Sexual Health Adviser Interventions Complex Coding Ceri Evans

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Sexual Health Adviser Interventions: Complex Coding Ceri Evans 10 Hammersmith Broadway Clinic Part of

Sexual Health Adviser Interventions: Complex Coding Ceri Evans 10 Hammersmith Broadway Clinic Part of Chelsea and Westminster Hospital, London

History 2010 - lightbulb moment! Started coding locally as HAX Too unwieldy - too

History 2010 - lightbulb moment! Started coding locally as HAX Too unwieldy - too many topics Started coding “common” topics 2016 - another lightbulb moment! Let’s go NATIONAL! • 2017 - Taken to BASHH Board and SSHA • 2018 - HERE WE GO! • • •

Why is it necessary to have Complex SHA Codes? The role of the Sexual

Why is it necessary to have Complex SHA Codes? The role of the Sexual Health Adviser has often been quite hard to explain to other members of staff and more recently to Commissioners. Traditionally there has been very little actual coding of the work that we do, although some clinics have local codes that they use. We also hope that it will support clinics in being able to keep Sexual Health Advisers in their job and to ensure that the “value added” role of the Sexual Health Adviser is recognised and appreciated.

Codes • HA 01 Risk Reduction = all types of risk reduction work, including

Codes • HA 01 Risk Reduction = all types of risk reduction work, including MI • HA 02 YP <18 = assessing risk, Fraser competence, child protection/safeguarding/Child sexual exploitation • HA 03 HSV = detailed support session around herpes, either first diagnosis or ongoing management • HA 04 Mental health/Psychological intervention = risk assessment, onward referral to psychology and/or psychiatry

 • HA 05 HIV/STI anxiety = support/counselling re: health anxiety reduction regarding HIV

• HA 05 HIV/STI anxiety = support/counselling re: health anxiety reduction regarding HIV and/or STIs • HA 06 Psychosexual issues = assessment for psychosexual therapy, counselling /1: 1 work re psychosexual issues • HA 07 Domestic violence/vulnerable adult/child safeguarding issues = counselling/ 1: 1 support re: historic or current sexual and/or domestic abuse

 • HA 08 Drugs (including chemsex issues)/Alcohol Harm minimisation = detailed discussion of

• HA 08 Drugs (including chemsex issues)/Alcohol Harm minimisation = detailed discussion of drug and/or alcohol use and sexual activity, information and support provided re: harm minimisation, onward referral • HA 09 First HIV diagnosis/follow up = Initial and or follow up appointment booked for new HIV diagnosis to discuss initial blood results, review coping, and support disclosure/PN. This could also be used for HCV and HBV if relevant • HA 10 PEP/Pr. EP = Full documented discussion of PEP or Pr. EP and options

 • HA 11 Sexual Assault (Male or female) = initial and/or ongoing support

• HA 11 Sexual Assault (Male or female) = initial and/or ongoing support for sexual assault/referral to other services as necessary • HA 12 Sexual exploitation/trafficking = initial and/or ongoing support and referral to other services as necessary. Knowledge of issues and local information. • HA 13 Other Consultations requiring considerable time to discuss issues = e. g. people with Learning Disabilities/working with patients on a hospital ward/Commercial Sex Workers/transfer of HIV care/Pregnancy or TOP options/ complex Partner Notification and/ or Provider Referral etc (Documentation should demonstrate a significant interaction that would not be covered by another code)

Current clinics Trialling Coding • • • Chelsea and Westminster, London Watford/St Albans Swindon

Current clinics Trialling Coding • • • Chelsea and Westminster, London Watford/St Albans Swindon Taunton and Somerset Sunderland Birmingham Sheffield Belfast Brighton Royal Berkshire Royal Bournemouth

Plan • Audit early January 2019 for previous 3/12 • Abstract for BASHH by

Plan • Audit early January 2019 for previous 3/12 • Abstract for BASHH by 1/3/19 • Poster/presentation BASHH Birmingham June 2019

Positive Comments…. • All going very well, coding is straightforward and was easy to

Positive Comments…. • All going very well, coding is straightforward and was easy to set up with our admin team. • It has been satisfying for me to highlight my input in this way. • The codes are straight forward for us as we have added the codes into our EPR system as a service code, which made it easier • It was really easy to set up and start using the codes, no problems at all. • No negative feedback, everyone thinks it is a good idea for the HAs to be able to capture their work in this way. • We received positive feedback, particularly from Drs who agreed this was an exciting development for Health Advisors and agreed this was an excellent way to further recognise our role. • So far it has been a unanimously positive experience • The department are really supportive about introducing the coding

Any Problems? • One slight teething problem at the beginning, despite an email going

Any Problems? • One slight teething problem at the beginning, despite an email going out to all staff about the coding, I found that a few ‘non. Nurse Advisers’ started to use the coding. I adjusted the coding and no problems since. • The only issue I have is that staff sometimes forget to tick the service code. • I have had a nightmare trying to get our systems manager to put them onto Mill • Remembering to add them! • They are reasonably subjective so I have noticed a slight difference in they way people approach them and classify a patient as 'complex', eg some would apply a complex code more freely than others • There haven’t been any problems as such so far, although we have recognised there are occasions where a single patient would suit multiple HA complex codes within the one attendance. In this instance we code the most pressing issue.

ceri. evans@chelwest. nhs. uk

ceri. evans@chelwest. nhs. uk