleeding from a central 
venous access device (CVAD- a device that is inserted into the body through a vein to enable the administration of fluids, blood products, medication and other therapies to the bloodstream).

The following changes have been made in the Major Bleeding pathway:

Patients who have Declared Wounds:
  • To identify patients who are receiving kidney dialysis or have a fistula (an abnormal connection between two body parts, such as an organ or blood vessel and another structure), two new questions have been added - ‘Is the bleeding from a fistula?’ and ‘Is the bleeding from a dialysis tube?’. Those without a fistula will be asked the new question ‘Is the bleeding from a dialysis tube?’ and if answered positively will receive new specific care advice.
  • Patients with neck wounds are now asked the new question ‘Is the bleeding from or around a neck breathing tube?’ and if answered positively, will receive new specific care advice.
Patients without Declared Wounds:
  • Patients not receiving kidney dialysis or who do not have a fistula will be asked the new question ‘Is the bleeding from or around a drain, tube or catheter' with further assessment questions: ‘Is the bleeding from or around a urinary catheter?’. ‘Is the bleeding from or around a neck breathing tube?’ with related new care advice. Patients with non-specific tubes or drains will receive  new specific care advice.

Acute Behavioural Disorder Restraint

NHS Pathways were required to make changes to the assessment for Acute Behavioural Disorder (ABD) for adults and children in Early Exit and Attend Incident to improve identification of when restraint has occurred.

What we changed
  • The new question ‘Has active restraint been declared?' has been created and included in Early Exit and Attend Incident to better identify when restraint has occurred in situations of known ABD and better identify it as a mental health emergency.

Deep Vein Thrombosis

Following stakeholder feedback, NHS Pathways were required to make changes to the assessment for Deep Vein Thrombosis (DVT).

The following changes were made
  • For adults and children, a new question has been created to enhance the assessment of pain associated with DVT: ‘Have you got either of the following symptoms? A new aching pain in one or both legs. A new pain in one or both calves.
  • Within the ‘Hip, Thigh or Buttock Pain or Swelling’ and ‘Knee or Lower Leg Pain or Swelling’ pathways, patients who were unable to walk 4 steps and had no other symptoms previously received a Non-Emergency Ambulance response (mapped to a category 4 response target) outcome but will now receive a 1 hour Treatment Centre outcome.
  • Those answering positively to the question ‘Has a whole leg suddenly become painful and swollen?’ previously received an Emergency Ambulance response outcome (mapped to a category 3 response target) but will now receive a 1 hour Treatment Centre outcome.

Breathing Supporting Information

Following stakeholder feedback, NHS Pathways were required to make changes to the question ‘Has the breathing got worse despite using prescribed medication?’.

We made the following change
  • The supporting information for the question ‘Has the breathing got worse despite using prescribed medication?’ has been amended to support Health Advisors and patients in differentiating between breathing improving whilst taking the medication and breathing improving overall.

Health info route PA159 enhancement

As part of the review to reduce the focus on COVID-19, numerous changes were required.

The following changes have been made:
  • The question ‘Has the caller declared that the problem is due to coronavirus?’ has been added to the assessment for patients requesting health information. If answered positively the patient will be assessed for COVID-19. If the question is answered negatively then the patient will be routed to the Health Information pathway.
  • All references to COVID-19 and/or self-testing have been removed from the questions ‘What information do you require?’ and ‘Can the caller access online services?’.
  • Patients who can access online services will receive new general health information care advice.

Last edited: 21 May 2024 10:28 am