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SwinE flu aSSESSmEnT -
clinical algoriThm
• This algorithm is intended to be used to assess patients over 1 year old. It is not for assessment of children under 1 year.
• 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, the algorithm should be completed to the final question for each patient assessment.
• 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 treatment. If antiviral treatment is required, information about the patient must be used to authorise the correct antiviral 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.
STEP 1 - Emergency Assessment
1.1 Does the patient have any of the following
• Are they unresponsive or unconscious, floppy, limp, or impossible or difficult to wake? • Do they have a breathing problem that is so severe that they are unable to finish a sentence? Or if they are a child under 16, are they breathing irregularly, grunting, or is their chest collapsing in as they breathe? • Do they feel that their throat is closing off and they are unable to swallow saliva or drooling excessively? • Does their skin feel icy cold and wet to touch or is there a change in colour - blue or greyness - particularly around the lips, mouth, fingers or toes? 1.2
• Does the patient have clusters of tiny purple
spots or a rash that looks like bleeding or • Or, despite any pain they may have, is the patient completely unable to move their chin down to touch their chest? Continue to question 2.1
STEP 2 - Flu assessment and
authorisation of antiviral treatment
2.1 Is the patient less than 1 year old?
2.2 Does the patient have a high temperature
and at least two of the following symptoms?
• Widespread muscle and joint aches
• A cough
• Headache
Continue to question 2.3
• Blocked or runny nose• Sore throat • Vomiting• Watery diarrhoea• Cannot stop crying (only children) The patient does not have symptoms of flu. If the patient is seriously unwell they should Continue to question 3.1
2.3 Has the patient had flu symptoms
Do noT auThoriSE
anTiViral TrEaTmEnT
2.4 Have these current flu symptoms
Do noT auThoriSE
(see question 2.2) been previously treated with anTiViral TrEaTmEnT
Continue to question 3.1
auThoriSE
anTiViral TrEaTmEnT
Continue to question 3.1
STEP 3 - Identify whether further
assessement or advice is required
3.1 Is the patient also experiencing any of these
additional symptoms?
• Breathing much faster than normal
• Sharp or stabbing chest pain when breathing• Thick yellow, green, brown or bloody phlegm • Breathing difficulties, for example unable to complete a sentence or, for children, chest skin sucked between ribs when breathing • Uncharacteristic changes in behaviour such as drowsiness, new confusion or appearing terrified (particularly children) 3.2 Has the patient's condition suddenly
worsened, or if the symptoms have lasted for more than 7 days (or 5 for a child), 3.3 Is the patient:
• Having treatment for immune deficiency
• On immunosuppressive drugs such as regular
steroids, methotrexate, azathioprine or cyclophosphamide • Having, or recently completed, treatment for • Transplant recipient• HIV positive Continue to question 3.4
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 • Diabetes or another metabolic disorder • Cystic fibrosis• Neurological conditions such as cerebral palsy, stroke, multiple sclerosis or muscular dystrophy 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) • Persistent watery diarrhoea• Markedly reduced urine output (or dry Continue to question 3.6
Continued from question 3.5
Advise patient to telephone midwifery team (if have not 3.6 Is the patient pregnant?
3.7 Does the patient attend a specialist renal or
kidney clinic for the care of renal or kidney failure? Provide patient with home care advice and authorise antiviral treatment if required End of assessment

Source: http://iscamp.co.uk/library/influenza/AC01%20NFS%20ACP%20Clinical%20algorithm_5.pdf