[PDF] Border Clinical Management System (BCMS) – Guide for General

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Updates Date

Updated Log-in Information and include BCMS form 23/12/21 Added section on identifying your patients 23/12/21

Added to pulse oximeter section 23/12/21

Removed Welfare Tasks creation ʹ now managed during reg health check

23/12/21

Added section on Weekend Care 23/12/21

Border Clinical Management System

(BCMS) ʹ Guide for General Practices in the

Southern District

Version 2.0

Last updated: 23 December 2021

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Contents

Section 1: BCMS ʹ Logging In .............................................................................................................. 3

Section 2: Identifying your patients .................................................................................................... 5

Section 3: Initial Assessment ʹ Day 1 .................................................................................................. 8

Section 4: Noting Covid Care Level of Patient & Summary ʹ Day 1 .................................................. 12

Section 5: Follow-up Assessment (Reg. HCx) ʹ Days 2 ʹ 14 (Daily or every other day depending on

Covid Care 1 or 2) .............................................................................................................................. 14

Section 6 ʹ Task - pulse oximiter is required (Covid Care Level 2 patients only) ............................. 18

Section 7 ʹ Twice Daily Observations ............................................................................................... 20

Section 8 ʹ Flags for Active Management ........................................................................................ 22

Section 9 ʹ Weekend Care ................................................................................................................ 24

Section 10 ʹ Acuity ............................................................................................................................ 26

Appendix 1 ʹ Practice Allocation ...................................................................................................... 27

Ctrl and click on the section you want to read above.

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Section 1: BCMS ʹ Logging In

Unfortunately the integration between the PMS and BCMS did not occur as planned by the Ministry of Health. We hope that this will be achievable in the New Year. However, in the interim you should use the form below to request a BCMS account. https://forms.office.com/r/D61BajCTz4 If you have completed the form and tried to access your account 24 hours later, and it does not work - please contact NCTS.Servicedesk@health.govt.nz Please follow the instructions below to log-in to the BCMS for the first time.

1. Using Google Chrome, navigate to https://covid.indici.nz/

2. Complete Username = firstname.lastname (all lowercase) ʹ or what was stipulated in form

3. Type in password = Covid@2021 and click Login

4. You will prompted to set a new password ʹ please choose your password

5. Click update

6. Re-type your new password.

7. Click login again

2 3 4

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8. You will be prompted to enter a passcode which is sent, via SMS, to your mobile phone. This

is required every time you log-in.

9. Once you enter the code click validate.

Practices: National indici PMS Practice

Facility Type: Community Care

Locations: You should only have one option here ʹ based on the location of the practice you work.*

11. Click Continue

*If you a clinician part of the Clinician Network you will have access to more than one location, but

you should choose the location of the practice where you work as a base.

12. Click Accept on Ts & Cs.

7 9

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Section 2: Identifying your patients

You should confirm that you are loaded into the correct location. The location is based on the geographical location of your practice and is how your

patients are loaded into the BCMS. Wen all locations selected they will all be highlighted green.

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found in Appendix 1. For example, if you are part of the Clinician Network you would search for CLN.

Click Search & Filter

In allocation type the three letter abbreviation of your practice, then click Search & Filter on the right hand side.

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This will generate the list of patients associated with your practice, including their bubbles.

͞quarantine to room͟.

You can easily identify Covid positve patients as they will have a red line under your practice name.

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Section 3: Initial Assessment ʹ Day 1

Once you have identifed your patients, you will have to do an initial assessment. The initial assessment determines if a patient is Covid Care 1 or Covid Care

2. For further information on these terms, please see the HealthPathway.

Obtain patient contact information

Patient contact information will be available via your PMS (if patient enrolled), and through page 3 of Guest Information in the the BCMS.

On the bottom right hand side of the screen, navigate to Page 3.

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Now you have the contact number, you can contact the patient. Ideally this would be a video call, made via the video call process within your practice.

However, video may not be possible for the first contact.

Day 1 Part A ʹ Initial HCx

Click on initial assessment.

The initial assessment has 5 pages to work through, however nothing is a mandatory field. Some of this information will eventually pre-populate. You

should leave Page 4 ʹ Base Welfare blank. Please confirm the patients address and contact numbers, including numbers of any friends or family, who are

not isolating, who can offer support. This may be important when considering pulse oximeter delivery (if required).

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Once you have worked through the initial assessment, hit complete (available on page 5) to save.

Day 1 Part B ʹ Reg. HCx

Once an initial assessment is complete, a follow-up assessment (Reg. health check) must also be completed on day 1.

Click Reg. Health Check.

Face to face is signs of Covid-19.

Telephone is symptoms of Cvoid-19

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Work through all sections (1-5) of the reg. Health Check. N.B you have to click on face to face to access all 5 pages.

On Page 3 of 5, you should determine the acuity of the patient from 1 ʹ 6, based off the guidance in Section 9.

This is important for prioritising discussion at the Virtual Ward round.

Page 4 of 5 is Base Welfare, please complete this section by clicking yes (if required) and determing what support is needed.

Please be as detailed as you can, by adding further information into the Further Information box. This automatically creates a task which MSD will take

responsibility for actioning. On Page 5, you should make any relevant notes, and click Complete when finished.

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Section 4: Noting Covid Care Level of Patient & Summary ʹ Day 1 When you click complete on the Reg. Health check, the below pop-up appears.

If you have assessed the patient and determined that they meet the Covid Care 2 criteria and need daily contact, click Yes for blue band.

This will add a blue line to the patient name ʹ an indicator that the patient is Covid Care 2. If patient is Covid Care 1 ʹ keep blue band at No. When finished, click Save to bring you to the summary page. A Covid positive patient who is Covid Care 2 ʹ denoted by red and blue bands.

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The summary page:

Displays vitals and symptoms over time.

Data can be displayed in graph format by clicking on any of the days at the top.

A timeline of notes can also be accessed here.

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Section 5: Follow-up Assessment (Reg. HCx) ʹ Days 2 ʹ 14 (Daily or every other day depending on Covid Care 1 or 2)

Identify patient requiring a follow-up assessment (Reg. HCx). ʹ This could be managed by an admisistrator and loaded into appointment books.

Click Reg. Health Check.

Face to face is signs of Covid-19.

Telephone is symptoms of Cvoid-19

Work through all sections (1-5) of the reg. Health Check. N.B you have to click on face to face to access all 5 pages.

On Page 3 of 5, you should determine the acuity of the patient from 1 ʹ 6, based off the guidance in Section 9.

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This is important for prioritising discussion at the Virtual Ward round.

Page 4 of 5 is Base Welfare, you should ask this question at every patient interaction and complete if patient has any welfare needs.

Please be as detailed as you can, by adding further information into the Further Information box. This automatically creates a task which MSD will take

responsibility for actioning. On Page 5, you should make any relevant notes, and click Complete when finished.

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Confirming Covid Care Level of Patient & Summary

When you have worked through the assessment and clicked complete, the below pop-up appears.

If during your assessment you have a patient who is currently Covid Care 1, but you feel now needs daily assessments, you can click Yes for blue band.

This will add a blue line to the patient name ʹ an indicator that the patient is Covid Care 2. If patient is Covid Care 1, and this is appropriate ʹ ignore this screen. If patient is already Covid Care 2 ʹ ignore this screen. When finished, click Save to bring you to the summary page.

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The summary page:

Displays vitals and symptoms over time.

Data can be displayed in graph format by clicking on any of the days at the top.

Timeline of whiteboard notes can also be accessed here. Always remember to add in the preferred method of communication if you are editing the

whiteboard notes.

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Section 6 ʹ Task - pulse oximiter is required (Covid Care Level 2 patients only)

Once initial assessment is completed, and you have determined patient should be Covid Care 2, immediately create a task to send a pulse oximiter.

Click on patient name, navigate to Tasks on the left hand side.

Complete as shown below.

2 ʹ Click NOW for start date.

3 ʹ Select the day after for End Date

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4 - Set status as Active

5 ʹ This field cannot be changed currently, ignore.

6 ʹ Select High priority.

7 ʹ Put Administrative as Type.

This will alert the coordinator to send the pulse oximiter to this patient.

Practices across the district shoud have received a small supply of pulse oximeters (outside of Dunedin and Invercargill). If you can arrange the delivery of

the pulse oximeter, please create a task detaling the pulse oximeter number (on the side of the pulse ox), and that the pulse oximeter has been delivered.

This way, we can keep track of the pulse oximeters.

The pulse oximeters which were delivered are not your only supply. We can manage the supply of pulse oximeters across the district, but it requires

practices to inform us of the pulse oximeters they send out, otherwise we will lose track.

For practices in Dunedin and Invercargill, please create a task as described above and WellSouth will arrange delivery.

N.B. Clinicians can also request a phone and data for a patient via the Task function, if required.

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Section 7 ʹ Twice Daily Observations

If you a feel a patient needs further observation you can add a task for this patient to have Twice

Daily Observations.

Locate the patient and click Tasks on the left hand side of the screen. complete the rest of the fields.

2 ʹ Consider how long you think the patient should be under twice daily obs and change the end

date accordingly.

Click Add Task when done.

An orange dot will appear under whiteboard notes beside the patients name. This notifies clinicians that this patient requires twice daily obs.

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You can also search by Task function as shown below to identify patients requiring Twice daily obs. Once the first observations of the day have been taken, click on the patient name and click whiteboard note (shown below) to add this as note. N.B It is important to add any existing information into the Notes that is required. When the second daily observations are complete this should be updated to say Obs #2 14/10/21 complete.

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Section 8 ʹ Flags for Active Management

an assessment. However, if you want to add a flag outside of an assessment you should navigate to the patient, click on clinical encounter, and flags for

active management, as shown below.

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This opens the page shown below. Not all flages are relevant but if you identify an appropriate flag please use it.

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Section 9 ʹ Weekend Care

If your practice cannot provide care to Covid positive patients during the weekend, the Clinician Network will provide this care.

To ensure your patient is contacted by a clinician on the weekend, you must follow the process below.

After your last contact with the patient during the week (remember this could be Thursday for CC1 patients who will next be contacted on Saturday)

navigate to Clinical Encounter and Flags for Active Management as shown above. You will be asked if the whole bubble should be placed into isolation, click no.

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Then click Save.

This creates a yellow band beside the practice name. The relevant flags also appear at the end of each follow up health check.

N.B. If you are part of the Clinician Network working on the weekend you should ensure you have selected all locations, and use the search and filter button

A Covid positive patient who is Covid Care 2 and needs to be cared for by the Clinician Network on the weekend ʹ denoted by red (Covid +ve), blue (CC2) and yellow (Clinician Network) bands.

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Section 10 ʹ Acuity

The clinical pathway within Southern District uses the acuity soring within Border Clinical Management System (BCMS) to identify patients who are causing heightened clinical concern, for discussion with the multi-disciplinary virtual ward round or the on-call Covid consultant team. The acuity tool is likely to be modified during the course of the next few months, as there is

potential to use all points on the 6 point scale. Initially, we will use acuity scores of 1, 3 and 6. The

acuity should be assigned at each patient contact. Patients who meet the admission criteria as outlined in HealthPathways should be discussed with the on-call Covid consultant (or paediatric consultant on call) for admission. This protocol is based on the information in the Southern HealthPathways COVID-19 Case Management pathway. This pathway has important information on co-morbidity, severity of symptoms and about virtual clinical history taking and exmaination. Table 1. Determining Acuity Score Category in Border Clinical Mangement System

Either Symptoms Or Risk = Acuity

Score

Action

COVID Care

Level 2

Moderate

SaO2 93-95%

Breathlessness

Concern about

hydration

Has required hospital admission

for COVID-19 during the illness

Some worsening of clinical

condition and o Pregnant (or within 6 weeks of pregnancy) o Mental health concerns o High and complex medical incl. Palliative, disability o High and complex social o Living rurally

Clinician concern

6 COVID-19 MDT

review (virtual ward round) or on-call consultant discussion

Asymptomatic

/mild,

SaO2 > 95%

Not breathless

Adequate

hydration

All other COVID Care Level 2

patients without above risks

3 Once daily

telehealth, video if possible, with pulse oximeter COVID Care

Level 1

Asymptomatic/mild

Not breathless

Adequate

hydration

Fully vaccinated (MĈori 12y-

43y, Pacific 12-38y, Other 12-

64y) or

Child > 3 month age and <

12years, and

No co-morbidity and

No high social needs

1 Alternate days

telehealth

Modified from NHRCC Acuity Scoring C-SIQ

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Appendix 1 ʹ Practice Allocation

Albany Street Medical Centre ALB Mornington Health Centre MHC Alexandra Family Medical Centre Ltd AFM Mosgiel Health Centre MOS Altimus Health Limited AHL Mountain Lakes Medical MLM Amity Health Centre AHC Murihiku Medical Services MMS Aspiring Medical Centre AMC Musselburgh Medical Centre MUM Aurora Health Centre AUC North End Health Centre NEH Bester McKay Family Doctors Ltd BMF Oamaru Doctors OAD Bluff Medical Centre BLU Otago Peninsula Medical Centre OPM Broadway Medical Centre BMC Otautau Medical Centre OMC Catherine St Medical Centre CSM Outram Medical Centre OUM Catlins Medical Centre CMC Pitt Street Medical PSM

Central Medical CEM Portsea Medical Centre PMC

Clutha Health First General Practice CHF Queens Park General Practice Ltd QPG Cromwell Family Practice CFP Queenstown Medical Centre QMC Cromwell Medical Centre CRM Ranfurly Medical Centre RMC Dunedin Health Centre DHC Roslyn Health Centre RHCquotesdbs_dbs26.pdfusesText_32

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