Important: Therapy
Vancomycin 125mg PO 6 hourly
If any features of life-threatening infection (see definitions in Notes below) - seek urgent surgical review
Notes:
Treatment duration: 10 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
Vancomycin 125mg PO 6 hourly
If any features of life-threatening infection (see definitions in Notes below) - seek urgent surgical review
Treatment duration: 10 days
Discuss with an infection specialist.
Second line options include:
If any features of life-threatening infection (see definitions in Notes below) - seek urgent surgical review
Fidaxomicin 200mg PO 12 hourly
If treatment failure identified as incomplete initial treatment course, then retreat as per 1st line treatment
Vancomycin 125mg PO 6 hourly
(i.e. as per 1st line treatment)
Treatment duration: 10 days
Discuss with infection specialist
Options include:
Review existing antibiotic treatment and stop it unless essential. If an antibiotic is still essential, consider changing to one with a lower risk of causing C. difficile infection (e.g. non 4C antibiotics)
Review the need to continue any treatment with:
Definitions:
Diarrhoea - passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual (i.e. in patients with chronic loose stools) The frequent passing of formed stools is not diarrhoea.
C difficile infection – diarrhoea with a C difficile toxin positive result.
C diff equivocal (GDH positive / C diff toxin negative result) - Usually reflects colonisation with C diff rather than infection, even in the presence of diarrhoea. Rarely, C diff equivocal results are found in stool from patients with very early genuine C diff infection, before detectable levels of toxin have accumulated. Recommend repeat stool sample if initial result equivocal and no alternative diagnosis made. Patients with two C diff equivocal results are highly unlikely to have C diff infection and diarrhoea is likely due to another cause, including alternative infectious pathogens so ensure final culture results reviewed.
Life-threatening CDI: CDI with any one of the following present: admission to ICU for CDI; hypotension with or without required use of vasopressors; ileus or significant abdominal distension; mental status changes, WBC ≥35 cells x 109 /L or <2 cells x 109 /L; serum lactate >2.2 mmol/l; end organ failure (mechanical ventilation, renal failure)