- Vaginal swab for combined Chlamydia/Gonorrhoea NAAT test.
- Consider high vaginal swab.
- Consider HIV and syphilis testing.
Blood cultures are required for patients admitted to hospital for IV therapies
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
Tables re-configured 11th April 2024
For full guidance see Pelvic Inflammatory Disease (PID) Guidance, Gynaecology Services Lothian (intranet only)
In pregnant or breast feeding see: Pelvic inflammatory disease in pregnancy
Blood cultures are required for patients admitted to hospital for IV therapies
Recommended total duration: 14 days
Doxycycline 100mg orally every 12 hours
AND
Metronidazole 400mg orally every 12 hours
If a high risk of gonorrhoea
Ceftriaxone 1000mg IM single dose
AND
Doxycycline 100mg orally every 12 hours
AND
Metronidazole 400mg orally every 12 hours
Ceftriaxone is associated with C.difficile diarrhoea.
Recommended total duration: 14 days
Recommended antibiotics |
Ceftriaxone 2g IV daily STOP when temperature <38oC for >24 hours and evidence of improvement of signs of sepsis, if present on admission (single dose treatment acceptable). AND Doxycycline 100mg orally every 12 hours AND Metronidazole 400mg orally every 12 hours |
Alternative in anaphylaxis to penicillin or cephalosporin allergy OR unable to tolerate oral medication OR doxycyline contraindicated |
Ciprofloxacin 400mg IV every 12 hours AND Metronidazole 500mg IV every 8 hours If signs of sepsis with organ dysfunction. ADD Vancomycin IV as per NHS Lothian AMT intranet calculator. |
See MHRA warning related to ciprofloxacin.
Ciprofloxacin and ceftriaxone are associated with C.difficile diarrhoea.
Doxycycline 100mg every 12 hours
AND
Metronidazole 400mg every 12 hours
Where doxycycline is contraindicated
Ofloxacin 400mg every 12 hours
AND
Metronidazole 400mg every 12 hours
See MHRA warning related to ofloxacin.
Ofloxacin is associated with C.difficile diarrhoea.
Likely organisms: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, anaerobes