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Announcements and latest updates

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

  1. Contingency planning for RDS outages

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.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

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.

 

  1. Guide to six stages of RDS toolkit development

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.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 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.)

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

Atopic eczema (Paediatric)

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

Atopic eczema may present as cradle cap in babies, before spreading to face, skin creases and extensor limb surfaces  then  flexural sites .  Rapid and early control is beneficial to long term outlook. May improve with advancing age. 

 

Atopic eczema

 

Atopic eczema

 

Atopic eczema

  

Eczema Herpeticum 

consider if any acute vesicular and painful flare. 

 

Topical Steroids: 

  • Prescribe a mild (face) and moderate (body) steroid in ointment form. 
  • Consider potent topical steroid to body in over 2’s 
  • Advise on fingertip units . 
  • Simultaneous application of emollients and topical steroid may reduce potency of steroid , advise a delay before steroid 
  • Reduce topical steroid to twice weekly maintenance when improved. 

Emollients: 

Consider Prescribing  an ointment  to use in the evening (if steroid used, apply after a suitable interval ) and a cream  to use in the morning. Ointments may cause less ‘stinging’ in inflamed skin. Discuss with  patient/parent  which  he/she prefers and will use regularly. 

Prescribe adequate quantities of emollients for daily use 

Soap substitutes and bath emollients: 

Soaps, shower gels and bubble baths are very irritant and should ALWAYS be avoided. 

Prescribe a bath additive or shower emollient instead which can also be used to wash hair. 

  

Eczema Herpeticum 

  • Stop topical steroids/tacrolimus and urgent referral 
  • Urgent viral PCR swab if available. 
  • consider if any acute vesicular and painful flare. 

Referral Management

  • Eczema not controlled (2+flares per month) despite maintenance and flare treatment with hydrocortisone to face and moderately potent steroid (up to 1 year) or potent steroid (in 1 year+) to trunk/limbs. 
  • Eczema causing severe psychological or social difficulties 
  • Diagnosis uncertain 
  • History of GI symptoms with severe widespread eczema not responding to topical steroids start on extensively hydrolysed formula and refer. 
  • Eczema Herpeticum: 
  • Contact Dermatology department immediately for advice. 

Clinical tips

  • Systemic antibiotics are only indicated if patient is systemically unwell 
  • Reassure patients that topical steroids are safe and effective if used as described. 
  • Ointments are preferable to creams. 
  • The vast majority of children with mild-moderate eczema that respond to treatment do not have food allergy. 
  • Light cotton or silk garments are available on prescription and can prevent scratching, help treatments to soak in and avoid staining of bedding and clothing. 
  • consider eczema herpeticum where there is an acute blistering flare of eczema, pain, fever and patient is unwell. 

Patient information resources

1.NHS Inform: www.nhsinform.scot 

2. NHS24 Tel: 08454 242424 

3. Text Phone: 18001 08454 24 24 24 

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways .

Co-Author(s): NHS Scotland, Scottish Dermatology Society.