For preseptal or periorbital cellulitis see Ophthalmology guidance: periorbital or preseptal cellulitis
Treatment
Flucloxacillin (IV or oral)
If true penicillin allergy:
Clindamycin (IV or oral)
Duration: 7 days
Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
The following toolkits are now live;
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.
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.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
For preseptal or periorbital cellulitis see Ophthalmology guidance: periorbital or preseptal cellulitis
Treatment
Flucloxacillin (IV or oral)
If true penicillin allergy:
Clindamycin (IV or oral)
Duration: 7 days
Seek surgical review. Urgent surgical debridement is crucial.
Theatre specimens should be sent for microscopy and culture to help determine aetiology. Contact microbiology labs to arrange urgent examination.
Meropenem IV (Maximum dose)
Plus
Clindamycin IV (Maximum dose)
The primary treatment for this condition is urgent surgical debridement.
Antibiotics have only a secondary role in therapy.
Gangrene develops in anaerobic areas with limited blood flow. Therefore, antibiotics do not penetrate and only protect contiguous areas.
Benzylpenicillin IV
Plus
Clindamycin IV
If true penicillin allergy:
Vancomycin IV
Plus
Clindamycin IV
Give antibiotic prophylaxis in all human, cat, dog and puncture bites, especially when hand, foot, face, joint, tendon, ligament involved; or when patient immunocompromised, diabetic, asplenic, cirrhotic, presence of prosthetic valve or prosthetic joint
If accompanied by marked cellulitis consider parenteral antibiotic therapy and seek plastic surgery advice.
Wound care and irrigation is very important
Consider tetanus prophylaxis
Assess risk of tetanus; HIV; hepatitis B&C; in human bites and rabies in animal bites
If bite was sustained abroad or if any other animal was involved, seek Microbiology advice
Co-amoxiclav IV or Oral
If true penicillin allergy:
Co-trimoxazole Oral
Plus
Metronidazole Oral
Duration: 7 days
Clean procedure
Flucloxacillin IV
If true penicillin allergy:
Clindamycin IV
If MRSA risk:
Vancomycin IV
Contaminated procedure
Co-amoxiclav IV
If MRSA risk:
Add Vancomycin IV
If true penicillin allergy:
Vancomycin IV
Plus
Ciprofloxacin IV (before prescribing review MHRA Safety Advice )
Plus
Metronidazole IV
Send a wound swab for culture prior to initiating treatment. Further therapy should be guided by laboratory results.
Take blood cultures and send joint aspirates for culture before starting empirical antibiotic therapy.
Cefotaxime IV
If true penicillin allergy:
Contact Microbiology
Initial intravenous therapy for 14 days, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav
Flucloxacillin IV
Plus
Clindamycin IV
If true penicillin allergy:
Clindamycin IV
Initial intravenous therapy for 72 hours, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav
In all cases seek specialist orthopaedic advice at the outset.
Do not start antibiotic therapy until appropriate samples have been obtained for culture.
In children >3 months to 5 years of age consider Kingella kingae. If unresponsive to initial therapy consider changing to ceftriaxone.
Seek specialist orthopaedic advice.
Appropriate specimens should be taken for culture prior to starting therapy