RiO Mental
Health
Trainer’s Name
1
Introductions
• Your Name
• Your Job Role
• What you expect to get out of this course
• Computer Experience
2
Domestics
• Safety (Fire & Evacuation)
• Posture & Seating
• Toilets
• Breaks
• Mobile phones
• Expected finish time
• Data Protection &
Information Governance
3
Training Approach
• Demonstrations of functionality
• Exercises to enable practice
• Assessment to check your knowledge of the system
4
Agenda – Day 1
• Introduction to RiO
• Logging on & off RiO
• Demographics & the Case Record
• Notifications
• Diary Management (Viewing & Filtering Only)
• Clinic Management
• Care Planning
• Progress Notes
• Documents & Letters
• Assessment / Review of Day 1
5
Agenda - Day 2
• Referrals
• Assessment Forms
• Recording Diagnosis
• CPA Management
• Mental Health Act
• Diary Management
• Case Load Management
• Inpatient Management
• Producing Reports
• Assessment / Review of Day 2
• Activation of Smart Cards
6
What is RiO?
• A single unified electronic patient record system
7
•
Designed to mimic the structure of paper based medical records
•
Used by Community Health (PCTs) & Mental Health Trusts
•
Developed by CSE Servelec
•
Users’ access to functionality and data is based on their role
(RBAC)
Benefits of RiO
• Our aim is to deliver services which are 'good enough for my
family', by which we mean services that are Safe, Timely,
Personalised, Recovery-focused and Sustainable.
• The Implementation of the RiO system is a key enabler in
supporting these core objectives.
8
Benefits of RiO
Key Benefits include
• Standardisation of core processes, consistency of care, best
practice, benchmarking, basis for service improvement
• Single Clinical Care Record across the trust.
• Improved access to clinical information (Trustwide, improved risk /
recovery Management)
• Improved Information Management in support recovery focused
patient care, clinical audit, operational management, service
modernisation and reform, performance and corporate reporting.
• Improved Information Governance
• Developing the IT skills of the workforce
9
Demographics & PDS
• PDS is the national electronic database of NHS patient
demographic details
• Information on the PDS is held nationally and accessed by
authorised healthcare professionals through their
organisation's local system, such as RiO
• Information “feed” into the Spine, a central database where
summary patient records are stored
• See the following for more info…
http://www.connectingforhealth.nhs.uk/resources/systserv/spine-factsheet
10
Searching on RiO
What are the 3 ways of searching in RiO?
Level 1: LOCAL RiO SEARCH
Searching for a client locally using available details.
Level 2: SIMPLE PDS SEARCH
Searching for a client nationally using basic details.
Level 3: ADVANCED PDS SEARCH
Searching for a client nationally using further details/ranges.
11
Case Record
• Viewing, entering and deleting Alerts
• Viewing consent to share status
12
CASE RECORD RECAP
• The Case Record acts as a client’s/patient’s front sheet within
RiO. It provides access to clinical information
• The folders displayed on the right hand side of the case record
depend on the user’s access
• All users with access to the Case Record can see alerts and
they remain on a client’s/patient’s record even after being
deleted, on a client’s/patient’s Alert History page
• Consent is recorded by the GP
• If someone withholds consent, you can still access their records
if necessary. Access to the client’s/patient’s record is audited
13
Notifications
• Add an item to the list
• Set an item as Read and Unread
• Redirect items from the list
• Delete items from the list
14
NOTIFICATIONS RECAP
• Notifications can be “redirected” to another HCP
• Notifications items must be “read” before they can be deleted
• Manually added Notifications items in RiO Mental Health are
‘High Priority’
• A gold envelope on the client banner means there is an
unread item
• Manually added unread items have a red flag next to them
15
Client Diary
• Access the Client Diary
• View and filter information in the Client Diary
• Access the Case Record and Referral details
16
CLIENT DIARY RECAP
17
•
The Client diary is accessed via the Case Record
•
The Client diary is automatically generated by RiO to show all
appointments that are made for patient in one view
•
Appointments with the client/patient’s carer are highlighted in green
and ad-hoc appointments are highlighted in beige
Clinic Management
• Book appointments in pre-defined clinic slots
• Book appointments via the Clinic Plan
• Book repeat appointments
• Record an outcome of a clinic appointment
• Cancel or Reschedule Clinics
• Freeze time slots and Overbook Clinics
• Search for available clinic slots
18
CLINIC MANAGEMENT
RECAP
19
-
•
The Clinics screen enables accurate recording of clinic
attendances, DNAs and time spent with patients
•
Appointments can be booked directly from the Clinic View
•
Multiple HCPs and clients can be booked to a single slot
•
Recurring appointments can be booked
•
You can select & print multiple appointment letters from Clinic View
•
Clinics can be cancelled & rescheduled
•
Available clinic slots can be frozen directly from Clinic View
•
A clinic can be set up with more than one stream
•
All or parts of a clinic can now be published to the national Choose
and Book service
Care Planning
• Create a new Care Plan
• Edit a Care Plan
• Add problems, goals and interventions
• Close problems/needs and interventions
• Hide, display and re-open closed problems and interventions
• Order Care Plan problems
• Close a Care Plan
• Use the Care Plan Library
20
CARE PLANNING RECAP
• Care Plans are accessed via the patient Case Record and the
folder is access driven
• When adding a problem/need to a care plan, the available
options from the drop down list will differ according to service
• You can reorder the list of Care Plans
• An intervention or the entire problem/need can be closed and reopened
21
Progress Notes
22
•
Access and enter a Progress Note
•
Edit a note and spell check options
•
View Details and History of a note
•
Validate a Progress Note
•
Mark a Progress Note as entered in error
•
Link Care Plan problems to Progress Notes
•
Filter notes
•
Indicate a note contains details of a significant event
PROGRESS NOTES RECAP
23
•
Progress Notes are accessed via the client Case Record and the
folder is access driven
•
A validated note can not be edited or deleted
•
Validated notes are shown in dark blue, unvalidated notes in pale
blue/green, and notes marked in error with a red strikethrough
•
Progress Notes can be linked to care plans. This makes it easier to
search for specific progress notes using the filter tool
•
A user can enter progress notes on behalf of someone else by
changing the “originator” name, but they won’t be able to validate
them
•
A note can be marked as a significant event
Significant Events
24
•
Record a significant event
•
Filter the Significant Events view
•
View the additional information relating to each event
SIGNIFICANT EVENTS RECAP
•
All events are listed in chronological order
•
Events are clearly identifiable due to colour coding e.g. light blue Inpatient stay and red - Referral
•
All significant events links are automatically created and shown in
the Significant Events area, with the exception of Progress Notes
The note must be flagged as a Risk or Significant Event for a link
to be created in the Significant Events area
25
Assessment & Review
• Total of 20 questions spread over 2 days
• Multiple choice, answer ONLY on sheet provided
DO NOT WRITE ON QUESTION PAPER
30
Referrals (Entry / Exit)
• Record a referral to a team
• Modify a referral
• Record changes to referral urgency and waiting status
• Add referral actions
• Transfer a referral
• View team transfer and allocation history
• Discharge a referral
• Reverse a referral
31
REFERRALS / ENTRY &
EXIT RECAP
• A referral can only be transferred to another team within the
same speciality
• Choose and Book referrals will appear automatically on the
referrals page whenever a Choose and Book appointment is
made.
• When a referral is discharged, any outstanding appointments
will be cancelled
• A referral can be reversed if entered in error (Sys Admin)
• A referral is not reversible if an appointment has been booked
for that referral.
32
Mental Health Assessment
Forms
• Complete new forms and validate fields
• Edit existing forms and validate
• Mark fields as NOT validated
• View a history of changes
• Record information in a form on behalf of another user
• View data validation controlling data entered on a form
• Record details on a graphical assessment.
33
Validation Statuses
•
34
There will be three possible statuses for each field which
indicate whether the field has been checked and whether it is
correct or incorrect
Reviewed
state
Correctness Display
state
status
unchecked
Unknown
unvalidated
checked
Correct
valid
checked
Incorrect
invalid
Validation
icon
USER TYPES OF VALIDATION
35
•
The two flags on the user configuration screen are labelled as “Validate
Own Entries” and “Validate Entries by Others”. These flags are used to
determine who may validate both Progress Notes and form entries
•
Below is a list of example roles and how the flags could be set up
User
Validate Own
Entries
Validate
Entries by
Others
'Entered on
Behalf Of'
requirement
Student
No
No
Optional
Medical
Secretary
No
No
Mandatory
Normal HCP
Yes
No
Optional
HCP
responsible for
Students
Yes
Yes
Optional
Assessment Forms
Referral Screening Form
This Form is used for recording information about the referral to the Mental
Health services. Eg. Reason for referral
Police Screening Request form
This form is completed by MH professionals to provide history and current
situation to the police when requesting assistance
Court Diversion form
This forms records the outcome of assessment of clients mental state,
history and the outcome of the court hearing
Carer’s Assessment
This form is used for recording information about the client in their Role as
the Carer of another service user
36
Assessment Forms (Cont…)
Relapse, Crisis and Contingency Plan
This is used for recording information about the referral to the contingency
plan that is to be used if the patient suffers a relapse or a crisis. (Access
via Care Plan – other information)
Pre Discharge Planning
This form records the specific elements of an individuals care plan relating
to their discharge from hospital
Delayed Discharge form
This is used to record details of inpatient admission requests. This allows
bed managers to plan bed use accordingly
37
Assessment Forms (Cont…)
CPA Review Management
This form is used for recording information about the CPA review meetings
MAPPA
The MAPPA form is used for recording details of risk to others
HCR 20
The HCR-20 is an internationally recognised assessment for assessing the
risk of violence. (Webster, Douglas, Eaves & Hart 1997). These forms
should only be used by Health Care Professionals who have been trained in
using the HCR-20 assessment
38
Risk Information Forms
Risk Assessment
This form contains the results of a risk assessment for the client/patient.
It is important to complete all areas of the form even if there is no risk of
a particular type to show that every area of risk has been considered
Safe guarding Child Summary
This form is used to record all details relating to child protection on an
individuals record
CGAS – Children’s Global Assessment Scale
This form is used by Child and Adolescent Mental Health Services
(CAMHS) to record a score for a child’s general functioning eg. In their
environment at home, school & with peers
39
Outcome Measure Forms
Paddington Complexity Scale
This form is used by CAMHS to record a score for complexity and severity of
client condition
Strengths and Difficulties
This form is used by CAMHS to record a score for strengths and difficulties.
eg. Emotional symptoms and peer problem score
Experience of Service
This form is used to record details of the client’s experience of the service
40
HoNOS Forms
(Health of the Nation Outcome Scale)
This measures the health and social functioning of people with
severe mental illness
• HoNOS (Working Age Adults)
• HoNOS65+ (Older Adults)
• HoNOS-ABI
• HoNOSCA
• HoNOS-LD
• HoNOS –Secure (V.2)
41
Specialist Assessment Forms
MOHO OT Assessment
These are a specialist Occupational Therapy assessment of an
individual’s occupational motivation, skills, interests etc
NCDS
This form is used to capture details of treatment offered and given
to children and adolescents and the professionals providing
treatment
NDTMS
This form is used to record the main details needed for the National
Drug Treatment Monitoring Service
Observations / Seclusions
These forms are used to record to access to fresh air, types of
inpatient observations and periods of seclusions
42
ASSESSMENTS FORMS
RECAP
43
•
Many forms are pre-populated with data and contain coded
selection lists which make completion faster and more accurate
•
The forms available depend on the user’s access level and area
of work
•
Most forms are service specific except the general assessments
that can be used by most services, for example the Additional
Personal Information form
•
Read-only versions of the forms allow users to view information
but not to change it
ASSESSMENT FORMS & VALIDATION
RECAP
•
Assessment forms in RiO have been created to facilitate structured
recording of clinical information by clinicians. They provide an
alternative to entering clinical assessment information in the progress
notes as free text
•
Valid entries on a form will be marked with a green tick. Invalid
entries will be marked with a red cross
•
When editing a form, an unedited field will be indicated by a hollow
tick or cross. An edited field will be indicated by a solid tick or cross
•
Requests for new forms or amendments to existing forms must go
via the following channels:
– Highlighted to Trust Representative
– Discussed at Best practice Groups
– Referred to CFH
44
Diagnosis / Clinical Coding
45
•
Record a patient primary and secondary
diagnosis
•
Remove a diagnosis
•
Display old/removed diagnosis
•
Confirm a diagnosis
•
Reverse an ICD-10 diagnosis confirmation
DIAGNOSIS / CLINICAL
CODING RECAP
46
•
ICD10 codes are used to record diagnoses. Users can search by
diagnosis code or description
•
Several diagnoses can be added at one time
•
RiO allows up to 13 secondary diagnoses to be associated with a
primary diagnosis
•
The Confirmation of a diagnosis can only be done following an
inpatient episode, referral or CPA review (MH Only)
•
A referral only becomes available for confirming a diagnosis when at
least one outpatient appointment has been booked against the
referral
•
A confirmed diagnosis can be reversed
CPA – Care Programme Approach
47
•
Record a client’s/patient’s CPA level
•
Record a client’s/patient’s Care Co-ordinator
•
View CPA History
•
Schedule a CPA Review
•
Record CPA Review details
•
Update/edit CPA Review Details
•
Validate a CPA Review
•
Create and print a CPA Review Pack
•
Reverse CPA details
CPA RECAP
48
•
CPA reviews can now be scheduled in advance
•
A history of previous CPA Reviews can now be viewed
•
Details of CPA Reviews can be recorded and then validated
•
CPA Review details are now automatically added as a progress note
•
CPA Review Packs can now be created and printed via the Editable
Letters function, which includes CPA details, Care Plans, Risk
Assessment etc
Mental Health Act
Sections, & Consent
• View a Client’s Section history
• Record Consent to Treatment & ECT
• Recording Section 117 Details
• Record Nearest Relative Information
49
Consent to Treatment Background
• Consent to treatment is needed before any medical
treatment is given to a patient including Electronic
Convulsive Therapy
• It may be that the patient is unable to give consent if they
are mentally ill in which case another member of the
family, or a second opinion authorised doctor (SOAD) will
need to be involved in Consent to Treatment
• Or a patient may not agree to the treatment in which case
a second opinion authorised doctor will need to review the
case and give authorisation (or not) to the treatment being
given
50
Consent to Treatment Background
• It is essential that consent to treatment is recorded properly and
accurately according to the Mental Health Act
• A client has to be on a Section before Consent to Medication is
recorded, but the same does not apply for ECT
• Trusts will have at least one Mental Health Act Administrator who is
there to ensure medical staff follow the Mental Health Act and
accurately record information. A one day RiO course has been
specifically created for Mental Health Act Administrators to ensure they
are confident in recording MHA information into RiO
51
Consent to Treatment
52
•
Record a patient’s current Consent to Treatment /
Medication status
•
Record a patient’s current Consent to ECT status
•
Record second opinion data for patient NOT consenting
to ECT
•
Record actions required by the MHA regarding Consent
to Treatment
•
View a patient’s consent history
Recording and Viewing
ECT Treatment
The Key Benefit is the ability to record and easily access detailed
medical information about ECT Treatments
Note:
ECT Treatment cannot be recorded in RiO until Consent to ECT Treatment has
been recorded in RiO
If consent to ECT has not been recorded, RiO will display a message to this
effect and will not allow any further information to be entered
53
Diary Management
• Navigate the Diary
• Book Appointments – Client & Non Client
• Add Additional HCPs to an appointment
• Add Additional Clients to an appointment
• Cancel Appointments
• Record Activities and Outcomes
• Reverse outcomes
54
DIARY MANAGEMENT
RECAP
• The Diary can be viewed in monthly, weekly or daily views
by clicking on the MWD blue icons
• The different colour codes in the diary reflect what type of
appointment has been booked
• Recurring appointments can be booked
• A user can record both client or personal appointments
• Additional clients or additional HCPs can be added to the
same appointment
• For most specialties, a client must have a valid referral for
that specialty before an appointment can be made
• An appointment outcome can be reversed if entered in error
55
Caseload Management
• View team or HCP Caseloads
• Allocate a referral to another HCP
• Re-Allocate all or part of a caseload - “Caseload Transfer”
• Share a client with another HCP
• Remove a client from caseload
56
Caseload Management Benefits
• The ability to view your caseload clearly
• Colour coding highlighting the status of your cases
• The ability to view and manage your caseload from a single
screen
• System check to prevent users from removing a referral from
their caseload, unless the referral is shared with someone else.
57
CASELOAD MANAGEMENT
RECAP
• The caseload view can be filtered to restrict the type of referral
displayed
• Allocation from the Caseload screen can only be done once. Any
further reallocation has to be done via the Caseload Transfer
screen
• A patient can be “shared” with more than one HCP
• A patient can only be removed from a Caseload if they exist on
another caseload and they do not have any future appointments
or if the referral is discharged
58
Inpatient Management
59
•
Understand the different Ward views and Bed icons
•
Record Ward Attenders and view their history
•
Admit a patient to a ward and discharge them
•
Transfer a patient from one bed to another
•
Swap beds and record a sleepover for a client
•
Set up and record leave details for a patient
•
Understand inpatient reverse options for admissions,
discharges, leave, transfers and sleepovers
•
View admission history
•
Close a bed
INPATIENT MANAGEMENT RECAP
•
60
2 ward views available:
•
List view – more suitable for printing
•
Bed view – gives a visual representation of the ward
•
You can only see wards that you have been authorised to view
•
Ward attendees can be recorded (patients who come into the ward for
treatment but do not need a bed)
•
You cannot reverse an inpatient event if a more recent event has taken
place
•
The reversal process is audited
•
Admission History provides read-only access to information about a
patient’s current and previous admissions
INPATIENT MANAGEMENT RECAP
(Cont’)
61
•
Use the Transfer – Out option to transfer the care of a patient without changing
their physical location or to move a patient to an unoccupied bed
•
Use the Transfer – Bed Swap option to swap the physical location of a patient,
with or without transferring their care
•
Use the Sleepover option if you are retaining responsibility for the patient’s care
but he or she is going to be sleeping temporarily in another location, e.g. due to
staff shortages
•
A bed, bay or ward can be closed and this will be reflected in the bed view icon
•
You cannot close beds that are currently occupied
•
Patients cannot be admitted to closed wards, bays or beds
•
DO NOT REGISTER A DEATH ON RiO
Inpatient Management Ward Planner
62
•
View the Ward Planner
•
Use the Ward Planner Tabular View
•
Plan inpatient events
•
Approve Planned Events
•
Record Planned Events
•
Edit or delete a Planned Event
WARD PLANNER RECAP
•
The Ward planner is a tool which allows events to be planned in
advance
•
You can only view dates in the future
•
There are two versions of the tabular view of the ward planner:
•
63
–
Ward Mode
enables you to view and plan events
–
All Mode
enables you to approve or remove approval from planned
events as well as planning and viewing them
You can only plan admissions into beds that are unoccupied
WARD PLANNER RECAP (Cont…)
64
•
You cannot record events (state that they have happened) that
are still awaiting approval
•
You cannot edit or delete events that are approved – you must
first change their status to Awaiting Approval
•
If you delete a planned admission and it is associated with
planned transfers or periods of leave, these will also be deleted
Reports
• View a selection of RiO Reports
• Use parameters to control data displayed in reports
• A Ward Manager wants to run a Bed Compliment State report to
check on bed availability
The Key Benefits are:
• Timely information derived from reports facilitates resourcing and
planning
65
Types of Report
READ ONLY REPORTS /STATIC
This type of report will open in a separate window allowing view only but no edits
• Past Non-Professional Patient Contacts
DYNAMIC REPORTS
These generally require parameters to be set to select items such as date range,
HCP or patient
• Printable Diary
• Discharges with discharge reasons
STATUTORY REPORTS
These type of Reports are run by the Trust System Admin staff and are generally
scheduled to be run at a quiet time on the system as they can be very large and
take a long time to compile
66
REPORTS RECAP
• READ ONLY REPORTS – open in a separate window, users cannot control
data displayed
• DYNAMIC REPORTS – usually require parameters such as date range,
HCP or patient. Most dynamic reports once run can be sorted by column
• STATUTORY REPORTS – usually run by the Trust System Administration
staff and are generally scheduled to be run at a quiet time on the system as
they can be very large and take a long time to compile
• The reports that a user will have access to is dependent on their user logon
type and RBAC code
• If you are running a report that allows you to specify a ward or a caseload
you will only be able to select wards or caseloads that you are authorised to
access
67
Assessment & Review
• Total of 20 questions spread over 2 days
• Multiple choice, answer ONLY on sheet provided
DO NOT WRITE ON QUESTION PAPER
68
SMART CARD ACTIVATION
1. Insert Smart Card
2. Launch the National Health Service Spine Portal
https://portal.national.ncrs.nhs.uk/
3. Select Manage
Passcodes
4. Enter New Smartcard
Passcode, Confirm and
Select Update
69
4. Keep your card Safe &
Secure ready for Go
Live.
5. DO NOT forget the
NEW Passcode
Summary – Final Thoughts
THANK YOU
Final Thoughts & Questions
70