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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

Pruritus

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

Treatment/ therapy

Generalised pruritus 

May occur without any underlying skin disease. Xerosis/dry skin in the elderly is one of the commonest caused of itch. 

In the absence of overt skin disease consider an underlying diagnosis  such as: 

  • Diabetes mellitus 
  • Anaemia / Iron deficiency 
  • Thyroid dysfunction 
  • Liver disease 
  • Medication induced (ie opiates) 

Rarely: 

  • Haematological malignancy eg Lymphoma 
  • Other malignancies 
  • Psychogenic itch 
  • HIV 

Vulval and perianal pruritus 

Consider the following diagnoses: 

  • Candidiasis 
  • Dermatophyte infection 
  • Irritant dermatitis or allergic contact dermatitis 
  • Lichen simplex 
  • Lichen sclerosis 
  • Infestation with thread worms 
  • Intra-epithelial neoplasia — ask about previous history of anogenital warts or cervical intra-epithelial neoplasm

Referral Management

Dermatology Referral Criteria 

Generalised pruritus 

  • Unresponsive to management 
  • Diagnostic uncertainty 

Vulval and perianal pruritus 

  • Diagnosis uncertainty 
  • Uncontrolled symptoms 
  • If contact allergy suspected 

Clinical tips

Generalised pruritus Treat any underlying disease Regular emollient and soap substitutes Oral antihistamines (sedating type may be more helpful in itch) Consider menthol in aqueous cream (0.5%- 2%) 

  

Investigations as appropriate 

  • Glucose 
  • Renal Function 
  • Full blood count 
  • Ferritin 
  • Liver Function tests 
  • Thyroid Function tests 
  • Medication review 

  

If indicated by history 

  • Chest x-ray 
  • Abdominal ultrasound 
  • HIV test 

Vulval and perianal pruritus Investigations as appropriate 

  • Urinalysis for glycosuria 
  • Swab for yeasts 
  • Stool sample for ova and parasites 

Management 

  • Emollients, soap substitutes and avoidance of irritants 
  • Treat the underlying disease where applicable 
  • Mild / moderate steroid plus antifungal / antibacterial 
  • Potent topical steroid may be required for limited period in lichen simplex and lichen sclerosis 

Patient information resources

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

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