SWINE FLU ASSESSMENT - CLINICAL ALGORITHM
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AC01
Part of the overall National Protocol for Pandemic Influenza
SWINE FLU ASSESSMENT –
CLINICAL ALGORITHM
January 2010
Guide for use
• This algorithm is intended to be used to assess patients who are 1 year and
over. It is not for assessment of children under 1 year.
• For a pregnant woman, this algorithm may be used but the assessment must
be made by a suitably qualified and experienced healthcare professional (see
“Pandemic Influenza: Guidance on preparing maternity services”, available on
the Department of Health website).
• The assessment includes a series of questions concerning the patient’s
current symptoms and their medical history.
• Unless the patient requires an emergency referral to 999 or is referred to
their GP surgery in step 2, all 3 steps must be completed for each patient.
• The assessment involves three steps:
STEP 1 – Determine whether the patient requires ambulance services (999)
STEP 2 – Confirm that the patient has flu symptoms and would benefit
from antiviral treatment
STEP 3 – Identify whether the patient requires additional healthcare services
• Step 1 will identify patients who need emergency care. These patients
should be directed to ambulance services (999) immediately.
• Step 2 will determine whether a patient should be authorised to receive
antiviral medicine. If an antiviral medicine is required, information about
the patient must be used to authorise the correct antiviral medicine for
the patient.
• Step 3 will determine whether the patient should seek further assessment
or advice from another healthcare service, and provide appropriate advice
for the patient.
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
STEP 1 – Emergency Assessment
1.1 Does the patient have any of the following
symptoms?
• Are they unresponsive or unconscious, floppy,
limp, or impossible or difficult to wake?
• Has their breathing become so difficult that
they are unable to finish a sentence or do they
appear to be choking or (if they are a child)
grunting when breathing?
Refer patient to
• Do they feel they have to sit up to be able YES ambulance services (999)
to breathe?
• Are they unable to swallow saliva or drooling
excessively?
• Does their skin feel both icy cold AND wet
to touch?
• Has their skin changed colour to blue or grey
particularly around the lips, mouth, fingers,
palms of hands or (if they are a child) toes?
• Are they having a fit now?
NO
1.2
• Does the patient have clusters of tiny purple
spots or a rash that looks like bleeding or
Refer patient to
bruising under the skin? YES ambulance services (999)
• Or, despite any pain they may have, is the
patient completely unable to move their chin
down to touch their chest?
NO
Continue to question 2.1
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
STEP 2 – Flu assessment and
authorisation of antiviral treatment
2.1 Is the patient less than 1 year old? YES Do not authorise antiviral.
NO Advise patient, parent, carer
or guardian to contact GP
surgery immediately for
2.2 Is the patient at risk of malaria? YES assessment and treatment
NO
2.3 Is the patient pregnant? YES - If you are not a Health Care
Professional, then do not
NO authorise an antiviral and
advise patient to contact
2.4 Does the patient have a high temperature GP surgery immediately for
and at least two of the following symptoms? assessment and treatment
• Widespread muscle and joint aches - If you are a Health Care
• A cough Professional continue
• Headache with the assessment.
• Blocked or runny nose
• Sore throat Health Care Professional
• Vomiting carrying out assessment
• Watery diarrhoea
• Cannot stop crying (only children) YES Continue to question 2.5
NO
The patient does not have symptoms of flu.
If the patient is seriously unwell they should
contact their GP, or otherwise contact Continue to question 2.6
NHS Direct for further advice
2.5 Has the patient had flu symptoms DO NOT AUTHORISE
(see question 2.2) for more than 7 days?
YES ANTIVIRAL TREATMENT
Continue to question 2.6 Continue to question 2.6
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
January 2010
2.6 Have these current flu symptoms
DO NOT AUTHORISE
(see question 2.2) been previously treated with YES ANTIVIRAL TREATMENT
oseltamivir (Tamiflu®) or zanamivir (Relenza®)?
NO
Continue to question 3.1
AUTHORISE
ANTIVIRAL TREATMENT
Continue to question 3.1
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
STEP 3 – Identify whether further
assessement or advice is required
3.1 Symptoms of swine flu include tiredness and
widespread body pains. In addition to these,
does the patient have any of the following
symptoms?
• Increasing difficulty breathing, for example
unable to complete a sentence or for children, Advise patient to telephone
skin sucked between ribs when breathing YES GP surgery urgently
• Sharp chest pains that make it difficult to
breathe or cough
• Thick yellow, green, brown or bloody phlegm
• Uncharacteristic changes in behaviour such
as new confusion or appearing terrified
(particularly children)
• So drowsy that they have difficulty with
eating, drinking or talking
NO
3.2 Has the patient’s condition suddenly
worsened, or if the symptoms have lasted Advise patient to telephone
for more than 7 days (or 5 for a child),
YES GP surgery
are they still getting noticeably worse?
NO
3.3 Is the patient:
• Having treatment for immune deficiency
• On immunosuppressive drugs such as regular
steroids, methotrexate, azathioprine or
Advise patient to telephone
cyclophosphamide YES GP surgery
• Having, or recently completed, treatment for
cancer, leukaemia or lymphoma
• Transplant recipient
• HIV positive
NO
Continue to question 3.4
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
Continued from question 3.3
3.4 Does the patient have any of the following
underlying conditions?
• Chronic lung disease or asthma which has
been medically treated within the last 3 years
• Heart disease Advise patient to contact
• Diabetes or another metabolic disorder YES GP surgery if underlying
• Chronic liver disease condition worsens
• Cystic fibrosis
• Neurological conditions such as cerebral palsy,
stroke, multiple sclerosis or muscular dystrophy
• Sickle cell disease
NO
3.5 Does the patient have any additional
symptoms as well as flu? For example:
• Drinking much less than usual (less than
half feeds if for a child who is bottle fed) Advise patient to contact
• Persistent vomiting YES NHS Direct for further advice
• Severe earache to manage symptoms
• Persistent watery diarrhoea
• Markedly reduced urine output (or dry
nappies for children)
NO
Continue to question 3.6
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0AC01
Part of the overall National Protocol for Pandemic Influenza
Continued from question 3.5
Advise patient to contact their
GP or specialist clinic if their
3.6 Does the patient attend a specialist renal or general condition worsens.
kidney clinic for the care of renal or kidney failure?
YES If the patient is having dialysis,
they should inform their renal
NO team now that they have flu.
Provide patient with home care advice and
authorise antiviral treatment if required
End of assessment
Authorised by the Department of Health on behalf of the relevant Ministers – 21 September 2009 v6.0You can also read
