Right Decisions
Antimicrobial prescribing: NHS Lothian
Specialty guidelines
Back
Hospital at Home (H@H)
Appendix 1 - Antibiotic administration and dose reduction in renal impairment summary (H@H)

Announcements and latest updates

Right Decision Service newsletter: June 2024

Welcome to the Right Decision Service (RDS) newsletter for June 2024.

1. Issues with RDS

Hopefully you all received the notification on Friday 28^th June about the worldwide security vulnerability relating to use of code from the Polyfill.io code library – typically used to enable use of functionality in older browsers and operating systems. This vulnerability has now been addressed within RDS. Thanks to Tactuum for their prompt action on this.

This incident served as a useful reminder about the importance of making sure all devices and desktop/laptop computers have up to date anti-malware installed.

2.Redesign and improvements to RDS

The most recent information is that final fixes and developments will take place during July, with a view to user testing taking place in August 2024.

3.Evaluation

3.1 Usage statistics

We will be running the six-monthly usage statistics reports for all RDS toolkits during July. Please contact his.decisionsupport@nhs.scot if you would like to receive the usage report for your toolkit(s).

3.2 Palliative care

The Scottish Palliative Care Group is carrying out a value and impact survey of the national Palliative Care Guidelines toolkit on RDS. We would appreciate your help in circulating this survey, available at https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/evaluation-survey/ /

3.3 Standard evaluation survey form

The Palliative Care Guidelines toolkit is using an adapted version of a generic impact evaluation form which the RDS team now encourages all toolkit owners to apply 6-12 months after launch of their toolkit. Please contact ann.wales3@nhs.scot if you would like to find out more.

4. Training and communications

The RDS Learning working group is in the final stages of developing and uploading new learning resources including:

Clinical and Care governance of RDS toolkits
The RDS toolkit development journey – from scoping to implementation and evaluation.
New 5-minute videos demonstrating key editorial functionality

We have also drafted a communication and training plan to support implementation of the redesigned RDS. The plan aims to reach both end-users and editors, who will benefit from new features such as the archiving and version control functionality.

4.1 Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 1 August 11 am – 12 pm
Wednesday 7 August 4-5 pm

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.)

4.2 Google analytics training

Remember that you can also organise 1-1 training sessions with Olivia on running Google Analytics reports if you want to look at data more frequently than the six-monthly reports.

5. New toolkits

The following RDS toolkits are now live:

SARCS (Sexual Assault Response Coordination Service)
Child protection procedures (North Lanarkshire)
NHS Lothian neonatal guidelines

The following toolkits are due to go live imminently:

NHS Grampian critical care
Care Inspectorate Safe Staffing guidance.

6. Toolkits in development

Some of the toolkits the RDS team is currently working on:

SIGN/NICE/BTS Asthma guideline – combination of old and new guidance.
New SIGN guideline around prevention and remission of type 2 diabetes
Updating of HIS national tissue viability guidance in collaboration with the and transfer to RDS as an extension to the Skin and wound care toolkit

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

7. Implementation projects

HIS is working with the Scottish Library and Information Council and the ALLIANCE to implement the second phase of the Collective Force for Health and Wellbeing Action Plan. This plan aims to strengthen the role of public, health and school libraries in empowering people to use digital tools and health information for self-management and choices about health and wellbeing. A key element of this new phase is supporting public libraries to promote the RDS citizen-facing apps for health and wellbeing.

We held a webinar on 28^th June about the implementation challenge for health and wellbeing apps for citizens. This included an overview of the evidence base around implementation, the critical importance of health literacy skills, and the early findings from tests of change of implementing the Being a partner in my care app. Please contact his.decisionsupport@nhs.scot if you would like a copy of the slides or access to the recording of this webinar (NHS staff only.)

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

Drug	Administration	Dosage reduction in renal impairment	Availability of suspension	Additional information
Amoxicillin	Dilute the IV dose to 100mL in sodium chloride 0.9% and give by infusion over 30 to 60 minutes	No dose reduction required with initial STAT IV dose at any level of renal impairment.	Amoxicillin 250mg/5ml (100ml)
Clarithromycin	Oral only	No reduction to oral doses.	Clarithromycin 250mg/5ml (70ml)	Check BNF for interactions, particularly with statins, warfarin, quinolones and steroids
Co-trimoxazole	Oral only	Use half normal dose (480mg twice daily) if eGFR 15–30 mL/minute/1.73 m². Avoid if eGFR less than 15 mL/minute/1.73 m²	Co-trimoxazole suspension 480mg/5ml (100ml)
Doxycycline	Oral	No dose reduction required.	Dispersible tablets (100mg)	Swallow with plenty fluid in upright position. If gastric irritation - give with food or milk.
Flucloxacillin	Oral	No reduction to oral doses.		30 minutes to 1 hour before meals
Fosfomycin	Oral	Contraindicated if CrCl <10ml/min (due to prolonged half-life)		Dissolve granules in water and take immediately, on an empty stomach (about 2–3 hours before or after a meal), ideally before bedtime, after emptying the bladder.
Gentamicin	IV infusion: Give over 30 minutes as per the NHS Lothian Gentamicin Policy. Dilute with 50 to 100ml Sodium Chloride 0.9% or Glucose 5%	Use calculator	n/a
Metronidazole	Oral / PR	No dose reduction required.	Metronidazole 200mg/5ml (100ml) Suppositories 1g	With/ after food, with water. Avoid alcohol.
Nitrofurantoin	Oral	In patients with an eGFR of less than 45 ml/minute. Nitrofurantoin may be used with caution for short-course therapy only in uncomplicated lower urinary tract infection, with eGFR 30-44 ml/min to treat resistant pathogens, when the benefits are expected to outweigh the risks.	Do not use suspension due to cost >£400. Non m/r formulation may be more appropriate for some patients.	With food or meals
Pivmecillinam	Oral	No dose reduction required.		Tablets should be swallowed whole with plenty of fluid during meals while sitting or standing.
Teicoplanin	See NHS Lothian IV handbook for reconstitution guidance: Doses ≤800mg as IV infusion in 100ml over 30 minutes Doses ≥800mg as IV infusion in 100ml over one hour	The teicoplanin dosing regimen adapted for H@H is based on the patient creatinine clearance.	n/a	Note while OPAT may bolus doses this is not advised for H@H situations. The H@H teicoplanin regimen is not for deep-seated infections- if this is a concern please contact an infection specialist.
Trimethoprim	Oral	Use half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m². Raised serum creatinine and blood urea nitrogen levels. Use half normal dose if eGFR less than 15 mL/minute/1.73 m².(BNF) Note: Trimethoprim inhibits the tubular creatinine secretion leading to a rapid but reversible increase in serum creatinine, independent of any changes in GFR. This translates into falsely low estimates of GFR when creatinine based equations are used. See publication below. Nephron Clin Pract 2011;119:c187–c194	Trimethoprim suspension 50mg/5ml (100ml)	Causes hyperkalaemia