Clinical Decision Infrastructure

Workflow Library

Clinstrux supports pharmacist and clinician decision-making across multiple clinical domains. Each workflow integrates patient parameters, clinical reasoning, and evidence-based recommendations in a single interactive interface.

Workflows

Clinical sections

Live

Parameter editing

Available workflows

3 of 3

Medication Safety · Rapid Review

Rapid Medication
Review

3–5 minute front-door medication safety screen. Evaluates indication gaps, renal and hepatic dosing, adverse drug reactions, adherence, and monitoring status — and determines whether a structured POLY review is required.

What you'll assess

Indication review, renal and hepatic dosing flags

Adverse drug reactions, adherence, monitoring gaps

Escalation decision: is a POLY review indicated?

3–5 min review Renal dose flags ADR screening Escalation output

Rapid screen · Any patient 4 sections

Open workflow

Antimicrobial Stewardship · Inpatient Review

Antibiotic Stewardship
Therapy Review

Day 3 inpatient antimicrobial review integrating inflammatory markers, clinical trajectory, and culture data. Demonstrates how Clinstrux supports IV-to-oral de-escalation decisions — with clinical improvement weighted appropriately against laboratory values.

What you'll assess

WBC, CRP, temperature, and clinical trajectory integration

IV-to-oral step-down logic and de-escalation criteria

Culture-guided therapy adjustment and renal dose review

WBC · CRP · Temp De-escalation logic Renal dose check Clinical trajectory

72 y/o Male · CS-2026-00842 5 sections

Open workflow

Medicines Optimisation · Advanced Review

Advanced Polypharmacy
& Medicines Optimisation

20–30 minute specialist structured review. Applies STOPP/START v3, frailty stratification, ACB scoring, FRID analysis, and deprescribing planning — with a GP-ready medication review letter as output.

What you'll assess

Frailty (CFS), ACB scoring, FRID falls-risk modelling

STOPP v3 deprescribing candidates & START v3 omissions

Taper protocols, monitoring plan, and GP letter

STOPP/START v3 Frailty engine ACB & FRID GP letter output

20–30 min · Specialist review 7 sections

Open workflow

Live parameter editing

Clinical Impression layer

Longitudinal tracking

Evidence-referenced output

Handoff documentation

Complete mandatory fields to begin

Culture result pending

Renal status not assessed

I — Patient Context

II — Clinical Assessment

III — Decision & Monitoring

Step 1

Patient Profile

Demographics, host risk factors, renal and hepatic function. Complete all mandatory fields to activate the reasoning engine.

Demographics & Host Factors

Age (years) ★

—

Not entered

Sex ★

—

Not entered

Weight (kg)

—

Optional — used for gentamicin dosing

Height (cm)

—

Optional — used for IBW calculation

Pregnancy ★

—

Affects agent selection

Urinary catheter ★

—

Complicating factor if present

Immunocompromised

—

Affects pathway

Structural urinary abnormality

—

Complicating factor if present

Penicillin allergy ★

—

Risk-stratified — affects agent selection

UTI site / classification ★

—

Drives primary pathway

Laboratory Values

eGFR (mL/min/1.73m²) ★

—

Required for dose adjustment

ALT (U/L)

—

Optional — hepatotoxicity screening

AST (U/L)

—

Optional — hepatotoxicity screening

WBC (×10⁹/L)

—

Inflammatory marker

CRP (mg/L)

—

Inflammatory marker

Procalcitonin (µg/L)

—

Optional — guides de-escalation

Temperature (°C)

—

Fever signal

NEWS2 score

—

≥5 triggers urosepsis upgrade

Treatment Context & History

Antibiotic course day ★

—

Day of current course (1-based)

IV days completed

—

0 if oral only

Current antibiotic ★

—

Active regimen

Prior antibiotics (90 days)

—

Resistance risk factor

Prior resistant organism

—

Resistance risk factor

Hospital-onset infection

—

Affects empirical spectrum

Clinical response ★

—

Primary stewardship signal

Fields marked ★ are mandatory. The reasoning engine activates once all mandatory fields are completed. Optional fields refine the output.

Step 2

Microbiology

Culture results, organism identification, ESBL status, and susceptibility data. Completing these fields enables culture-directed de-escalation and resistance logic.

Culture result ★

—

Primary de-escalation gating field

Organism identified

—

If culture positive

ESBL status

—

Extended-spectrum beta-lactamase

Susceptibility profile

—

Breadth of effective agents

Culture result is the primary de-escalation gating field. De-escalation in urosepsis must never proceed without microbiological confirmation per NICE NG112.

Step 3

Clinical Assessment

Clinical reasoning layer — interpreting inflammatory trends, trajectory, culture data, and classification together.

Clinical Status Summary

Antimicrobial Stewardship Assessment — UTI

Awaiting input

Inflammatory Trend

—

Fever Status

—

Clinical Trajectory

—

Renal Status

—

Overall Assessment

Complete mandatory fields in Patient Profile and Microbiology to generate the clinical assessment.

Clinical Impression Day — Review

Complete mandatory fields to generate clinical impression.

Clinical direction

Assessment is generated from current parameters. Clinical judgment must be applied before any antimicrobial decision.

Step 4

Stewardship Recommendation

Primary recommendation with rationale, confidence, classification pathway, and supporting decision logic.

—

Stewardship recommendation — NICE NG112 · NICE NG15

Complete mandatory fields to generate recommendation

Awaiting input

Enter patient profile and microbiology data to activate the reasoning engine.

—

Awaiting assessment

Complete mandatory fields to generate confidence score

De-escalation target

—

Prerequisite

—

Guideline source

NICE NG112 · NICE NG15
UKHSA AMR guidance

Stewardship decision logic

Reasoning — why each option was considered or declined

Continue current therapy Conditional

—

Reserve for early course (day 1–2) or culture pending in urosepsis

IV continuation carries line-associated infection risk — minimise duration

De-escalate —

—

Clinical improvement is the primary step-down trigger per NICE NG112

—

Escalate —

—

Mandatory if worsening response regardless of laboratory values

Mandatory if resistant organism confirmed — do not continue ineffective agent

Stewardship recommendations require clinical validation. This is a decision-support tool, not a prescribing system.

Step 5

Monitoring Parameters

Safety monitoring, renal dose status, culture follow-up, and duration check for the current antimicrobial regimen.

Current course day

—

Complete Patient Profile to populate

Culture result

—

Complete Microbiology section

Renal monitoring

—

eGFR not entered

Monitoring schedule

Checkpoint

Labs / tests

Clinical assessment

Action trigger

48–72hr

Culture result, eGFR recheck, WBC, CRP

Clinical trajectory, fever, oral tolerance

Sensitive + improving → de-escalate. Resistant → escalate immediately. Worsening → senior review.

Daily

Temperature, WBC if clinically indicated

Fever, organ function, oral tolerance

New fever or deterioration → do not de-escalate. Reassess site classification.

End of course

End-of-treatment CRP if upper UTI or urosepsis

Reassess need for further therapy

Stop antibiotics when clinical criteria met and course duration achieved per guideline.

Renal dose status — current agent

Current agent — renal-adjusted dose

—

Complete Patient Profile and select current antibiotic to populate.

eGFR status

—

Enter eGFR in Patient Profile.

Monitoring requirement

eGFR recheck

Acute infection may cause transient renal deterioration. Recheck eGFR at 72hr if impaired.

Active flags & safety considerations

— Complete Microbiology section to generate culture flag.

— Enter eGFR to generate renal flag.

— Enter antibiotic day to generate duration check.

ℹ Gentamicin monitoring — see below.

ℹ Document indication, intended duration, and review date in clinical notes at each contact — stewardship standard.

Follow-up schedule

Complete mandatory fields to generate follow-up schedule.

Monitoring schedule is illustrative. Adapt to local antimicrobial stewardship policy and patient-specific factors.

STEP · CLINICAL SUMMARY

Clinical Summary

Structured clinical output synthesised from all workflow inputs. Suitable for documentation, audit, and handover.

Complete medication profile to begin

Organ function not assessed

Adherence & ADR pending

I — Medication Profile

II — Safety Screening

III — Assessment & Plan

Step 1

Medication Profile

Enter medication burden and organ function. Mandatory parameters activate safety screening.

Medication Burden & Organ Function

Total medications ★

—

Enter total regular medications

Renal function ★

—

eGFR category

Hepatic function

—

Child-Pugh class

Indication review ★

—

Medication justification status

Adherence

—

Patient-reported adherence

Adverse drug reactions

—

Current ADR status

Monitoring status

—

Required parameters

Step 2

Safety Screening

Six-axis medication safety assessment. Red or amber findings require clinical action.

Renal Function

—

Enter renal function in Step 1

Hepatic Function

—

Enter hepatic status in Step 1

Indication Review

—

Enter indication status in Step 1

Adherence

—

Enter adherence in Step 1

Adverse Drug Reactions

—

Enter ADR status in Step 1

Monitoring Status

—

Enter monitoring in Step 1

Medication Safety Drivers

WHAT IS DRIVING SAFETY RISK IN THIS REGIMEN

Complete Step 1 to generate medication safety drivers.

Step 3

Clinical Assessment

Synthesised clinical impression across all safety domains.

Complete all medication profile parameters to generate clinical impression.

Step 4

Recommendation

Clinical recommendation, confidence level, and POLY escalation decision.

Recommended action

Complete review parameters to generate recommendation

Pharmacist Clinical Summary

EXECUTIVE SUMMARY & KEY FINDINGS

Complete the review to generate the pharmacist clinical summary.

Clinical Handoff

RAPID REVIEW — CLINICAL HANDOFF

Complete the review to generate the clinical handoff note.

Follow-up Plan

Complete the review to generate the follow-up plan.

STEP 5 · CLINICAL SUMMARY

Clinical Summary

Structured output synthesised from the medication review. Ready for documentation and export.

Complete renal profile to begin

KDIGO risk not yet stratified

I — Patient Context

II — Clinical Assessment

III — Plan & Monitoring

IV — Summary

Step 1

Patient & Renal Profile

Age, sex, renal function and proteinuria. Age + eGFR activate the full reasoning engine.

Demographics & Clinical Context

Age (years) ★

—

Required — drives CKD risk interpretation

Sex

—

Biological sex

Diabetic

—

Drives SGLT2i / RAASi eligibility

Weight (kg)

—

Used for renally-dosed medicines

Renal Function & Proteinuria ★ required to activate engine

eGFR (mL/min/1.73m²) ★

—

Required — determines GFR category

ACR (mg/mmol)

—

Required to complete the KDIGO heat map

GFR category

—

ACR category

Not yet tested

KDIGO heat-map risk

—

Enter age and eGFR to begin risk stratification.

CLINICAL IMPRESSION

Complete renal function fields to generate the clinical impression.

Step 2

Medication List

Enter current medications. Nephrotoxic agents are flagged automatically and screened against eGFR in the next section.

Medication name

Dose

Route

Flags

No medications entered. Click “Add medication” to begin.

Step 3

Renal Dose Adjustment & Nephrotoxicity

Current medications screened against eGFR for dose adjustment, avoidance, and nephrotoxic-combination risk.

Findings (0)

Add medications in Section 2 to screen for renal dose adjustment and nephrotoxicity.

Step 4

RAASi & Hyperkalaemia

ACEi/ARB optimisation and potassium management — KDIGO 2024 favours treating potassium over stopping RAASi where possible.

RAASi Status & Potassium

On ACEi/ARB

—

Current RAAS-inhibitor status

Most recent potassium (mmol/L)

—

Drives hyperkalaemia tier

% creatinine rise since RAASi start/dose change

—

Optional — only if RAASi recently initiated/titrated

Potassium status Enter most recent potassium

Action —

RAASi creatinine check Enter % creatinine rise to assess, if applicable.

RAASI NARRATIVE

Record RAASi status and most recent potassium to assess.

Step 5

Risk Stratification & Referral

Clinical flags drive guideline-supported therapy opportunities and NICE NG203 nephrology referral criteria.

Clinical Flags

Haematuria Resistant hypertension (≥4 agents) Rapid eGFR decline Suspected genetic/rare cause Already under nephrology Already on statin Already on SGLT2 inhibitor Already on finerenone Already on GLP-1 RA

Therapy Opportunities (0)

No additional guideline-supported therapy opportunities identified yet.

Nephrology Referral Criteria (0)

No nephrology referral criteria currently met.

Step 6

Monitoring Schedule

Monitoring frequency and parameters derived from the KDIGO heat-map risk category.

Complete Section 1 to generate the monitoring schedule.

Monitoring frequency —

Parameters —

Referral status —

Step 7

Clinical Summary

Consolidated findings and a draft GP/referral letter, ready for review and export.

GP / Referral Letter

CHRONIC KIDNEY DISEASE REVIEW — LETTER

Complete mandatory fields to begin

GDMT review pending

Complete age, EF category and NYHA class to activate engine

I — PATIENT & PROFILE

II — GDMT OPTIMISATION

III — CLINICAL REVIEW

IV — SUMMARY

ESC 2023 HF NICE NG106 SIGN 147 BNF Heart Failure Review

STEP 1 Mandatory fields required ESC 2023 HF

Patient & HF Profile

Demographics, HF phenotype, NYHA functional class, and aetiology. Mandatory fields activate the reasoning engine.

DEMOGRAPHICS & CARE SETTING

AGE (YEARS) ★

—

Enter patient age

Age (years)

Patient age in years.

AGE (YEARS)

SEX ★

—

Biological sex

Sex

Biological sex for clinical calculations.

SEX

WEIGHT (KG)

—

For dose calculations

Weight (kg)

WEIGHT (KG)

CARE SETTING

—

Where patient is managed

Care Setting

HF PHENOTYPE ★ REQUIRED TO ACTIVATE ENGINE

EF CATEGORY ★

—

HFrEF / HFmrEF / HFpEF

EF Category

Select the HF phenotype based on echocardiography. Drives GDMT eligibility rules (ESC 2023).

EF CATEGORY

NYHA CLASS ★

—

Functional classification

NYHA Functional Class

New York Heart Association classification based on symptom severity and exercise tolerance.

NYHA CLASS

LVEF (%)

—

Echo-derived EF

Left Ventricular Ejection Fraction (%)

Echocardiographic EF. Used alongside EF category for context.

LVEF (%)

AETIOLOGY

—

Underlying cause of HF

HF Aetiology

CARDIAC RHYTHM

—

Current ECG rhythm

Cardiac Rhythm

Influences ivabradine eligibility (sinus rhythm required).

DEVICE THERAPY

—

ICD / CRT status

Device Therapy

BNP (PG/ML)

—

Optional — biomarker context

BNP (pg/mL)

Optional biomarker. Used for clinical context in summary. BNP >35 or NT-proBNP >125 supports HF diagnosis (ESC 2023).

BNP (PG/ML)

200

STEP 2 ESC 2023 HF

Current Therapy

Document current GDMT agents and doses. This drives the target dose tracking and optimisation engine.

RAAS INHIBITION

ACEi / ARB / ARNI

—

Current RAASi agent class

ACEi / ARB / ARNI

Select the class of RAASi currently prescribed. ARNI (sacubitril/valsartan) is preferred in HFrEF if tolerated (ESC 2023 Class I).

SPECIFIC AGENT

—

Named drug for dose tracking

RAASi — Specific Agent

CURRENT DOSE

—

e.g. Ramipril 2.5 mg BD

RAASi — Current Dose

BETA-BLOCKER

—

Agent with mortality evidence in HF

Beta-blocker

Only bisoprolol, carvedilol, metoprolol succinate, and nebivolol (>70y) have mortality evidence in HFrEF (ESC 2023 Class I).

BB DOSE LEVEL

—

Current dose relative to target

Beta-blocker Dose Level

MRA & SGLT2 INHIBITOR

MRA

—

Spironolactone / Eplerenone

Mineralocorticoid Receptor Antagonist

Avoid if K+ >5.0 or eGFR <30. Monitor K+ and renal function within 1–2 weeks of initiation.

MRA DOSE

—

Current vs target

MRA Dose Level

SGLT2 INHIBITOR

—

Dapagliflozin / Empagliflozin

SGLT2 Inhibitor

ESC 2023 Class I in HFrEF/HFmrEF; Class IIa in HFpEF. Fixed dose 10 mg OD — no titration. Benefit independent of diabetes.

IVABRADINE

—

If HR ≥75 in sinus rhythm

Ivabradine

ESC 2023 Class IIa in HFrEF with sinus rhythm and resting HR ≥75 bpm on maximally tolerated beta-blocker.

DIURETIC

DIURETIC AGENT

—

Loop / thiazide / other

Diuretic Agent

DIURETIC DOSE (MG)

—

Current daily dose

Diuretic Dose (mg)

40 mg

STEP 3 ESC 2023 HF

GDMT Optimisation

Guideline-directed medical therapy review across the four pillars: ACEi/ARB/ARNI · Beta-blocker · MRA · SGLT2 inhibitor.

GDMT PILLARS

—

OPPORTUNITIES

—

Therapy actions identified

Complete mandatory fields to activate GDMT reasoning engine.

STEP 4 ESC 2023 HF BNF

Target Dose Tracking

Comparison of current doses against trial-validated target doses. Uptitration should proceed in a stepwise fashion with monitoring at each step.

Enter current therapy (Section 2) to populate target dose tracking.

STEP 5 ESC 2023 HF NICE NG106

Blood Pressure & Volume Status

Haemodynamic assessment to guide GDMT uptitration safety. Volume status assessment to inform diuretic strategy.

HAEMODYNAMICS

SYSTOLIC BP (MMHG)

—

Current resting SBP

Systolic Blood Pressure (mmHg)

Resting SBP. Key threshold: SBP <100 limits ARNI initiation; SBP <85 is a contraindication to vasodilatory GDMT.

120 mmHg

DIASTOLIC BP (MMHG)

—

Current resting DBP

Diastolic Blood Pressure (mmHg)

80 mmHg

HEART RATE (BPM)

—

Resting HR

Heart Rate (bpm)

Resting HR. Ivabradine threshold: sinus rhythm with HR ≥75 bpm on maximally tolerated beta-blocker (ESC 2023 Class IIa).

75 bpm

Enter blood pressure to generate BP assessment.

Enter heart rate to generate HR assessment.

VOLUME STATUS

FLUID STATUS

—

Clinical assessment of volume

Fluid Status

Clinical assessment based on examination findings: oedema, raised JVP, orthopnoea, weight gain, pulmonary crepitations.

Enter fluid status to generate volume assessment.

STEP 6 ESC 2023 HF NICE NG106

Renal & Potassium Review

Renal function and electrolyte review to guide MRA and RAASi safety. SGLT2 inhibitor suitability assessment.

RENAL FUNCTION & ELECTROLYTES

eGFR (ML/MIN/1.73M²)

—

CKD-EPI estimated GFR

eGFR (mL/min/1.73m²)

Key thresholds: MRA contraindicated below 30. SGLT2i licensed to eGFR ≥20 (empagliflozin) or ≥25 (dapagliflozin) for HF indication.

POTASSIUM (MMOL/L)

—

Serum K+

Potassium (mmol/L)

K+ >5.0: do not uptitrate MRA or RAASi. K+ >5.5: consider dose reduction. K+ >6.0: hold MRA, urgent review. K+ <3.5: review diuretic and consider MRA.

4.2 mmol/L

SODIUM (MMOL/L)

—

Serum Na+

Sodium (mmol/L)

Hyponatraemia (<130) is associated with poor prognosis in HF. Fluid restriction may be required.

138 mmol/L

Enter eGFR to generate renal assessment.

Enter potassium to generate electrolyte assessment.

Enter sodium to generate electrolyte assessment.

SGLT2 INHIBITOR SUITABILITY

Enter EF category and eGFR to assess SGLT2 inhibitor suitability.

STEP 7 ESC 2023 HF BNF

Diuretic Optimisation

Review of diuretic strategy based on fluid status, renal function, and electrolytes. Diuretics should be titrated to achieve euvolaemia.

CURRENT DIURETIC

DIURETIC ACTIONS (0)

Complete clinical data to generate diuretic recommendations.

STEP 8 ESC 2023 HF NICE NG106

Clinical Summary

Structured clinical summary including GDMT status, risk flags, clinical impression, monitoring plan, and GP letter.

Complete mandatory fields (age, EF category, NYHA class) to generate Clinical Summary.

Workflow Library

Clinical Summary

Clinical Summary

Patient & HF Profile

Current Therapy

GDMT Optimisation

Target Dose Tracking

Blood Pressure & Volume Status

Renal & Potassium Review

Diuretic Optimisation

Clinical Summary

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