Welcome to the Right Decision Service (RDS) newsletter for September 2024.
This business case has now been endorsed by the HIS Board and will shortly be submitted to Scottish Government.
To balance increasing demand with available capacity and financial resource, the RDS team and Tactuum are now working together to implement closer management of support tickets. As a key part of this, we want to ensure clear, timely and consistent communication with yourselves as requesters.
Editors will now start seeing new messages come through in response to support ticket requests which reflect this tightening up and improvement of our processes.
Key points to note are:
2.1 Issues confirmed by the RDS and Tactuum teams as meeting the critical/urgent and high priority criteria will continue to be prioritised and dealt with immediately.
Critical/urgent issues are defined as:
Example – RDS website outage.
Please remember to email ann.wales3@nhs.scot and his.decisionsupport@nhs.scot with any critical/urgent issues in addition to raising a support ticket.
High priority issues are defined as:
Example – Build to app not working.
2.2 Support requests that are outwith the warranty period of 12 weeks since the software was originally developed will not be automatically addressed by Tactuum. The RDS team will consider these requests for costed development work and will obtain estimate of effort and cost from Tactuum for priority issues.
2.3 Support tickets for technical issues that are not classified as bugs will not be automatically addressed by Tactuum. The definition of a bug is ‘a defect in the software that is at variance with documented user requirements.’ Issues that are not bugs will also be considered for costed development work.
The majority of issues currently in support tickets fall into category 2 or 3 above, or both.
2.4 Non-urgent requests that require a deployment (i.e a new release of RDS) will normally be factored into the next scheduled release (currently end of Nov 2024 and end of Feb 2025) unless by special agreement with the RDS team.
Please note that we plan to move in the new year to a new system whereby requests all come to an RDS support portal in the first instance and are triaged from there to Tactuum when appropriate.
We will be organising a webinar in a few weeks’ time to take you through the details of the current support processes and criteria.
The next scheduled RDS deployment will take place at the end of November 2024. We are reviewing all outstanding support tickets and feature requests along with estimates of effort and cost to determine which items will be included in this deployment.
We will update you on this in the next newsletter and in the planned webinar about support ticket processes.
Many thanks to those of you who attended our recent webinar on the contingency arrangements being put in place to prevent future RDS outages as far as possible and minimise impact if they do occur. Please contact ann.wales3@nhs.scot if you would like a copy of the slides from this session.
The NES clinical knowledge pathway (CKP) publisher is now retired and the majority of pathways supported by this tool have been transferred to the RDS. Examples include:
NHS Lothian musculoskeletal pathways
NHS Fife rehabilitation musculoskeletal pathways
NHS Tayside paediatric pathways
Include:
Focus on frailty (from HIS Frailty improvement programme)
NHS GGC Money advice and support
If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot
To go live imminently:
We have recently analysed the results of a survey of users of the Scottish Palliative Care Guidelines toolkit. Key findings from 61 respondents include:
Key strengths identified included:
Users highlighted key areas for improvement in terms of navigation and search functionality. The survey was very valuable in enabling us to uncover the specific issues affecting the user experience. Many of these can be addressed through content management approaches. The issues identified with search results echo other user feedback, and we are costing improvements with a view to implementation in the next RDS deployment.
This decision support software, sponsored by Scottish Government Effective Prescribing and Therapeutics Division, is now available for all primary care clinicians across NHS Tayside. Board-wide implementation is also planned for NHS Lothian, and NHS GGC, NHS Ayrshire and Arran and NHS Dumfries and Galloway have initial pilots in progress. The University of Dundee has been commissioned to evaluate impact of this decision support software on prescribing practice.
Ten bite-size (5 mins or less) video tutorials for RDS editors are now available in the “Resources for providers of RDS tools” section of the RDS. These cover core functionality including Save and preview, content page and media management, password management and much more.
10. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
1.1 Patients with cancer most at risk of hypercalcaemia are those with known bone metastases or myeloma. 20% do not have bone metastases.
1.2 Patients presenting with symptoms and/or signs suggestive of hypercalcaemia should have serum calcium and albumin checked. Symptoms include polydipsia, polyuria, confusion, constipation, anorexia.
1.3 The decision to treat is based on the corrected serum calcium level:
Corrected serum calcium = actual serum calcium+{(40- serum albumin g/L) x 0.02}
2.1 Step 1
Adequate hydration to correct dehydration.
3L over 24 hours 0.9% NaCl based on patient’s cardiac status.
2.2 Step 2
If glomerular filtration rate (GFR) > 30ml/min and still hypercalcaemic after adequate hydration, give IV zoledronate 4mg over 15 minutes in 100ml 0.9% sodium chloride (no dose adjustment if GFR > 30)
2.3 Step 3
If GFR < 30ml/min after hydration, discuss with consultant and give pamidronate if benefit outweighs risk (see note 3.4 below)
3.1 Review medication affecting renal function (e.g. NSAIDs, diuretics, ACE-inhibitors) and consider stopping or withholding.
3.2 Check U+E in 3-4 days (note that it can take up to 7 days for the full effects of bisphosphonate therapy to manifest). If corrected serum calcium has not returned to reference range, discuss future management with the consultant.
3.3 If consultant recommends rescue therapy, administer zoledronate 8mg over 60 minutes.
3.4 When using pamidronate in renal impairment:
3.4.1 Adjust dose according to the level of the corrected calcium as follows:
Calcium <3.0: 30mg
Calcium 3-3.5: 60mg
Calcium >3.5: 90mg
3.4.2 If GFR <30ml/min then administer pamidronate at a rate of 20mg/hour (in at least 500ml 0.9% sodium chloride. Volume will depend on renal function)
3.5 Please also refer to ‘Bisphosphonates in Myeloma’ on the haematology intranet site for further information on the use of bisphosphonates in myeloma.
3.6 Certain patients may require long-term bisphosphonate therapy to prevent recurrence of hypercalcaemia – discuss with consultant if this is unclear.
Acute Oncology Guidelines