Ensure PSDs are created after verbal consent

app/components/app_patient_session_triage_component.rb

@@ -1,9 +1,10 @@
 # frozen_string_literal: true
 
 class AppPatientSessionTriageComponent < ViewComponent::Base
-  def initialize(patient_session, programme:, triage_form: nil)
+  def initialize(patient_session, programme:, current_user:, triage_form: nil)
     @patient_session = patient_session
     @programme = programme
+    @current_user = current_user
     @triage_form = triage_form || default_triage_form
   end
 
@@ -13,7 +14,7 @@ def render?
 
   private
 
-  attr_reader :patient_session, :programme, :triage_form
+  attr_reader :patient_session, :programme, :current_user, :triage_form
 
   delegate :govuk_button_link_to, to: :helpers
   delegate :patient, :session, to: :patient_session
@@ -50,5 +51,7 @@ def latest_triage
       )
   end
 
-  def default_triage_form = TriageForm.new(patient_session:, programme:)
+  def default_triage_form
+    TriageForm.new(patient_session:, programme:, current_user:)
+  end
 end

app/components/app_triage_form_component.html.erb

@@ -4,11 +4,11 @@
     <%= f.govuk_radio_buttons_fieldset :status_and_vaccine_method, **fieldset_options do %>
       <% form.safe_to_vaccinate_options.each do |option| %>
         <%= f.govuk_radio_button :status_and_vaccine_method, option do %>
-        <% if show_psd_options?(option) %>
-          <%= f.govuk_radio_buttons_fieldset :psd_action,
+        <% if form.show_add_patient_specific_direction?(option) %>
+          <%= f.govuk_radio_buttons_fieldset :add_patient_specific_direction,
                                              legend: { text: "Do you want to add a PSD?", size: "s" } do %>
-            <%= f.govuk_radio_button :add_psd, "true", label: { text: "Yes" } %>
-            <%= f.govuk_radio_button :add_psd, "false", label: { text: "No" } %>
+            <%= f.govuk_radio_button :add_patient_specific_direction, "true", label: { text: "Yes" } %>
+            <%= f.govuk_radio_button :add_patient_specific_direction, "false", label: { text: "No" } %>
           <% end %>
         <% end %>
       <% end %>

app/components/app_triage_form_component.rb

@@ -19,12 +19,6 @@ def initialize(form, url:, method: :post, heading: true, continue: false)
 
   def builder = GOVUKDesignSystemFormBuilder::FormBuilder
 
-  def show_psd_options?(option)
-    patient_session.session.psd_enabled? &&
-      option == "safe_to_vaccinate_nasal" &&
-      policy(PatientSpecificDirection).create?
-  end
-
   def fieldset_options
     text = "Is it safe to vaccinate #{patient.given_name}?"
     hint =

app/controllers/draft_consents_controller.rb

@@ -106,6 +106,8 @@ def handle_triage
     @triage_form.assign_attributes(triage_form_params)
 
     @draft_consent.assign_attributes(
+      triage_add_patient_specific_direction:
+        @triage_form.add_patient_specific_direction,
       triage_form_valid: @triage_form.valid?,
       triage_notes: @triage_form.notes,
       triage_status_and_vaccine_method: @triage_form.status_and_vaccine_method,
@@ -145,7 +147,13 @@ def update_params
   end
 
   def triage_form_params
-    params.expect(triage_form: %i[status_and_vaccine_method notes])
+    params.expect(
+      triage_form: %i[
+        status_and_vaccine_method
+        notes
+        add_patient_specific_direction
+      ]
+    )
   end
 
   def set_draft_consent
@@ -184,6 +192,9 @@ def set_triage_form
     @triage_form =
       if policy(Triage).new?
         TriageForm.new(
+          add_patient_specific_direction:
+            @draft_consent.triage_add_patient_specific_direction,
+          current_user:,
           notes: @draft_consent.triage_notes,
           vaccine_methods: @draft_consent.vaccine_methods,
           patient_session: @patient_session,

app/controllers/patient_sessions/triages_controller.rb

@@ -18,6 +18,7 @@ def new
 
     @triage_form =
       TriageForm.new(
+        current_user:,
         patient_session: @patient_session,
         programme: @programme,
         triage: previous_triage
@@ -46,8 +47,6 @@ def create
         )
         .each { send_triage_confirmation(@patient_session, @programme, it) }
 
-      @triage_form.add_psd? ? ensure_psd_exists : remove_existing_psd
-
       redirect_to redirect_path, flash: { success: "Triage outcome updated" }
     else
       render "patient_sessions/programmes/show",
@@ -59,7 +58,13 @@ def create
   private
 
   def triage_form_params
-    params.expect(triage_form: %i[status_and_vaccine_method notes add_psd])
+    params.expect(
+      triage_form: %i[
+        status_and_vaccine_method
+        notes
+        add_patient_specific_direction
+      ]
+    )
   end
 
   def redirect_path
@@ -70,34 +75,4 @@ def redirect_path
       return_to: "triage"
     )
   end
-
-  def ensure_psd_exists
-    # TODO: Handle programmes with multiple nasal vaccines.
-    vaccine = @programme.vaccines.nasal.first
-
-    psd_attributes = {
-      academic_year: @academic_year,
-      delivery_site: "nose",
-      patient: @patient,
-      programme: @programme,
-      vaccine:,
-      vaccine_method: "nasal"
-    }
-
-    return if PatientSpecificDirection.exists?(**psd_attributes)
-
-    PatientSpecificDirection.create!(
-      psd_attributes.merge(created_by: current_user)
-    )
-  end
-
-  def remove_existing_psd
-    PatientSpecificDirection.find_by(
-      {
-        academic_year: @academic_year,
-        patient: @patient,
-        programme: @programme
-      }
-    )&.destroy!
-  end
 end

app/forms/triage_form.rb

@@ -6,23 +6,21 @@ class TriageForm
 
   attr_accessor :patient_session, :programme, :current_user
 
-  attribute :status_and_vaccine_method, :string
-  attribute :add_psd, :boolean
+  attribute :add_patient_specific_direction, :boolean
   attribute :notes, :string
+  attribute :status_and_vaccine_method, :string
   attribute :vaccine_methods, array: true, default: []
 
+  validates :add_patient_specific_direction,
+            inclusion: {
+              in: [true, false]
+            },
+            if: :requires_add_patient_specific_direction?
   validates :status_and_vaccine_method,
             inclusion: {
               in: :status_and_vaccine_method_options
             }
   validates :notes, length: { maximum: 1000 }
-  validates :add_psd,
-            inclusion: {
-              in: [true, false]
-            },
-            if: -> { add_psd.present? }
-
-  def add_psd? = add_psd
 
   def triage=(triage)
     self.status_and_vaccine_method =
@@ -40,11 +38,14 @@ def triage=(triage)
   end
 
   def save
-    Triage.create!(triage_attributes) if valid?
+    save! if valid?
   end
 
   def save!
-    Triage.create!(triage_attributes)
+    ActiveRecord::Base.transaction do
+      handle_patient_specific_direction
+      Triage.create!(triage_attributes)
+    end
   end
 
   def safe_to_vaccinate_options
@@ -67,6 +68,11 @@ def consented_to_injection? = consented_vaccine_methods.include?("injection")
 
   def consented_to_injection_only? = consented_vaccine_methods == ["injection"]
 
+  def show_add_patient_specific_direction?(option)
+    session.psd_enabled? && option == "safe_to_vaccinate_nasal" &&
+      can_create_patient_specific_directions?
+  end
+
   private
 
   delegate :team, :patient, :session, to: :patient_session
@@ -87,7 +93,7 @@ def triage_attributes
       programme:,
       status:,
       vaccine_method:,
-      academic_year: session.academic_year
+      academic_year:
     }
   end
 
@@ -113,4 +119,53 @@ def vaccine_method
       "nasal"
     end
   end
+
+  def requires_add_patient_specific_direction?
+    show_add_patient_specific_direction?(status_and_vaccine_method)
+  end
+
+  def can_create_patient_specific_directions?
+    PatientSpecificDirectionPolicy.new(
+      current_user,
+      PatientSpecificDirection
+    ).create?
+  end
+
+  def handle_patient_specific_direction
+    if add_patient_specific_direction
+      create_patient_specific_direction!
+    elsif add_patient_specific_direction == false
+      destroy_patient_specific_directions!
+    end
+  end
+
+  def create_patient_specific_direction!
+    vaccine_method = "nasal"
+
+    # TODO: Handle programmes with multiple nasal vaccines.
+    vaccine = programme.vaccines.find_by(method: vaccine_method)
+
+    attributes = {
+      academic_year:,
+      delivery_site: "nose",
+      patient:,
+      programme:,
+      vaccine:,
+      vaccine_method:
+    }
+
+    return if patient.patient_specific_directions.exists?(attributes)
+
+    patient.patient_specific_directions.create!(
+      created_by: current_user,
+      **attributes
+    )
+  end
+
+  def destroy_patient_specific_directions!
+    patient
+      .patient_specific_directions
+      .where(academic_year:, programme:)
+      .destroy_all
+  end
 end

app/models/draft_consent.rb

@@ -32,6 +32,7 @@ class DraftConsent
   attribute :recorded_by_user_id, :integer
   attribute :response, :string
   attribute :route, :string
+  attribute :triage_add_patient_specific_direction, :boolean
   attribute :triage_notes, :string
   attribute :triage_status_and_vaccine_method, :string
   attribute :vaccine_methods, array: true, default: []
@@ -309,6 +310,8 @@ def write_to!(consent, triage_form:)
     consent.academic_year = academic_year if academic_year.present?
 
     if triage_allowed? && response_given?
+      triage_form.add_patient_specific_direction =
+        triage_add_patient_specific_direction
       triage_form.notes = triage_notes || ""
       triage_form.current_user = recorded_by
       triage_form.status_and_vaccine_method = triage_status_and_vaccine_method

app/views/patient_sessions/programmes/show.html.erb

@@ -8,7 +8,7 @@
   <div class="app-grid-column-patient-session">
     <%= render AppPatientSessionConsentComponent.new(@patient_session, programme: @programme) %>
 
-    <%= render AppPatientSessionTriageComponent.new(@patient_session, programme: @programme, triage_form: @triage_form) %>
+    <%= render AppPatientSessionTriageComponent.new(@patient_session, programme: @programme, current_user:, triage_form: @triage_form) %>
 
     <%= render AppPatientSessionRecordComponent.new(@patient_session, programme: @programme, current_user:, vaccinate_form: @vaccinate_form) %>
 

config/locales/en.yml

@@ -146,7 +146,7 @@ en:
             status_and_vaccine_method:
               blank: Choose a status
               inclusion: Choose a status
-            add_psd:
+            add_patient_specific_direction:
               blank: Select yes or no
               inclusion: Select yes or no
         vaccinate_form:

db/seeds.rb

@@ -261,6 +261,7 @@ def create_team_sessions(user, team)
   create_user(:medical_secretary, team:, email: "admin.hope@example.com")
   create_user(:superuser, team:, email: "superuser@example.com")
   create_user(:healthcare_assistant, team:, email: "hca@example.com")
+  create_user(:prescriber, team:, email: "prescriber@example.com")
 
   attach_sample_of_schools_to(team)
 

spec/components/app_patient_session_triage_component_spec.rb

@@ -3,12 +3,15 @@
 describe AppPatientSessionTriageComponent do
   subject { render_inline(component) }
 
-  let(:component) { described_class.new(patient_session, programme:) }
+  let(:component) do
+    described_class.new(patient_session, programme:, current_user:)
+  end
 
   let(:programme) { create(:programme) }
   let(:session) { create(:session, programmes: [programme]) }
   let(:patient_session) { create(:patient_session, session:) }
   let(:patient) { patient_session.patient }
+  let(:current_user) { create(:nurse) }
 
   before do
     patient_session.reload.strict_loading!(false)