Welcome to the Right Decision Service (RDS) newsletter for June 2024.
Hopefully you all received the notification on Friday 28th 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.
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.
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).
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/ /
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.
The RDS Learning working group is in the final stages of developing and uploading new learning resources including:
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:
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.)
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.
The following RDS toolkits are now live:
The following toolkits are due to go live imminently:
Some of the toolkits the RDS team is currently working on:
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.
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 28th 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
Source control through drainage of pus or surgical resection provides optimal treatment; consider referral for surgical assessment.
Organisms:
Community associated diarrhoea – viruses, Campylobacter and C. difficile
Intra-abdominal infections are often polymicrobial with enterobacteriaceae, anaerobes, Streptococci, enterococci.
Investigations:
Stool culture and C.difficile testing if diarrhoea.
Blood cultures if febrile
No antimicrobials recommended (East Region Formulary).
Consider C. difficile as a differential diagnosis in all patients presenting with abdominal pain. Diarrhoea is not always present in severe infection where the white cell count can be raised and abdominal pain and guarding and signs of ileus are present.
Take bloods and use East Region Formulary https://www.formulary.nhs.scot/east/infections/gastro-intestinal/clostridioides-difficile/ for appropriate treatment.
If the patient is a care home resident and has CDI then consult with the health protection team in Public Health for advice regarding reducing the risk of transmission to other residents
Consider hospital admission.
Consider goals of care.
Discuss with senior colleague.
Send blood cultures
Consider C. difficile as a differential diagnosis in all patients presenting with abdominal pain.
Diarrhoea is not always present in severe infection where the white cell count can be raised and abdominal pain and guarding and signs of ileus are present.
Options for effectively treating a severe intra-abdominal infection are limited. Making a diagnosis is a priority to guide effective therapy and future care.
Preferred:
Amoxicillin 1g orally every eight hours
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 400mg orally every 8 hours
Penicillin allergy:
Teicoplanin intravenous (see Appendix 2 for protocol)
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 400mg orally every 8 hours
Alternative/ oral option:
Co-trimoxazole 960mg orally every 12 hours
(see Appendix 1 for dose reduction in renal impairment)
PLUS
Metronidazole 400mg orally every 8 hours
If oral route not available very limited options are available for community management.
If antibiotic therapy deemed appropriate:
Amoxicillin 2g intravenous every 12 hours
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 1g by rectum every 8 hours for 3 days, then 1g by rectum
every 12 hours
Penicillin allergy and no oral option:
Teicoplanin intravenous (see Appendix 2 for protocol)
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 1g by rectum every 8 hours for 3 days, then 1g by rectum
every 12 hours
Gentamicin should not be extended for more than 72 hours in H@H patients without advice from an infection specialist, with consideration of toxicities and monitoring. (Note this differs from advice for patients in acute care settings where up to 5 days may be given).
If the patient is responding and there are no positive culture results, consider oral co-trimoxazole and metronidazole to complete antibiotic course.
Antimicrobial prescribing: NHS Lothian