Health Promotion Audit Proforma

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Health Promotion Audit Proforma Powered By Docstoc
					       User Manual
             For
National Health Promotion in
 Hospitals Audit (NHPHA)



       www.nhphaudit.org
Contents

Purpose ........................................................................................................... 3
Audience .......................................................................................................... 3
Overview .......................................................................................................... 3
Patient selection............................................................................................... 4
   Inclusion criteria – all hospitals .............................................................................. 4
   Exclusion Criteria – all hospitals ............................................................................ 4
   Time frame ............................................................................................................ 4
   Sample size ........................................................................................................... 4
Demographic Data ........................................................................................... 5
   Manual input .......................................................................................................... 5
Simple guide to collecting data and completing the audit pro forma .............. 11
   Assessment of risk factor ..................................................................................... 11
   Identification of risk factor/need for health promotion ........................................... 11
   Health Promotion delivered.................................................................................. 11
   Step-by-step guide to completing the pro forma ................................................... 16
Double data collection.................................................................................... 17
Detailed user guide to completing each question on the pro forma and data
base ............................................................................................................... 18
   Patient Data ......................................................................................................... 18
   Smoking .............................................................................................................. 18
   Alcohol................................................................................................................. 21
   Weight and nutrition ............................................................................................. 25
   Physical activity ................................................................................................... 29
Website structure and database stages ......................................................... 33
   Login page ........................................................................................................... 34
   Change password page ....................................................................................... 35
   Data entry stages................................................................................................. 36
   Patient Demographic data stage .......................................................................... 37
   CSV file upload stage .......................................................................................... 38
   Select patient for audit data entry – CSV upload screen ...................................... 39
   Manual input of demographic data - Submit another patient record stage screen 41
   Select patient for audit data verification screen .................................................... 42
   General notes on data entry wizard and the data entry controls........................... 44
   Data entry wizard: Stage 1 – patient details (CSV file upload) ............................. 45
   Data entry wizard: Stage 2 – Smoking ................................................................. 46
   Data entry wizard: Stage 3 – Alcohol ................................................................... 48
   Data entry wizard: Stage 4 – Weight & nutrition ................................................... 50
   Data entry wizard: Stage 5 – Physical Activity ..................................................... 52
   Download hospital data and summary report screen ........................................... 53
CSV Upload File Specification for the NHPHA data entry system ................. 55
   Structure of the CSV File: .................................................................................... 55
   Validation tests that will be performed on the CSV data ....................................... 56
   Sample CSV file structure: ................................................................................... 58

The contents section is hyperlinked – press CTRL and click on the required section.




Created on 24/02/2011 12:32:00 Third draft                                                                              -2-
Purpose
The purpose of this document is to describe in detail how to undertake the National
Health Promotion in Hospitals Audit.

Audience
This document has been written for all users of the National Health Promotion in
Hospitals Audit, in particular IT analysts and data collectors.

Overview
The National Health Promotion in Hospitals Audit is an IT application in which audit
information regarding the assessment of adult hospitalised patients for risk factors –
smoking, alcohol misuse, obesity and physical inactivity - and the delivery of health
promotion to patients who are found to smoke/misuse alcohol/be obese/physically
inactive is recorded.

When providing demographic details by downloading the CSV file, the IT system has
two main components:
1. The user adds demographic data to the system by importing (CSV) data files onto
the database. These data files are uploaded to the system by the user via the web
front-end. Details of the CSV upload file specification are provided on page 52.
2. The demographic details become the record for selecting cases to directly input
data on assessment of risk factors, evidence of risk factors, and delivery of health
promotion using data-entry screens specific to each risk factor.

When demographic details are provided manually by the data collector then these are
added on a case by case basis at the same time as inputting the data from the audit
pro forma until 100 cases have been entered.

This document provides the details of how to select patients for inclusion into the audit,
the CSV Upload File Specification for patients‟ demographic details and a simple guide
to collecting data and completing the audit pro forma. The information provided in
these sections should be adequate to complete the audit data collection as the paper
pro forma and database have been designed to be intuitive to complete and user
friendly. However, a user guide is also provided which gives detailed information on
how to complete each field on the database and pro forma. This information is also
directly accessible via the help icons next to each data field on the database. In
addition, a step-by-step guide to using the website pages and each data entry screen
making up the IT database system are provided. If you have any additional queries or
comments on this user manual please contact the NHPHA offices on 0161 419 4220/
0161 419 5984 or support@nhphaudit.org.




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Patient selection
Inclusion criteria
Patients must have been discharged alive.
Patients must have been discharged from a medical or surgical ward – HES (Hospital
Episode Statistics) treatment specialty can only be “general medicine” or “general
surgery”.
Patients must have been hospitalised – i.e. admitted for at least 1 day.
Patients must be aged 17 years or older.
Patients must have been discharged between March 1st and March 31st 2011
inclusive.
Patients must have the following demographic details available: age, gender, date of
discharge, duration of episode, treatment specialty, primary diagnosis (ICD-10 code).


Exclusion Criteria
The following patients are excluded:
    paediatric patients
    maternity patients
    day cases
    outpatients
    rehabilitation admissions
    respite care admissions
    any patient with a terminal malignancy: ICD-10 diagnoses code C77-C80
       inclusive (metastatic cancer). Patients should also be excluded if inspection of
       case notes reveals a terminal illness. They will need to be deleted from the
       database – please contact the administrator to do this
    Patients less than 17 years of age
    Admitted for less than 1 day (same admission and discharge date)


*Time frame - The discharge dates are between March 1st and March 31st 2011
inclusive HOWEVER if less than 120 patients have been discharged in this time
period, you should extend the first time period to the date at which you will have 120
discharged patients by March 31st 2011. For example if you have only 110 eligible
patients discharge between March 1st and March 31st 2011, if 10 more patients were
discharged between February 22nd 2011 and February 28th 2011, extend your time
period for inclusion to February 22nd 2011 to March 31st 2011 inclusive. DO NOT
extend the final discharge data of March 31st 2011.

Sample size
Data will be collected for a total of 100 patients. To ensure that 100 cases are
available to data collectors, 120 patients meeting the inclusion criteria should be
randomly selected by IT. If dates need to be extended due to small sample size, then
120 patients exactly should be selected from the extended time frame. From the list of
120 patients, data collectors should complete the audit on the first 100 cases they are
able to pull.




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Demographic Data

Manual input

This section is intended for data collectors that will be manually inputting demographic
details onto the on-line database. A demographic details data collection sheet can be
downloaded directly from the website at https://www.nhphaudit.org/Publications.aspx
and is also provided overleaf. The following details are required for each case:

   System ID - This will be sequential from 1 for the first patient, 2 for the second
    patient and so on until 100.
   Age - Patient‟s age at discharge in whole years. This must be between 17 and
    120.
   Gender - Male or Female.
   Postcode District – OPTIONAL - First part of postcode plus first digit of
    second part of postcode e.g. BN43 2 not BN43 2BD. If you can not get
    details of the postcode, then this information can be left out.
   Length of Stay – provide the value in whole days. This information should be
    provided to you by your IT department. If you need to calculate it yourself, then
    use your patient administration system to get the admission date for the episode
    that relates to the episode with the discharge date between March 1st and March
    31st 2011*. Length of stay is the difference in days between the admission date
    and the discharge date; and the value must be between 1 and 731 days.
   Discharge Date – INFORMATION NOT PUT ON ON-LINE TOOL - provide details
    in the following UK format: DD/MM/YYYY. Date must not be after 31/3/2011.
   Treatment Specialty – This must be General surgery OR General medicine.
   Primary Diagnosis – An ICD-10 code which has either 3 characters e.g. R56 or 4
    characters e.g. R56.8. There will be a drop down menu to select the ICD-10 code
    from. Please make sure ICD-10 codes C77-C80 are not present (see Exclusion
    Criteria).
   HRG Code - OPTIONAL – This is the Healthcare Resource Group HRG
    V3.5 code. Details may be provided by your IT department, but if you can
    not get these details then this section can be left blank.
   User Defined ID – INFORMATION NOT PUT ON ON-LINE TOOL - this is so that
    the data collector can identify the case in order to get data – for example, patient‟s
    case note number, hospital number or national insurance number could be used.




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You may use this sheet to record demographic details that you will be inputting onto the online database. Complete the information
below only when you have the case notes – you will be expected to input data onto the on-line database for each case in the order
that the details are provided below, i.e. the case note with system ID 1 is the first case note that you will input audit data for, system
ID 5 will be the 5th case note, and so on until data on 100 cases has been inputted.

System          Age -         Gender -      Postcode               Length       Discharge              Treatment            Primary                 HRG Code           User Defined ID –
                Patient‟s
ID - This
                age at
                              write M       District - 1st         of Stay      Date –                 Specialty –          Diagnosis –             - Healthcare       this is so that you know
will be 1                     (male) or F   part of postcode                    DD/MM/YYYY             Must be either       ICD-10 code             Resource Group     which case note the
for the first   discharge     (female).                            - value in                                                                                          information relates to –
                in whole                    & first digit of 2nd   days.        formatted date. Date   General surgery or   accepted by HES:        HRG V3.5 code.
patient, 2                                  part only e.g.                      must not be after      General medicine.    either 3 characters     This is optional   for example, patient‟s
for the         years. This                                        Must be                                                                                             case note number,
                must be                     BN43 2 NOT             between 1    31st March 2011 –                           e.g. R56 or 4           so can be left
second                                      BN43 2BD. If                        30/03/2011.                                 characters e.g.         blank.             hospital number or
patient and     between 17                                         and 731.                                                                                            national insurance
                and 120.                    the patient does                                                                R56.8 (full stop will
so on until                                 not have a                                                                      be removed in the                          number.
100.                                        postcode leave                                                                  drop down list on
                                            blank.                                                                          the database)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

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System    Age       Gender      Postcode     Length    Discharge   Treatment   Primary     HRG Code   User Defined
ID                              District     of Stay   Date        Specialty   Diagnosis
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

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System    Age       Gender      Postcode     Length    Discharge   Treatment   Primary     HRG Code   User Defined
ID                              District     of Stay   Date        Specialty   Diagnosis
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

Created on 24/02/2011 12:32:00 Third draft                              -8-
System    Age       Gender      Postcode     Length    Discharge   Treatment   Primary     HRG Code   User Defined
ID                              District     of Stay   Date        Specialty   Diagnosis
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100



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CSV Upload File Specification for the NHPHA data entry system

This information is intended for the IT analyst(s) responsible for selecting patients for
inclusion into the audit and can be downloaded directly from
https://www.nhphaudit.org/Publications.aspx or found at the end of this document at
CSV Upload File Specification for the NHPHA data entry system.




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Simple guide to collecting data and completing the audit pro forma

Data for this audit will consist of any written documentation in a patient‟s case notes that
they were asked about risk factors (assessed), and where there was evidence of a risk
factor, that some form of health promotion was delivered. Written documentation could
include medical and nursing admission notes, integrated care pathway documents, ward
notes, medication lists, discharge letters and so on. This will assess everyday practice of
hospital healthcare professionals rather than efforts of specific health promotion staff. For
patients with a treatment specialty of “general medicine” only look at case notes relating to
the hospital episode which ended with the discharge date selected for inclusion into the
audit. For patients discharged with a treatment specialty of “general surgery”, we are
requesting that the notes from the whole spell are reviewed for details of risk factor
assessment, etc. This will include pre-operative outpatient department notes, the
anaesthetic pre check and the post- operative visit.

Assessment of risk factor
Any documented mention within a patient‟s case notes that they were or were not a
smoker is recorded as a smoking history being recorded.
A record of alcohol intake (this could take the form of number of units per day or week, or
a written label: occasional/low, hazardous, and harmful) is classified as recording alcohol
history.
Several measurements (body mass index, waist measurement, mid-arm circumference,
triceps skin fold thickness, and clinical impression) can be used to categorise the patient‟s
weight as underweight, normal weight, overweight, obese or morbidly obese.
Assessment of physical activity can be difficult to establish, so any written indication that
the patient was asked about their normal physical activity is taken as an indicator that the
patient‟s level of physical activity was recorded.

Identification of risk factor/need for health promotion
Health promotion is deemed as “needed” for each risk factor independently:
If someone is a smoker or quit smoking for less than 4 weeks they should have received
health promotion for smoking cessation.
For alcohol: consumption of alcohol above recommended weekly limits of greater than 21
units for men, and greater than 14 units for women (more details for categorisation alcohol
consumption are given on the back of the paper pro forma and provide in the help notes
on the NHPHA database).
For weight management health promotion: all patients who are categorised as obese
should be delivered health promotion for weight loss. As it may be appropriate to deliver
health promotion to patients who are overweight, it will be possible to record any health
promotion that is delivered to overweight patients as well as obese patients.
For physical activity: if the patient is independently mobile at discharge, then evidence that
they engage in less than thirty minutes of moderate physical activity five times a week
(Department of Health guidelines) indicates physical inactivity.

Health Promotion delivered
All forms of potential health promotion for each risk factor are to be recorded. This
includes verbal advice, written advice, referral to a specialist, and referral to a GP/practice
nurse. Specific drug treatments are also included: nicotine replacement therapy in the
case of smokers, and Chlordiazepoxide for alcohol withdrawal (however the latter is not
deemed as health promotion).

The paper pro forma is provided below, followed by a simple step-by-step guide to
completing it. Download the pro forma at https://www.nhphaudit.org/Publications.aspx.

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1. User help notes on alcohol categorisation
Written descriptions of the amount of alcohol consumed can vary greatly within and between case notes. If the
written descriptions describe the patient‟s alcohol consumption using the terms provided as options (e.g.
recommended) then use these. If someone is described as a “sensible” drinker or drinking a “low” amount of
alcohol then respond “recommended”. If the patient is described as a dependent drinker, respond “Harmful”.

If the amount of alcohol consumed is described in terms of units then the following definitions apply:

For women 2 to 3 units a day: Recommended               For men 3 to 4 units a day: Recommended
For women 1 to 14 units a week: Recommended             For men 1 to 21 units a week: Recommended
For women 15 to 35 units a week: Hazardous              For men 22 to 50 units a week: Hazardous
For women more than 36 units a week: Harmful            For men more than 51 units a week: Harmful


If the only written information describes the type and amount of alcohol consumed, e,g, one glass of sherry a day
then the units can be calculated using the alcohol unit calculator found at http://units.nhs.uk/unitCalculator.html or
by using the drinkaware.co.uk Unit Calculator provided.

The following descriptions of alcohol consumption are examples of what can be classified as recommended,
hazardous, and harmful alcohol consumption in men and women:

For women 1 glass (50ml) of sherry (fortified wine) a day: Recommended
For women 1 (750ml) bottle of wine a week: Recommended
For women 3 (750ml) bottles of wine a week or 1 standard bottle (700ml) of spirit a week:
Hazardous
For women a 1 litre bottle of spirits a week: Harmful

For men 1 pint of beer (3% to 6% strength) a day: Recommended
For men 7 cans (440ml) of beer (4% strength) and 1 bottle of wine (12% strength) a week:
Recommended
For men a 1 litre bottle of spirits a week: Hazardous
For men 1 standard bottle (700ml) of spirit and 7 super strength (9%) 440ml cans of beer a
week: Harmful


2. User help notes on weight categorisation
Weight category based on BMI supersedes any of the other measurements that may have been used to describe
the patient‟s weight in their case notes. Weight categorisation based on waist measurement, mid arm
circumference, and triceps skinfold thickness supersedes “weight only” and “clinical impression”. Clinical
impression supersedes “weight only”.

If you have the details of the patient‟s weight and height, you can calculate BMI in the following way:
                               2
Weight (kg) ÷ height (metres)
e.g. if someone weighs 65 Kgs and are 1.65 metres tall then their BMI is 65 ÷ (1.60 x 1.60) = 65 ÷ 2.56 = 25.39
which is “overweight”. A BMI calculator can be found at http://www.fitandtrim.co.uk/bmi_calculator.html which
allows you to enter either metric or imperial measurements to calculate BMI.

The BMI categories are as follows:          Underweight = BMI <18.5          Normal weight = BMI of 18.5 to 24.9
Overweight = 25 to 29.9                     Obesity = BMI of 30 to 40.0      Morbidly obese = BMI  40

3. User help notes on determining whether health promotion for physical activity is required
The Department of Health (DH) recommends that adults participate in at least thirty minutes of moderate intensity
activities on five days of the week. “Moderate intensity” describes any activity that will result in feeling warm,
slightly out of breath, a raised heart rate and a light sweat. Examples include brisk walking, cycling, housework,
and dancing. If an adult does not participate in at least thirty minutes of moderate intensity activities on five days
of the week they are described as “inactive”.

Respond “NO” to “Was health promotion required?” if the patient is not independently mobile - if the patients is
described as immobile, bed mobile, wheelchair mobile or mobile with a walking device, then the immediate
priority is expected to be on improving mobility rather than increasing physical activity to DH guidelines above.

Respond “YES” to “Was health promotion required?” if the patient was independently mobile (if known) and/or
inactive and/or needed to lose weight and/or had a condition which would benefit from increasing physical activity
(e.g. cardiovascular disease, diabetes, musculoskeletal diseases, and clinical depression).

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In response to concerns that data collectors were completing all pro forma fields, even when they were not relevant and/or that the audit pro
forma did not follow the logic steps of the on-line tool, an alternative paper pro forma has been designed which reflects the logic steps:




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Created on 24/02/2011 12:32:00 Third draft   - 15 -
          Step-by-step guide to completing the pro forma




                                                                                       No further questions can be answered about this risk
                                                        2. No        Reason?                        factor, go to next risk factor
             1. Risk factor history recorded?

                                                        3. Yes



                                                                                                   4. No
                                    Is there information indicating that the patient
                                                  has the risk factor?
                                                                                                   5. Yes




                                                                           Was the patient given any of the described forms
                                                                          of health promotion aimed at changing the patient‟s
                                                                                behaviour in relation to the risk factor?




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Questions follow a similar pattern for each risk factor.

1. Was their any written information in the patient‟s case notes that indicated the
patient was asked about a risk factor, e.g. “smoking history recorded?”. This question
must be answered. The only possible options are “yes” or “no”.

2. If the answer to 1. is “no”, then you are asked whether the reason for the patient not
being assessed was due to the patient being unconscious for the whole spell or
diagnosed with delirium or dementia. If one of these is not the reason, then respond
“no” to the question “was a reason given for “no”?” No more questions can now be
answered about the risk factor. Move on to questions on the next risk factor on the pro
forma/next data entry screen in the database.

3. If the answer to 1. is “yes” then you must answer the next question(s) which ask for
information to ascertain whether the patient is engaging in a risky behaviour (e.g.
smoking cigarettes) or has a risk factor (e.g. obesity).

4. If there is no information indicating that patient engages in the risky behaviour/has
the risk factor then questions concerning health promotion for the risk factor are
irrelevant and no more questions concerning the risk factor need to be completed.
Move on to the next risk factor on the pro forma/next data entry screen in the
database.

5. If the patient does engage in the risky behaviour/have the risk factor then the
questions concerning health promotion should all be answered. On the paper pro
forma you can place a tick or cross in each box, on the data entry screens of the
database you will be asked to respond “yes” or “no” to each option – none should be
left unselected.

6. Move on to the next risk factor until data on all risk factors has been completed.

Double data collection
Once the audit data for all patients has been collected the web database will
automatically select a random sample of 20 patients, of which 10 should have double
data collection (20 are initially selected to ensure that the data collector can access the
case notes for 10 patients). This will entail a second data collector who did not
previously collect data to review these 10 patients‟ case notes and to complete the
same NHPHA data again. Purpose: to assess inter-rater reliability as a check for
accuracy in recording data.




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       Detailed user guide to completing each question on the pro forma and data base

                Field                               Field Options      Help notes
     Patient    System ID                           1-100              This will be a number from 1 to 100 only. The first case you collected data on should be
                                                                                                                                                               th
     Data                                                              system ID 1, for the second patient this will be system ID 2 and so on until the 100
                                                                       case, which is system ID 100. Do not collect data on more than 100 cases.
                Age                                 17-120 years       This is the age of the patient at discharge in whole years. Anyone under the age of 17
                                                                       years old is excluded.
                                                                       This information is mandatory.
                Gender                              Male, Female       This is the gender of the patient.
                                                                       This information is mandatory.
                Postcode District                   Free text          Provide details of the first part of postcode and first digit of second part only e.g. BN43 2
                                                                       not BN43 2BD. If you can not get details of the postcode, then this information can be left
                                                                       out – this information is optional.
                Length of Stay                      1-731 days         This is the length of stay in whole days. Length of stay can be calculated as the
                                                                       difference in days between the admission date and the discharge date. For example, if
                                                                                                               th                            th
                                                                       the patient was admitted on March 12 and discharged on March 15 , the length of stay
                                                                       3 days.
                                                                       This information is mandatory.
                Treatment Specialty                 General surgery,   This is the treatment speciality. Contact your IT department if you are having difficulty
                                                    General medicine   getting this information.
                                                                       This information is mandatory.
                Primary Diagnosis                   Free text          This will be an ICD-10 code which has either 3 characters e.g. R56 or 4 characters e.g.
                                                                       R56.8 and can be a primary diagnosis. ICD-10 codes C77-C80 are not present as cases
                                                                       with these diagnoses codes are excluded from the audit.
                                                                       For further information on acceptable ICD 10 codes see
                                                                       http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=203
                                                                       and
                                                                       http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=214
                HRG Code                            Free text          This is the Healthcare Resource Group HRG V3.5 code. If you can not get these details
                                                                       then this section can be left blank – this information is optional.

     Smoking    Was the patient‟s smoking history   No, Yes            Information on smoking history is most likely to be recorded during admission or pre-




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                recorded?                                                    operatively. However all written information on a patient‟s spell ) should be looked at for
                                                                             information that a patient was asked whether they smoke tobacco - i.e. all documentation
                                                                             from date of admission to discharge for “general medicine” including the nursing Kardex;
                                                                             and for “General surgery” this also includes the pre-op assessment, outpatients notes,
                                                                             the anaesthetic pre-check and the post-op visit notes.

                                                                             Respond “yes” if there is any information which allows you to tell that the person is not a
                                                                             smoker or is/was a smoker as this indicates that the patient‟s smoking history has been
                                                                             recorded. You can assume that a person‟s smoking history has been recorded even in
                                                                             the absence of an explicit statement that the patient is a smoker if, for example, there is
                                                                             information pertaining to smoking cessation, e.g. “patient told to quit smoking”.
                                                                             Respond “no” if there is absolutely no documentation about the person‟s smoking status
                Was a reason given for no smoking   No, Unconscious for
                                                                             If you have answered “no” to “was the patient‟s smoking history recorded?” you must
                history being recorded?             whole spell, delirium,   provide a response to this question.
                                                    dementia
                                                                             If the case notes indicate that the patient was unconscious for the WHOLE spell (i.e. not
                                                                             just part of the spell) then respond “unconscious for whole spell”,

                                                                             If the patient has been diagnosed with any of the following forms of delirium: F05
                                                                             Delirium, Not Induced By Alcohol And Other Psychoactive Substances F05.0 Delirium,
                                                                             Not Superimposed On Dementia, So Described F05.1 Delirium, Superimposed On
                                                                             Dementia F05.8 Other Delirium or the case notes indicate that the patient has delirium
                                                                             then respond “delirium”,

                                                                             If the patient has a diagnosis of dementia (ICD-10 code diagnosis of F00 to F03
                                                                             inclusive) then respond “dementia”.

                                                                             Patients with delirium or dementia have not been excluded from this study due to
                                                                             previous Research Ethics Committee opinion that these patients should not be excluded
                                                                             from the delivery of health promotion.

                                                                             If the patient was conscious and does not suffer from dementia or delirium, then respond
                                                                             “No”.

                                                                             Once you have answered this question you will be automatically directed to the next




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                                                                      screen as the remaining questions on smoking can not be answered.
                Is the patient a smoker?         Ex-smoker, current   If there is any written documentation that the patient has smoked in the past, but no
                                                 smoker, never        longer smokes, then respond “Ex-smoker”. Whether the patient stopped smoking years
                                                 smoked               or weeks ago, they should be categorised as an “Ex-smoker”.

                                                                      If there is any written documentation that the patient smokes tobacco respond “current
                                                                      smoker”. The amount smoked does not influence this categorisation – anyone from a
                                                                      social smoker to a heavy smoker should be categorised as “current smoker”.

                                                                      If there is any written documentation that the patient was asked whether they smoke and
                                                                      they responded “no” or the notes state that the patients does not smoke, and never has
                                                                      smoked, then respond “never smoked”.
                Was health promotion required?   No, Yes              If the patient is a current smoker then respond “yes”.

                                                                      If the person is an ex-smoker and length of time quit is less than 4 weeks and/or they quit
                                                                      during this hospital admission then respond “yes”. If the patient is an ex-smoker but has
                                                                      asked for advice, etc on continuing to quit smoking then respond “yes”.

                                                                      If the patient is an ex-smoker and has quit for more than 4 weeks, and/or quit before this
                                                                      hospital admission (if admission has been more than 4 weeks), and/or has not asked for
                                                                      advice, etc on continuing to quit then respond “no”.
                Patient asked if want to quit?   No, Yes              If there is any written documentation that any healthcare professional caring for the
                                                                      patient has asked him/her whether he/she wishes to stop smoking; and/or asked the
                                                                      patient if they want to be provided with advice on how to stop smoking then respond
                                                                      “yes”.

                                                                      The provision of health promotion for smoking cessation (verbal advice, written advice,
                                                                      referral to a smoking cessation service or specialist) does not necessarily indicate that
                                                                      the patient was asked if they want to quit.
                Did patient want to quit?        No, Yes              If there is any written documentation that the patient responded that they wanted to quit,
                                                                      respond “yes”.
                                                                      If there is any written documentation that the patient responded that they did not want to
                                                                      quit, respond “no”.
                                                                      If there is no written documentation concerning whether or not the patient wanted to quit
                                                                      (even if asked whether they wanted to quit), then leave as “Not selected” (i.e. default




Created on 24/02/2011 12:32:00 Third draft                                - 20 -
                                                                           button)
                Given verbal advice?                 No, Yes               If there is any written documentation that the patient was told about the dangers of
                                                                           smoking, told about the benefits of smoking cessation, verbally advised to stop smoking,
                                                                           or verbally given information with the intention that it will enable the patient to stop
                                                                           smoking then respond “yes”.
                                                                           For example, if it is written “patient told that they should stop smoking” respond “yes”.
                Given written advice?                No, Yes               If there is any written documentation that the patient was provided with written
                                                                           information (e.g. leaflets) about the dangers of smoking, the benefits of smoking
                                                                           cessation, written advice on how to stop smoking and/or written information on smoking
                                                                           cessation services then respond “yes”. Only respond “yes” if it is clear that this advice
                                                                           was provided in a written format.
                Prescribed NRT?                      No, Yes               If there is any written documentation that the patient was prescribed nicotine
                                                                           replacement therapy (NRT) then respond “yes”. This information should be found written
                                                                           in the in-patient prescription chart. All forms of NRT: transdermal patches, chewing gum,
                                                                           nasal spray, tablets and inhalers and all brands are accepted.
                Referred to smoking cessation        No, Yes               If there is any written documentation that the patient was specifically referred to a
                nurse?                                                     smoking cessation nurse (within or outside of the hospital) then respond “yes”.
                                                                           Advice to contact a smoking cessation service does not constitute a “yes” response here.
                Referred to smoking cessation        No, Yes               If there is any written documentation that the patient was specifically referred to a
                service?                                                   smoking cessation service (within or outside of the hospital) then respond “yes”.
                                                                           Advice to join a smoking cessation programme does not constitute a “yes” response
                                                                           here.
                Referred to specialist respiratory   No, Yes               If there is any written documentation that the patient was specifically referred to a
                nurse?                                                     specialist respiratory nurse (within or outside of the hospital) the respond “yes”.
                Advised to contact GP/Practice       No, Yes               If there is any written documentation that the patient was advised (verbally or written) to
                nurse?                                                     contact their GP or practice nurse for advice on smoking cessation respond “yes”.

     Alcohol    Was the patient‟s alcohol history    No, Yes               Information on alcohol history is most likely to be recorded during admission or pre-
                recorded?                                                  operatively, however all written information on a patient‟s spell should be looked at for
                                                                           information that the patient was asked whether they drink alcohol and recorded the
                                                                           quantity of alcohol consumed. If there is any information which allows you to tell that the
                                                                           person does or does not drink alcohol indicates that the patient‟s alcohol history has
                                                                           been recorded, i.e. answer “yes”. If there is absolutely no documentation about the
                                                                           person‟s alcohol consumption then the answer must be “No”.
                Was a reason given for no alcohol    No, Unconscious for
                                                                           If you have answered “no” to “was the patient‟s smoking history recorded?” you must




Created on 24/02/2011 12:32:00 Third draft                                     - 21 -
                history being recorded?           whole spell, delirium,   provide a response to this question.
                                                  dementia
                                                                           If the case notes indicate that the patient was unconscious for the WHOLE spell (not just
                                                                           part of the spell) then respond “unconscious for whole spell”,

                                                                           If the patient has been diagnosed with any of the following forms of delirium: F05
                                                                           Delirium, Not Induced By Alcohol And Other Psychoactive Substances F05.0 Delirium,
                                                                           Not Superimposed On Dementia, So Described F05.1 Delirium, Superimposed On
                                                                           Dementia F05.8 Other Delirium or the case notes indicate that the patient has delirium
                                                                           then respond “delirium”,

                                                                           If the patient has a diagnosis of dementia (ICD-10 code diagnosis of F00 to F03
                                                                           inclusive) then respond “dementia”.
                                                                           Patients with delirium or dementia have not been excluded due to previous Research
                                                                           Ethics Committee opinion that these patients should not be excluded from the delivery of
                                                                           health promotion.
                                                                           If the patient was conscious and does not suffer from dementia or delirium, then respond
                                                                           “No”.
                                                                           Once you have answered this question you will be automatically directed to the next
                                                                           screen as the remaining questions on alcohol can not be answered.
                Does the patient drink alcohol?   No, Yes                  If there any written documentation that the patient consumed alcohol – this could range
                                                                           from a very small amount such as 1 small glass of sherry a week to a very large amount
                                                                           such as 1 bottle of vodka a day – then respond “yes”.
                                                                           Only respond “no” if there is written documentation that the patient is a non-drinker.
                Alcohol categorisation            Low/Recommended,         Written descriptions of the amount of alcohol consumed can vary greatly within and
                                                  Medium/Hazardous,        between case notes.
                                                  High/Harmful/Not
                                                  Known                    If the written descriptions describe the patient‟s alcohol consumption using the terms
                                                                           provided as options (e.g. Low) then use these. If someone is described as a “sensible”
                                                                           drinker then this respond “Low/recommended”. If the patient is described as a dependent
                                                                           drinker, respond “High/Harmful”.

                                                                           If the only written information is that the patient does drink alcohol but there is no
                                                                           indication of the quantity of alcohol consumed then respond “Not Known”.




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                                             If the amount of alcohol consumed is described in terms of units then the following
                                             definitions apply:

                                             For women 2 to 3 units a day: Low/Recommended
                                             For women 1 to 14 units a week: Low/Recommended
                                             For women 15 to 35 units a week: Medium/Hazardous
                                             For women more than 36 units a week: High/Harmful

                                             For men 3 to 4 units a day: Low/Recommended
                                             For men 1 to 21 units a week: Low/Recommended
                                             For men 22 to 50 units a week: Medium/Hazardous
                                             For men more than 51 units a week: High/Harmful

                                             If the only written information describes the type and amount of alcohol consumed, e,g,
                                             one glass of sherry a day then the units can be calculated using the alcohol unit
                                             calculator found at http://units.nhs.uk/unitCalculator.html To use the calculator click
                                             “start”, you then have to choose “Hers” or “His”, you then choose which type of alcohol
                                             (Beer, fortified wine, etc) from the drop down menu and press “go”. Next you can select
                                             the strength of the alcohol volume (if known – if you do not know then choose the lowest
                                             alcohol volume provided) and the size of the glass or bottle (if known) and select how
                                             many of these drinks were consumed by using the “-“ and “+” signs which follow “how
                                             many”. Once you have done this click on “calculate total units”. The total units are given
                                             at the top right hand of the calculator. If you have more drinks to calculate then click on
                                             “add another drink” and continue as above until all the alcohol described has been
                                             calculated into units. You can then compare the number of units calculated with the
                                             categorisations given above for men and women.

                                             The following descriptions of alcohol consumption are examples of what can be
                                             classified as low, medium or high alcohol consumption in men and women:

                                             For women 1 glass (50ml) of sherry (fortified wine) a day: Low/Recommended
                                             For women 1 (750ml) bottle of wine a week: Low/Recommended
                                             For women 3 (750ml) bottles of wine a week or 1 standard bottle (700ml) of spirit a week:
                                             Medium/Hazardous
                                             For women a 1 litre bottle of spirits a week: High/Harmful




Created on 24/02/2011 12:32:00 Third draft       - 23 -
                                                                 For men 1 pint of beer (3% to 6% strength) a day: Low/Recommended
                                                                 For men 7 cans (440ml) of beer (4% strength) and 1 bottle of wine (12% strength) a
                                                                 week: Low/Recommended
                                                                 For men a 1 litre bottle of spirits a week: Medium/Hazardous
                                                                 For men 1 standard bottle (700ml) of spirit and 7 super strength (9%) 440ml cans of beer
                                                                 a week: High/Harmful
                Given verbal advice?                   No, Yes   If there is any written documentation that the patient was told about the dangers of their
                                                                 alcohol consumption/alcohol in general, told about the benefits of reducing their alcohol
                                                                 consumption/abstinence, verbally advised to reduce the amount of alcohol they
                                                                 consume, or verbally given information with the intention that it will enable the patient to
                                                                 drink a sensible amount of alcohol (low/recommended) then respond “yes”.
                                                                 For example if it is written “patient told that their alcohol intake is endangering their
                                                                 health” respond “yes”.
                Given written advice?                  No, Yes   If there is any written documentation that the patient was provided with written
                                                                 information (e.g. leaflets) about the dangers of excessive alcohol consumption, about
                                                                 sensible drinking, the benefits of reducing alcohol consumption, written advice on how to
                                                                 reduce alcohol consumption and/or written information on alcohol services such as
                                                                 Alcoholics Anonymous or local organisations then respond “yes”. Only respond “yes” if it
                                                                 is clear that this advice was provided in a written format.
                Advised to contact GP/Practice         No, Yes   If there is any written documentation that the patient was advised (verbally or written) to
                nurse?                                           contact their GP or practice nurse for advice on alcohol intake respond “yes”.
                Advised to contact an alcohol          No, Yes   If there is any written documentation that the patient was advised to contact an alcohol
                service?                                         service – this could be a hospital-based, community, or national service such as
                                                                 Alcoholics Anonymous (AA) – then respond “yes”.
                                                                 If the patient was actually referred to the service then respond “no” and answer “yes” to
                                                                 the question “Referred to an alcohol service?” below.
                Given Community Alcohol Team‟s         No, Yes   If there is any written documentation that the patient was given the Community Alcohol
                contact information?                             Team‟s contact information respond “yes”.
                Referred to an alcohol service?        No, Yes   If there is any written documentation that the patient was referred by a healthcare
                                                                 professional to an alcohol service – this could be a hospital-based, community, or
                                                                 national service such as Alcoholics Anonymous (AA) – then respond “yes”.
                                                                 If the patient was only advised to contact an alcohol service, then respond “no”.
                Referred to hospital alcohol liaison   No, Yes   If there is any written documentation that the patient was referred to the hospital alcohol
                worker?                                          liaison nurse/practitioner respond “yes”.
                Was Chlordiazepoxide prescribed?       No, Yes   This information should be found written in the in-patient prescription chart. Brands




Created on 24/02/2011 12:32:00 Third draft                           - 24 -
                                                                  include Librium ® and Tropium ®

     Weight      Was the patient described as           No, Yes   All written documentation on a patient‟s spell should be looked at for information that the
     and         malnourished?                                    patient was assessed for malnourishment and found to be malnourished. This
     nutrition                                                    information is most likely to be found in the admission notes. Screening should be
                                                                  repeated weekly for inpatients when there is clinical concern of malnourishment, so
                                                                  repeat information on malnourishment should be found within the case notes of those
                                                                  described as malnourished on admission who are admitted for more than a week. If the
                                                                  patient is described as malnourished at any point during their admission then respond
                                                                  “yes” even if their status changes during the admission to not malnourished.
                                                                  Malnourishment may be assessed by a specific tool such as the Malnutrition Universal
                                                                  Screening Tool (MUST) or based on clinical impression of body mass index
                                                                  (BMI)/unplanned weight loss/lack of nutritional intake.

                                                                  The definition of malnourished is defined by NICE as “a BMI of less than 18.5;
                                                                  unintentional weight loss greater than 10% within the last 3–6 months; or a BMI of less
                                                                  than 20 and unintentional weight loss greater than 5% within the last 3–6 months.” (NICE
                                                                  2006; http://www.nice.org.uk/guidance/index.jsp?action=byID&o=10978 ).

                                                                  You should not respond “yes” if it states that the patient maybe at risk of malnutrition as
                                                                  mentioned in the next question.

                                                                  If there is no documentation indicating that the person is malnourished then respond
                                                                  “No”.
                 Was the patient described as at risk   No, Yes   If the patient is described as “malnourished”, i.e. you responded “yes” to “was the patient
                 of malnutrition?                                 described as malnourished” then do not respond to this question – leave as “unselected”.

                                                                  At risk of malnutrition, is “defined by having eaten little or nothing for more than 5 days
                                                                  and/or are likely to eat little or nothing for the next 5 days or longer; who are unable to
                                                                  take in nutrients properly, and/or who have increased nutritional needs.” (NICE 2006; see
                                                                  http://www.nice.org.uk/guidance/index.jsp?action=byID&o=10978 for guidance on
                                                                  nutrition support in adults). If there is any written documentation which indicates that the
                                                                  patient is “at risk of malnutrition”, respond “yes”.

                 Was the patient‟s weight recorded?     No, Yes   If there is any written evidence that the patient‟s weight was recorded (imperial and




Created on 24/02/2011 12:32:00 Third draft                            - 25 -
                                                                      metric measures are both acceptable – Kg, stones and lbs) the respond “yes”.
                                                                      If details of the patient‟s BMI are reported, e.g. BMI = 29, but there are no details of the
                                                                      patient‟s actual weight, you can still assume that weight was recorded as it is required for
                                                                      the calculation of BMI; i.e. respond “yes”.
                                                                      If Waist measurement, Mid arm circumference, Triceps skinfold thickness, or Clinical
                                                                      impression were used to categorise weight, but there is no record of the patient‟s weight
                                                                      (Kg, stones and lbs) then you can not assume that they were weighted; i.e. respond “no”.
                Was body mass index (BMI)       No, Yes               BMI is most likely to be recorded during admission or pre-operatively, however all case
                recorded?                                             notes should be reviewed for evidence that BMI was recorded. While weight and height
                                                                      provide the information required to calculate body mass index (BMI), measurements of
                                                                      weight and/or height alone do not constitute a record of BMI. If only weight and/or height
                                                                      details are recorded within the patient‟s case notes then respond “No”.

                                                                      Only if a numerical BMI score is provided (usual range is from 9 to 46), or the response
                                                                      to a question on BMI in the notes is answered with a category of Underweight, Normal
                                                                      weight, Overweight, Obese, or Morbidly obese should you respond “Yes” to this
                                                                      question.
                Was any other measure used to   No, Yes               If a person has been described as Underweight, Normal weight, Overweight, Obese, or
                classify weight category?                             Morbidly obese then answer “yes” to this question. If there is no indication of the person‟s
                                                                      weight category then respond “No”.
                What measure was used?          Waist measurement,    If you responded “Yes” to “was any other measure used to classify weight category?” you
                                                Mid arm               must answer this question. If the weight category is just stated in the notes e.g. “patient
                                                circumference,        is overweight” then respond “clinical impression”.
                                                Triceps skinfold
                                                thickness, Clinical
                                                impression
                Weight category                 Underweight, Normal   Weight category based on BMI supersedes any of the other measurements that may
                                                weight, Overweight,   have been used to describe the patient‟s weight in their case notes. Weight
                                                Obese, Morbidly       categorisation based on waist measurement, mid arm circumference, and triceps skinfold
                                                obese                 thickness supersedes “weight only” and “clinical impression”. Clinical impression
                                                                      supersedes “weight only”.

                                                                      If you have the details of the patient‟s weight and height, you can calculate BMI in the
                                                                      following way:
                                                                                                     2
                                                                      Weight (kg) ÷ height (metres)




Created on 24/02/2011 12:32:00 Third draft                                - 26 -
                                                                            e.g. if someone weighs 65 Kgs and are 1.65 metres tall then their BMI is 65 ÷ (1.60 x
                                                                            1.60) = 65 † 2.56 = 25.39 which is “overweight”. A BMI calculator can be found at
                                                                            http://www.fitandtrim.co.uk/bmi_calculator.html which allows you to enter either metric or
                                                                            imperial measurements to calculate BMI.

                                                                            The BMI categories are as follows:
                                                                            Underweight = BMI <18.5
                                                                            Normal weight = BMI of 18.5 to 24.9
                                                                            Overweight = 25 to 29.9
                                                                            Obesity = BMI of 30 to 40.0
                                                                            Morbidly obese = BMI  40
                Oral/enteral/parenteral nutrition   No, Yes , Nutritional   Nutrition support should be considered in people who are malnourished or at risk of
                support provided?                   support deemed          malnourishment.
                                                    inappropriate
                                                                            However NICE guidelines have noted that “the provision of nutrition support is not always
                                                                            appropriate. Decisions on withholding or withdrawing of nutrition support require a
                                                                            consideration of both ethical and legal principles (both at common law and statute
                                                                            including the Human Rights Act 1998). When such decisions are being made guidance
                                                                                                                      1                                  2
                                                                            issued by the General Medical Council and the Department of Health should be
                                                                            followed.”
                                                                            1
                                                                              Withholding and withdrawing life prolonging treatments: good practice in decision
                                                                            making. General Medical Council. Available from www.gmc-uk.org at http://www.gmc-
                                                                            uk.org/guidance/current/library/witholding_lifeprolonging_guidance.asp#a21
                                                                            The guidance states that “Where patients have capacity to decide for themselves, they
                                                                            may consent to, or refuse, any proposed intervention of this kind. …. Where death is not
                                                                            imminent, it usually will be appropriate to provide artificial nutrition or hydration. However,
                                                                            circumstances may arise where you judge that a patient's condition is so severe, and the
                                                                            prognosis so poor that providing artificial nutrition or hydration may cause suffering, or be
                                                                            too burdensome in relation to the possible benefits.” If the patient‟s condition is so severe
                                                                            that nutritional support is deemed inappropriate then it is likely that this patient is not
                                                                            suitable for this audit and you should reconsider whether they are eligible for inclusion
                                                                            in this audit.
                                                                            Alternatively, if nutritional support has been deliberately paused while an acute event
                                                                            (e.g. pneumonia with a high temperature) settles, respond “nutritional support deemed
                                                                            inappropriate”.




Created on 24/02/2011 12:32:00 Third draft                                      - 27 -
                                                                              2
                                                                                Reference guide to consent for examination or treatment (2001) Department of Health.
                                                                              Available from www.dh.gov.uk
                Given verbal advice?               No, Yes                    If there is any written documentation that the patient was told about the health
                                                                              consequences of being overweight/obese, told about the benefits of reducing their
                                                                              weight, or verbally advised and enabled to lose weight then respond “yes”.
                Given written advice?              No, Yes                    If there is any written documentation that the patient was provided with written
                                                                              information (e.g. leaflets) about the health consequences of being overweight/obese, the
                                                                              benefits of reducing their weight, or written information on how to lose weight or where to
                                                                              go for advice/assistance in losing weight such as details of a local weight loss group then
                                                                              respond “yes”. Only respond “yes” if it is clear that this advice was provided in a written
                                                                              format.
                Advised to contact GP/practice     No, Yes                    If there is any written documentation that the patient was advised (verbally or written) to
                nurse?                                                        contact their GP or practice nurse for advice on weight loss respond “yes”.
                Advised to join a weight loss      No, Yes                    If there is any written documentation that the patient was advised (verbally or in writing)
                programme?                                                    to join a national weight loss programme such as Weight Watchers ® respond “yes”.
                Referred to any of the following   Nutritionist, Dietitian,   If there is any written documentation that the patient was referred to any of these experts
                experts?                           GP, Other specialist       in nutrition, respond by clicking in the circle next to the relevant job title. More than one
                                                                              option can be selected.
                Referred to a weight loss          No, Yes                    If there is any written documentation that the patient was referred to a hospital-based,
                programme?                                                    community, or national weight loss programme (e.g. Weight Watchers or Slimming
                                                                              World) then respond “yes”.
                Patient on a weight loss           No, Yes                    If there is documentation that the patient is currently attending a hospital-based,
                programme?                                                    community, or national weight loss programme the respond “yes”.
                Referred to hospital gym?          No, Yes                    If there is any written documentation that the patient was referred to the hospital gym,
                                                                              respond “yes”.
                Referred to a community            No, Yes                    If there is any written documentation that the patient was referred to community
                organisation?                                                 organisation for weight loss – i.e. an organisation that is located in the local area for the
                                                                              specific purpose of enabling participants to lose weight - respond “yes”.




Created on 24/02/2011 12:32:00 Third draft                                        - 28 -
     Physical   Was the patient‟s level of physical   No, Yes                  All written information on a patient‟s spell should be looked at for information that the
     activity   activity recorded?                                             patient was asked about their daily/weekly physical activity when not in hospital. If there
                                                                               is any information which allows you to gauge the amount/level of physical activity the
                                                                               patient usually engages in then respond “yes”. If there is absolutely no documentation
                                                                               about the person‟s usual physical activity then the answer must be “No”.

                Was a reason given for no level of    No, Unconscious for
                                                                               If you have answered “no” to “was the patient‟s level of physical activity recorded?” then
                physical activity being recorded?     whole spell, delirium,
                                                                               please provide details about why this was not recorded.
                                                      dementia
                                                                               If the case notes indicate that the patient was unconscious for the WHOLE spell (not just
                                                                               part of the spell) then respond “unconscious for whole spell”,

                                                                               if the patient has been diagnosed with any of the following forms of delirium: F05
                                                                               Delirium, Not Induced By Alcohol And Other Psychoactive Substances F05.0 Delirium,
                                                                               Not Superimposed On Dementia, So Described F05.1 Delirium, Superimposed On
                                                                               Dementia F05.8 Other Delirium or the case notes indicate that the patient has delirium
                                                                               then respond “delirium”,

                                                                               If the patient has a diagnosis of dementia (ICD-10 code diagnosis of F00 to F03
                                                                               inclusive) then respond “dementia”.
                                                                               Patients with delirium or dementia have not been excluded due to previous Research
                                                                               Ethics Committee opinion that these patients should not be excluded from the delivery of
                                                                               health promotion.

                                                                               If the patient was conscious and does not suffer from dementia or delirium, then respond
                                                                               “No”.

                                                                               Once you have answered this question, if you have finished entering data on all the
                                                                               previous screens, please click on the “submit” button at the bottom of the screen. Once
                                                                               you have clicked on the submit button you will be asked to confirm that you wish to
                                                                               submit this record. No more amendments to this record can be made and the record will
                                                                               no longer be accessible to the data collector.
                What was the patient‟s mobility       Immobile, Bed            If there is written documentation that the patient is “immobile”, or information that
                status?                               mobile, Wheelchair       indicates that the patient is unable to move the joints of the body in a functional manner,
                                                      mobile, Mobile with a    then respond “Immobile”




Created on 24/02/2011 12:32:00 Third draft                                         - 29 -
                                                     walking device,         If the patient is described as able to move joints and the body, then they are mobile and
                                                     Independently mobile,   should be categorised in only one of the following mobility categories given below. The
                                                     Not known               categories are in order of severity with “bed mobile” having the least mobility and
                                                                             “independently mobile”, the most mobility.

                                                                             “Bed mobile”: ability to move and position oneself in bed

                                                                             “Wheelchair mobile”: moving from place to place aided by a wheelchair

                                                                             “Mobile with a walking device”: walking with the assistance of a cane, walker or crutches

                                                                             “Independently mobility”: ability to move from place to place without assistance

                                                                             If there is conflicting information concerning the mobility of the patients, then their
                                                                             mobility at/nearest to discharge is the category that should be accepted.
                                                                             If it is unclear when during the episode the mobility information relates to, then the
                                                                             category reflecting the greatest degree of mobility should be chosen. For example,
                                                                             where there is evidence that the patient can move in a wheelchair (wheelchair mobile)
                                                                             and there is also information that they are walking without assistance (independently
                                                                             mobile), then respond “Independently mobile” if you can not identify which category is
                                                                             nearest to the discharge date. If however, the patient was admitted independently
                                                                             mobile, but by discharge was “wheelchair mobile” then respond “wheelchair mobile”.

                                                                             If there are no details relating to the patient‟s mobility, then respond “Not known”.

                                                                             Only if the patient is “independently mobile” or their mobility is unknown, will you be
                                                                             expected to provide details concerning whether health promotion for physical activity was
                                                                             required.
                Does the patient do less than 30     No, Yes, Unknown        The Department of Health recommends that adults participate in at least thirty minutes of
                minutes of moderate intensity                                moderate intensity activities on five days of the week. “Moderate intensity” describes any
                physical activity, 5 times a week?                           activity that will result in feeling warm, slightly out of breath, a raised heart rate and a
                                                                             light sweat. Examples include brisk walking, cycling, housework, and dancing. For
                                                                             activity to be effective in achieving health benefits it needs to be regular. However, the 30
                                                                             minutes of activity does not have to be done in one session – multiple bouts of physical
                                                                             activity in one day (e.g. three 10 minute sessions) are just as beneficial as one
                                                                             continuous 30 minute session. If an adult does not participate in at least thirty minutes of




Created on 24/02/2011 12:32:00 Third draft                                       - 30 -
                                                           moderate intensity activities on five days of the week they are described as “inactive”.
                Was health promotion required?   No, Yes   Respond “no” if the patient is Immobile, Bed mobile, Wheelchair mobile, or Mobile with a
                                                           walking device as it is deemed inappropriate at this point in the patient‟s recovery to be
                                                           provided with information that goes beyond returning mobility to independent mobility.

                                                           Respond “yes” if the patient is categorised as “independently mobile” (if known) or
                                                                                                                                       1
                                                           mobility is “not known” AND there is evidence that the patient was inactive and/or
                                                                                  2
                                                           needed to lose weight , and/or had a condition which would benefit from increasing
                                                                             3
                                                           physical activity .
                                                           1
                                                            The Department of Health‟s recommendation to do at least thirty minutes of moderate
                                                           intensity activities on five days of the week is for the minimum amount of activity
                                                           required to stay healthy. If the patient does less than this, then they are “inactive” and
                                                           require health promotion – respond “yes”.
                                                           2
                                                            Recent recommendations on the amount of activity required to lose weight ranges from
                                                           60 to 90 minutes of vigorous activity (any activity that results in feeling out of breath, a
                                                           raised heart rate, and a sweat such as jogging, squash, etc) most days of the week. So if
                                                           the patient is overweight, obese, or morbidly obese and judged as medically able to
                                                           participate in physical activity and is not participating in at least 1 hour of vigorous activity
                                                           5 times a week, respond “yes”.
                                                           3
                                                            There is moderate evidence that physical activity has a therapeutic effect on the
                                                           following conditions: cardiovascular disease, diabetes, musculoskeletal diseases, and
                                                           clinical depression. If the patient currently has any of these conditions and is not
                                                           undertaking a beneficial level of physical activity, respond “yes”.

                                                           There is no age limit on recommending physical activity, though type of activities in the
                                                           elderly are likely to be moderate intensity and include balance exercises.
                Given verbal advice?             No, Yes   If there is any written documentation that the patient was told about the health
                                                           consequences of inactivity, told about the benefits of increasing their level of physical
                                                           activity and the types of activity they could do, or verbally advised and enabled to partake
                                                           in more physical activity then respond “yes”.
                Given written advice?            No, Yes   If there is any written documentation that the patient was provided with written
                                                           information (e.g. leaflets) about the health consequences of inactivity, the benefits of




Created on 24/02/2011 12:32:00 Third draft                      - 31 -
                                                            increasing their level of physical activity and the types of activity they could do, or written
                                                            information on how to be physically active or where to go for advise/assistance in
                                                            becoming more physically active such as details of a local walking group, use of
                                                            pedometers, etc then respond “yes”. Only respond “yes” if it is clear that this advice was
                                                            provided in a written format.
                Referred to a physiotherapist?    No, Yes   If there is any written documentation that the patient was referred to a physiotherapist or
                                                            physiotherapy service respond “yes”.
                Referred to a rehabilitation      No, Yes   Respond “yes” if there is any written documentation that the patient was referred to a
                specialist/service?                         rehabilitation specialist who focuses on physical activity, e.g. a cardiac rehabilitation
                                                            nurse (do not include physiotherapist), or was referred to a rehabilitation service that
                                                            focuses on physical activity, e.g. cardiac rehabilitation.
                Referred to a physical activity   No, Yes   If there is any written documentation that the patient was referred to a physical activity
                programme?                                  programme – i.e. a programme which may include assessment of the patient‟s need for
                                                            physical activity and ability to participate in physical activity, development of a tailored
                                                            physical activity programme, monitoring progress and providing follow-up - respond
                                                            “yes”.




Created on 24/02/2011 12:32:00 Third draft                      - 32 -
Website structure and database stages
www.nhphaudit.org

The NHPHA web site has two purposes: it provides a public point of reference
for people that are interested in the project and additionally provides access to
the data entry and reporting facilities for registered users.

The following areas of the NHPHA site will only be available to registered and
authenticated (hospital) users:
    CSV patient data import
    Audit and verification data entry wizards
    Hospital summary report and data download

The remainder of the site will be available to public anonymous users in order
to:
     Present the project to the public
     Publish the annual reports
     Provide relevant reference links
     Provide a point of contact for the project

The website menu will be located on the left of all pages of the website
(excluding the data entry wizard pages).

The image below highlights the functionality that will be offered by the menu.


                        Link to the home (about the project) page

                        Link to the login page or to the relevant data entry stage


                        Link to the annual reports, publicly available

                        Link to the links to other online resources


                        Link to the contact us page



                        Sponsored by writing followed by a link to the Department of Health website




In the image above, the Home button is currently selected indicating that the
user is viewing the Homepage of the website.
A context sensitive menu will also be displayed under the website banner on
the right. This menu will change depending on whether the user is
authenticated or not. When the user is not authenticated, only the „Login‟


Created on 24/02/2011 12:32:00 Third draft                                               - 33 -
option will be given. When the user clicks on this link the login page will be
displayed. When the user is authenticated two options will be offered:
Change password – when clicked, the Change password page will be
displayed
Logout – when clicked, the user will be logged out of the system and if
currently in a part of the website only available to authenticated users, the
login page will be displayed. Users will automatically be logged out after 30
minutes of inactivity.

Login page




Availability: Public
Purpose:      This page will enable users to log in into the system.




Created on 24/02/2011 12:32:00 Third draft                                  - 34 -
Change password page




Availability: Authenticated (hospital) users.
Purpose:      This page will allow users to change their password.

Which records will be displayed and where can this screen be launched
from?

Launched From                           User access
After login, if password is expired,    All authenticated users
user is redirected here
„Change password‟ button on the top All authenticated users
right under the banner




Created on 24/02/2011 12:32:00 Third draft                           - 35 -
Data entry stages
The data entry process can be split into a sequence of stages. Each hospital
is required to:

      Upload the CSV file OR manually input demographic data
      Enter the audit data
      Re-enter some of the data for verification

Once the verification data has been entered and validated offline by the
NHPHA project office, the hospital users will be allowed to view the hospital
summary report and download the hospital data. If the data input by the
hospital is deemed to be invalid by the NHPHA project office, then they will
revert the hospital back to the most appropriate stage.

Therefore, the application can be in one of the following states at any point in
time, depending on the user's hospital or their role:

Stage                       Description
Logged out                  The user is not logged in and can only access the
                            public areas of the web site.
Patient demographic         A hospital user is logged in and required to choose
data stage                  whether they are providing demographic details by
                            uploading a CSV file, or manually entering
                            demographic data
CSV upload stage            A hospital user is logged in and required to upload
                            the patient data CSV file.
Submit demographic          A hospital user is logged in and required to add a
data (manual input)         record manually and check which records have
                            already been added.
Audit data entry stage      A hospital user is logged in and required to enter
                            the audit data for each patient.
Verification data entry     A hospital user is logged in and required to enter
stage                       the verification data for each patient.
Waiting for manual data     A hospital user is logged in, data entry is now
verification stage          completed and no action can be performed on the
                            hospital data at this stage. The NHPHA project
                            office check the data for the hospital and then give
                            permission to the hospital users to view the report
                            and data.
Hospital summary report     A hospital user is logged in, the data has been
and data available stage    deemed as valid and the report and data can now
                            be downloaded.
Administrative mode         An administrator is logged in and administrative
                            functionality is offered.


Concurrency management

A hospital may have more than one user.



Created on 24/02/2011 12:32:00 Third draft                                  - 36 -
In the event of an action conflict (on upload CSV or enter audit/verification
data for a patient), the first user to perform the action will be able to achieve it
successfully, while the second user will be presented with an informative
error.


Patient Demographic data stage




                        EXAMPLE SCREEN ONLY


Purpose: This screen enables hospital users to choose whether to provide
demographic details using a CSV file or to manually enter demographic data.
CSV file is the advised option as this means less time entering data.
If CSV file is chosen then hospital users can use this screen to upload a CSV
file containing the details of the patients discharged in the 1 month study
window. The CSV file will contain the demographic and diagnosis data for
each patient. It will not contain the pro forma data on assessment of risk factor
and health promotion delivered. The upload is intended to be run once by
each hospital so all patients in the study must be included in the CSV file.

ALTERNATIVELY, the data collector can choose to input demographic details
manually. There will be the option to “agree” and confirm that “All patient data
will be entered manually”. Once this has been agreed, the user will
automatically be taken to the “Submit another record screen”.




Created on 24/02/2011 12:32:00 Third draft                                     - 37 -
CSV file upload stage




Purpose:

The CSV structure and data will be validated on import and any anomalies will
cause the data to be rejected with a validation error. The validation error will
provide the line number of the anomaly and a description of the error. The
import will report on the first error found.

Once the user has completed their CSV upload, they will then be able to input
the audit details using the data entry wizard described next.




Created on 24/02/2011 12:32:00 Third draft                                 - 38 -
Select patient for audit data entry – CSV upload screen




Purpose: This screen acts as the base for hospital users to input audit data
for each patient. Once the CSV import has completed, each patient in the
audit is listed on this screen. Patients are removed from the list once audit
data is submitted for them. The screen always acts as a checklist of the
remaining data entry effort.

Once audit details have been submitted for all patients, this screen will no
longer be available. The Audit data verification screen will be shown in its
place.




Created on 24/02/2011 12:32:00 Third draft                                 - 39 -
Where can this screen be launched from?

Launched From Record set                     Table           User access
Menu              All patients that have Hospital patients   All hospital users.
                  not yet had audit data                     This screen will not
                  entered                                    be available until the
                                                             CSV import has been
                                                             run. It will be
                                                             replaced by the audit
                                                             data verification
                                                             screen once audit
                                                             details have been
                                                             submitted for all
                                                             patients.




Created on 24/02/2011 12:32:00 Third draft                               - 40 -
Manual input of demographic data - Submit another patient record stage
screen




                          EXAMPLE SCREEN ONLY




Purpose
Once the user has agreed to manually input all data, they are transferred to
this screen. This screen acts as the base for hospital users to manually input
patient demographic data about their patients. By pressing the “new patient”
button, a new case can be added (up to 100 cases only). Details of cases that
have already been submitted are provided at this stage.
Once audit data on all 100 cases have been submitted, this screen will no
longer be available. The audit data verification screen will be shown in its
place.




Created on 24/02/2011 12:32:00 Third draft                               - 41 -
Select patient for audit data verification screen




Purpose: This screen acts as the base for hospital users to input the audit
verification data for a random sample of patients with audit data already
completed. 20 patients will be randomly selected automatically by the system
for double data collection but data on only 10 cases should be completed.
They will be identified by the fields listed in the screenshot above. Patients are
removed from the list once audit verification data is submitted from them.
Therefore, the screen always acts as a checklist of the remaining data
verification effort.
The process for inputting the verification data will be the same as for inputting
the data the first time around: the user will be shown the patient details and
then asked to input the audit details.

The input of the verification data must be performed by a different person than
the initial audit data collector(s). This process will be organised by the
hospital. The NHPHA project office will supply two usernames for each
hospital to avoid the need for password sharing.

The initial audit data and double audit data will automatically be compared
when the double data is submitted. If the data does not match, the user will be
offered the opportunity to double check what they have entered. A flag will be
stored in the dataset to indicate if the data matched.

The double data will be stored in the database so it can be used by the
NHPHA project office as a basis for a kappa analysis for inter-rater reliability.

Once audit verification details have been submitted for all patients, this screen
will no longer be available. An information screen to indicate that the hospital


Created on 24/02/2011 12:32:00 Third draft                                   - 42 -
has completed the data entry and verification process will be shown in its
place until the NHPHA project office kappa statistic analysis is complete.
Once the data analysis is complete, the user will be shown the download CSV
data / hospital report screen.

Where can this screen be launched from?

Launched        Record set                   User access
From
Menu            All patients that have       All hospital users. This screen will not be
                not yet had audit            available audit data has been submitted for
                verification data entered    all patients. It will cease to be available once
                                             audit verification data has been submitted
                                             for all patients.




Created on 24/02/2011 12:32:00 Third draft                                    - 43 -
General notes on data entry wizard and the data entry controls

Availability: The data entry wizard will only be available to authenticated (logged in) users.

Throughout the application, data entry controls are laid out as shown in the image below. The layout is divided into five parts: 1.
Help button – All information here is also provided in the detailed user guide section. 2. Field label, 3. Data entry control(s), 4. Error
icon and 5. Error description.


          Field label – to describe the                           Error icon – usually hidden, displayed
          data to enter                                           if a validation error occurs.




                                                   Data entry control(s) – this can               Error description –
 Help button – when                                include text boxes, radio                      usually hidden,
 clicked the help is                               buttons, check boxes and other                 displayed if a
 displayed in a                                    input controls which allow the                 validation error
 separate window.                                  application to collect data from               occurs. It describes
                                                   the user                                       the validation error.




Created on 24/02/2011 12:32:00 Third draft                                   - 44 -
Data entry wizard: Stage 1 – patient details (CSV file upload)




Purpose: This is the first screen in the data entry wizard. This screen displays
the demographic data for the selected patient in read only format. The data is
provided by CSV import and is not manually entered by the data entry user.
The user will need to click the “Next” button in order to move to the next
screen.

Demographic data entry screen for manual input is not currently available.

Which records will be displayed and where can this screen be launched
from?

Launched From                  Record set                  User access
'Input audit details' screen   Patient details for the     All hospital users
or' Input double entry'        selected patient
screen




Created on 24/02/2011 12:32:00 Third draft                                 - 45 -
Data entry wizard: Stage 2 – Smoking




PILOT VERSION - EXAMPLE SCREEN ONLY




Purpose: This is the second screen in the data entry wizard. It is designed to
capture and validate data on smoking. It must be filled out before the next
stage of the wizard can be accessed or the previous stage returned to.
However, the user can return to this screen and amend the details at any
point up to submission of the record.



Created on 24/02/2011 12:32:00 Third draft                                - 46 -
The user will need to click the “Next” button in order to move to the next
screen. They will not be able to do this if they have any validation errors
remaining.

The application will automatically try to move the user to the next screen in
the following instances:
User enters a reason for no history being recorded
User selects 'Never smoked' in response to 'Is the patient a smoker?'
User selects 'no' for 'Was health promotion required?'
This will fail if they have a conflicting validation error and they will be asked to
correct it.




Created on 24/02/2011 12:32:00 Third draft                                     - 47 -
Data entry wizard: Stage 3 – Alcohol




   PILOT VERSION - EXAMPLE SCREEN ONLY




Purpose: This is the third screen in the data entry wizard. It is designed to
capture and validate data on alcohol use. It must be filled out before the next
stage of the wizard can be accessed or the previous stage returned to.
However, the user can return to this screen and amend the details at any
point up to submission of the record.




Created on 24/02/2011 12:32:00 Third draft                                 - 48 -
The user will need to click the “Next” button in order to move to the next
screen. They will not be able to do this if they have any validation errors
remaining.

The application will automatically try to move them to the next screen in the
following instances:
User enters a reason for no history being recorded
User selects 'No' in response to 'Does the patient drink alcohol?'
User selects 'Low/recommended' in response to 'Alcohol categorisation'
This will fail if they have a conflicting validation error and the user will be
asked to correct it.




Created on 24/02/2011 12:32:00 Third draft                                    - 49 -
Data entry wizard: Stage 4 – Weight & nutrition




PILOT VERSION - EXAMPLE SCREEN ONLY




Created on 24/02/2011 12:32:00 Third draft        - 50 -
Purpose: This is the fourth screen in the data entry wizard. It is designed to
capture and validate data on weight and nutrition history. It must be filled out
before the audit data can be submitted or the previous wizard stage returned
to. However, the user can return to this screen and amend the details at any
point up to submission of the record.

If the user answers "no" to the first four questions, the system will attempt to
move them to the next stage of the wizard.

If the user selects weight category as “normal” and patient not malnourished
or at risk of malnourishment, the system will attempt to move them to the next
stage of the wizard.




Created on 24/02/2011 12:32:00 Third draft                                   - 51 -
Data entry wizard: Stage 5 – Physical Activity




  PILOT VERSION - EXAMPLE SCREEN ONLY




Purpose: This is the fifth screen in the data entry wizard. It is designed to
capture and validate the patient‟s physical activity history. It must be filled out
before the survey data can be submitted or the previous wizard stage
returned to. However, the user can return to this screen and amend the
details at any point up to submission of the record.

The user will need to click submit in order to finish and commit their record to
the database. They will not be able to do this if they have any validation
errors remaining. Once submitted, the record cannot be edited by the user.

If the user responds 'no' to 'was health promotion required?', the application
will ask whether the record is ready to be submitted.




Created on 24/02/2011 12:32:00 Third draft                                    - 52 -
Download hospital data and summary report screen




Availability: Authenticated (hospital) users.

Purpose: This screen enables hospital users to download the data they have
submitted and to access their hospital summary report. It is available as soon
as the NHPHA project office have flagged the dataset for the hospital as being
valid. This screen enables the user to download the patient and audit data
they have submitted in CSV format. This can be opened directly in Microsoft
Excel. Only the initial entered data can be downloaded. Data that was
submitted as part of the 'double data entry' verification exercise will not be
included. This is to make the dataset simpler to interpret. The CSV file will be
zipped to minimise the download time from the server.




Created on 24/02/2011 12:32:00 Third draft                                 - 53 -
The CSV data will be provided in a denormalised format. This means that
there will be one row per patient and the field values will be the text
descriptions for each field e.g. "Male" rather than the numeric identifiers used
internally by the database.
The report viewer in the page will allow the users to export the report in a
variety of formats:




NB: The report viewer in this page relies on JavaScript to work. If this
technology is not supported or disabled a strip-down alternative will be
provided, as shown in the screen below.




Where can this screen be launched from?

Launched From                User access
Menu                         All hospital users assuming that their data has been
                             flagged as valid by the NHPHA project office.




Created on 24/02/2011 12:32:00 Third draft                                  - 54 -
CSV Upload File Specification for the NHPHA data entry system

This information is intended for the IT analyst(s) responsible for selecting patients for
inclusion into the audit and can be downloaded directly from
https://www.nhphaudit.org/Publications.aspx.

The CSV file can be created from an Excel spreadsheet in the following way: go to
“file”, “save as”, where there is the option to “Save as type” select from the scroll down
menu “CSV (comma delimited)” and your Excel spreadsheet is now a CSV file.

As described above, the NHPH audit will examine the patient case notes of a number
of patients discharged within a specified time period. The list of patients included in the
study is defined by the contents of a CSV export from each hospital's MIS system.
This will list qualifying patients that were discharged in the study window. For
simplicity, the required data is based on a small subset of the HES dataset so the IT
team should hopefully be able to re-use their existing export routines. The contents of
this patient export are used by the NHPHA data entry system as the check list of
patients who require their assessment and health promotion details to be inputted.

The patient details stored by the data entry system have been carefully selected to
avoid a patient being uniquely identified without significant cross referencing with the
hospital's internal management information system.

The CSV file is intended to be uploaded once by each hospital, so all 120 potential
cases in the study must be included in the CSV file. If more than the necessary
number of patients have been discharged in the specified time period, then patients
must be randomly selected by the IT analyst for inclusion. If there are less than the
necessary number of patients discharged in the specified two week time period, then
the date should be extended to include discharge days that are earlier than those in
the specified time period until the necessary number of patients is reached. The final
discharge date should not change (see information on time frame above, p.4).

Structure of the CSV File:
The CSV file is expected to consist of 10 columns. The first row will contain the column
headers. The fields that the CSV file must contain are given below. Please note that it
is important that a reference is given to each patient to allow the data collector to
access the patients‟ case notes. This is the “User defined” field and should include a
unique identifier such as patient case note number, NHS number of hospital number.
This information will not be uploaded onto the NHPHA database, and will therefore not
be accessible to anyone with access to the NHPHA database, it is solely to enable the
data collector(s) to find the patients‟ case notes.




Created on 24/02/2011 12:32:00 Third draft                                   - 55 -
Field name          HES         Description                                    Contents
                    Source
SystemID            n/a         Sequential integer value intended to           Integer value. This will be 1
                                provide a link between the local CSV data      for the first patient, 2 for the
                                and the information stored in the NHPHA        second patient and so on
                                database. This is how the patients will be     until 30 for the pilot, and
                                referred to in the NHPHA database.             100 for the main audit.
Age                 endage      Patient age at discharge. This must be         Integer value
                                between 17 and 120
Gender              sex         Patient gender. 1 indicates male and 2         Integer value
                                indicates female.
PostDistrict        postdist    Postcode district.                             First part of postcode and
                                                                               first digit of second part e.g.
                                                                               BN43 2. If the patient does
                                                                               not have a postcode,
                                                                               ZZ999 must be provided.
LengthOfStay        speldur     Length of stay in hospital in days             Integer value between 1
                                                                               and 731
DischargeDate       epiend      Date patient discharged from hospital.         DDMMYYYY formatted
                                Must be within the study window                date
TreatmentSpecialty tretspef     Specialty in which consultant was working      Integer value. 100 (General
                                during period of care                          surgery), 300 (General
                                                                               medicine )will be accepted
PrimaryDiagnosis    Diag_nn     ICD10 code of the primary diagnosis. This      ICD10 code with full stop
                                must be an ICD 10 code accepted by             removed.
                                HES: either 3 or 4 character code. Details
                                of the acceptable codes can be
                                downloaded at
                                http://www.hesonline.nhs.uk/Ease/servlet/
                                ContentServer?siteID=1937&categoryID=
                                203 and
                                http://www.hesonline.nhs.uk/Ease/servlet/
                                ContentServer?siteID=1937&categoryID=
                                214
HRGCode             Hrgnhs      HRG V3.5 code                                  HRG V3.5 code
                                Eligible codes can be found at
                                http://www.hesonline.nhs.uk/Ease/servlet/
                                ContentServer?siteID=1937&categoryID=
                                206
UserDefined                     This will be ignored by the system but         User defined. For example,
                                should be used by the hospital to store a      patient‟s case note number,
                                link between the patient record and the        hospital number or national
                                hospital management system so that case        insurance number.
                                notes can be retrieved by the data
                                collector for the audit. It must not contain
                                any commas.

         Validation tests that will be performed on the CSV data
         All field values will be trimmed for excess white space before they are tested against
         the validation rules. All validation tests will be case insensitive. Only the first error will
         be reported on. It is the responsibility of the user to correct and resubmit the data.




         Created on 24/02/2011 12:32:00 Third draft                                         - 56 -
Applied to Test                                              Validation message
   Overall Check that file has a CSV extension.              This file cannot be uploaded because it does
                                                             not have a .CSV file extension
   Overall Check that the CSV file contains between 21       This file cannot be uploaded because it
           and 10001 rows.                                   contains x rows. The file must contain between
                                                             21 and 10001 rows.
    Line 1 Check that a standard string is present here      The column headers in line 1 of the CSV file do
            containing the column headers. We expect this    not match the expected string:
            to be:                                           SystemID,Age,Gender,PostDistrict,LengthOfSt
            SystemID,Age,Gender,PostDistrict,LengthOfSt      ay,DischargeDate,TreatmentSpecialty,
            ay,DischargeDate,TreatmentSpecialty,             PrimaryDiagnosis, HRGCode,UserDefined
            PrimaryDiagnosis, HRGCode,UserDefined
 Every line Check that the expected number of commas is      Line x has y commas. Each line in the CSV file
            present. The expected number is 9 giving 10      is expected to have 9 commas.
            fields.
   Patient Check that the value in column 1 (SystemID) is    The data item in line x, column 1 (SystemID) is
     rows an integer                                         expected to be an integer number representing
                                                             the ID number for the NHPHA system to refer
                                                             to the patient.
   Patient Check that the value in column 1 (SystemID) is    The data item in line x, column 1 ( SystemID)
     rows equal to the line number minus one. We expect      is expected to be <x-1>.
           the user to assign values to this column
           sequentially starting from 1. The header row is
           not included in the count.
   Patient Check that the value in column 2 (Age) is         The data item in line x, column 2 (Age) is
     rows between 17 and 120.                                expected to be between 17 and 120 inclusive.
   Patient Check that the value in column 3 (Gender) is      The data item in line x, column 3 (Gender) is
     rows either 1 or 2.                                     expected to be either 1 or 2.
   Patient Check that the value provided for column 4        The data item in line x, column 4 (PostDistrict)
     rows (PostDistrict) that it is between 3 and 5          is expected to contain between 3 and 5 alpha-
           characters in length and contains only alpha      numeric characters.
           numeric characters.
   Patient Check that the value in column 5                  The data item in line x, column 5
     rows (LengthOfStay) is between 1 and 731                (LengthOfStay) is expected to be an integer
                                                             between 1 and 731
   Patient Check that the value in column 6                  The data item in line x, column 6
     rows (DischargeDate) is a readable date formatted       (DischargeDate) is expected to be a readable
           as DDMMYYYY.                                      date formatted as DDMMYYYY.
   Patient Check that the value in column 6                  The data item in line x, column 6
     rows (DischargeDate) is in the study window             (DischargeDate) is expected to be within the
                                                             study window
   Patient Check that the value in column 7                  The data item in line x, column 7
     rows (TreatmentSpecialty) matches the accepted          (TreatmentSpecialty) is expected to be either:
           codes from HES for treatment specialty. These     100, 300, 710 or 99999
           are 100, 300, 710 and 99999 ( older adult
           mental illness)
   Patient Check that the value in column 8                  The data item in line x, column 8
     rows (PrimaryDiagnosis) matches a permissible           (PrimaryDiagnosis) is expected to be a valid
           ICD10 code for the study. We expect the full      ICD10 codes ( with the full stop removed).
           stop to be removed.
   Patient Check that the value in column 9 (HRGCode)        The data item in line x, column 9 (HRGCode)
     rows matches a permissible NHS V3.5 code.               is expected to be a valid HRG V3.5 code.




            Created on 24/02/2011 12:32:00 Third draft                                      - 57 -
Sample CSV file structure:

The following text shows sample CSV file contents for 5 patients when the
document is opened within Microsoft Word:


SystemID,Age,Gender,PostDistrict,LengthOfStay,DischargeDate,TreatmentSpecialty,Primary
Diagnosis,HRGCode,UserDefined

1,22,1,NG12,2,17062008,100,A431,E41,232332
2,37,2,NG76,10,20062208,100,B356,D41,435543
3,41,2,OX113,5,22062008,300,A160,P04,343443
4,18,1,RG301,20,23062008,300,B348,J44,222211
5,60,1,BN432,100,29062008,710,B954,C15,456654

Due to feedback from hospitals that some patients do not have an
HRG code recorded, this field has been made non-mandatory, but
please make every effort to find this information as it is important for
further analysis of the data. If HRG code can not be found then this
field can be left blank as shown in the last row below. The comma to
indicate that the field is blank must be left in place.

SystemID,Age,Gender,PostDistrict,LengthOfStay,DischargeDate,TreatmentSpecialty,PrimaryDiagnosis,H
RGCode,UserDefined

1,22,1,NG12,2,17062008,100,A431,E41,232332
2,37,2,NG76,10,20062208,100,B356,D41,435543
3,41,2,OX113,5,22062008,300,A160,P04,343443
4,18,1,RG301,20,23062008,300,B348,J44,222211
5,60,1,BN432,100,29062008,710,,456654 –HRG code missing




Created on 24/02/2011 12:32:00 Third draft                                       - 58 -

				
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