15Titration & Episodes

Purpose

Managing patients whose medication is being actively adjusted, and recording titration episodes so they can be billed correctly.

Procedure

1. Add the patient to the titration tab under their funding stream.
2. Record the titration episode number. Billing is per episode, not per appointment.
3. Record the date of next prescription, next appointment date, prescription status and any notes.
4. Determine whether an appointment is required before the next prescription. If so, set a booking reminder (06) and chase using C1.
5. Determine whether observations are required before the next prescription. If so, chase using C1 and 16.
6. Once automated reminders expire, send a separate Semble notification confirming medication is discontinued until the patient makes contact.
7. Record the expiry date of the notifications and the expiry date of the medication.
8. Where medication is discontinued, remove the patient from the titration sheet so the practitioner knows not to issue a prescription, and issue the 8-week warning via C2.
9. Record every appointment and DNA at the morning meeting so the episode can be invoiced (27).

Fields recorded

Funding stream · NHS number · allocated clinician · DOB · titration episode number · date of next prescription · next appointment date · prescription status · notes · appointment required (Y/N) · booking reminder set · reminder expiry · notification received · obs required (Y/N) · obs reminder expiry · medication expiry date · date prescription sent · tracking number

Variations

Episode numbering - Episode 1 is the initial titration. If a patient goes onto shared care and is later referred back in by the GP, or returns via annual review, that is episode 2 - and so on.

Episode closure - An episode closes when the patient goes onto shared care, or is discharged for any reason.

Notes

• Billing starts once the patient attends their first titration appointment. Dates are then added so the number of appointments taken to complete titration is visible.
• Titration patients also appear on the New Referral / Waiting List sheet for medication reviews.

Open points

• Whether an episode that ends in DNA or non-engagement is still billable.

Flowchart