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Right Decision Service newsletter: May 2024

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

Issues with RDS and Umbraco access

A fix was deployed on Thursday 30th May to address the stability issues experienced with the Right Decision Service over recent weeks. These arose principally when multiple toolkits were built simultaneously or successively to the mobile app  We are hopeful that the stability issues are now resolved. If you encounter any problems with this newly deployed site, please email ann.wales3@nhs.scot and onivarova@tactuum.com immediately as well as raising an Urgent support ticket.

Thank you again for your patience while we have been resolving these issues.

New editor request form

A form to request creation of new editors, or updates to existing editor details, is available in the Standard Operating Procedures toolkit  .

Redesign and improvements to RDS

The timeline for this work has been slightly delayed because effort has been diverted to addressing the recent stability issues.  However, the redesign of search, browse, archiving and version control have now been through a second round of testing and Tactuum is beginning to work on amendments.  We now plan to go out to user acceptance testing in July 2024 and will let you know when we are ready to do this.

Deep linking direct to individual toolkits on the mobile app

We are awaiting clarification from Tactuum on the time and effort required for this development. We should hear this week and I will let you know as soon as information is available.

New feature requests

Once we have completed the current redesign and deep linking we will be able to take stock of outstanding new feature requests and update you on what can be achieved within available resource.

Training

Introductory webinars for new RDS editors will be held on the following dates:

  • Thursday 27 June 11 am – 12 pm
  • Wednesday 3rd July 3.15 pm – 4.15 pm

To book to attend one of these webinars, please contact Olivia.graham@nhs.scot , stating your name, job title, health board and preferred date for training.

The RDS Learning working group is also progressing work on “train the trainer” resources for RDS editors and toolkit leads. These resources include:

  • A module on clinical and care governance for RDS content
  • A step by step introduction to the toolkit development process.
  • Video learning bytes to introduce key editorial features and functions.

We aim to have initial content available on the RDS Learning area by end of June/early July.

Evaluation

Thanks to Fergus Donachie in NHS Dumfries and Galloway and Sheila Grecian in NHS Lothian, who have shared the results of user surveys for their referral management and diabetes & endocrinology toolkits. The results provide excellent insights into how RDS is improving practice and saving time for clinicians. And there are also helpful suggestions for improving the service.

This all provides valuable material to support the business case to Scottish Government for the next stages of RDS development. If you have carried out local evaluation we would be very pleased to hear from you.

New toolkits

The following RDS toolkits are now live:

The Right Decisions toolkit for SIGN 171: Management of diabetes in pregnancy.

SIGN 168: Assessment, diagnosis, care and support for people with dementia and their carers. This toolkit is live and just awaiting final editorial review to remove the “in development” status.

Living well with dementia - for everyone. We recommend that you use the mobile version of this toolkit, as the web version contains only informational resources. The mobile app provides access to the Dementia wellbeing diary, which enables people in early post-diagnostic stages and their carers to keep track of their wellbeing outcomes. Each wellbeing outcome is linked to resources and services supporting that outcome. The mobile toolkit also provides a digital version of the “Getting to know me” form, and a range of resources and tools for people living with dementia and their carers. Four HSCPs have localised this app to include directories of local support services, but this generic app is available for anyone in any location to use.

The following toolkits are due to go live imminently:

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

Toolkits in development

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

Waiting Well – national toolkit for healthcare professionals. This toolkit is being developed for the Scottish Government Waiting Well team in collaboration with NHS GGC knowledge services staff. It provides healthcare teams in NHS Boards and HSCPs with guidance and tools to develop and implement their action plans to support people on waiting lists with access to information, signposting to local community assets and services, and to professional support and services.

NHS Borders RefHelp – referral guidance for NHS Borders. Work is about to start on a similar toolkit for NHS Tayside.

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.

Quality audit

Thank you to everyone who has completed the retrospective Quality Assurance checklist. I am pleased to say that the latest report was well-received within Healthcare Improvement Scotland, with positive comments on the commitment shown by NHS Boards and other organisations to ensuring the quality and safety of their content on the RDS.

 

Implementation projects

A knowledge exchange session to share learning about implementation of patient and public-facing RDS apps is scheduled for 28th June 11 am – 12 pm.  This will include sharing key points from a recent literature review, and the results of early tests of change of implementing the ‘Being a partner in my care’ app, which aims to help citizens to become active partners in Realistic Medicine. 

If you would like to attend this session and have not yet received an invitation, please contact ann.wales3@nhs.scot .

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

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

Viral Warts

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

Treatment/ therapy

Warts are caused by a common viral infection, the human papillomavirus (HPV). Most resolve spontaneously within a year or two. They may vary in appearance depending on the types of HPV, the anatomical site involved and the host immune response. They often have small black dots, representing coagulated capillaries, particularly evident on paring. 

Common hand warts 

Common Hand Warts

Deep plantar wart (verruca) 

  • May be tender on pressure 

Deep Plantar Wart

Mosaic plantar wart 

  • May be slow to resolve in comparison to other warts 

Mosaic Plantar Wart

Plane wart 

  • Flat topped pink or pale brown. Often on face or other sun exposed sites 

Plane Wart

Filiform facial wart 

Filiform Facial Wart

Most patients with viral warts can be managed in primary care. 

Consider no  treatment as warts usually resolve spontaneously 

Common hand warts 

  • Self treatment daily with salicylic acid (up to 26%) or glutaraldehyde paints or gels after paring the warts 
  • Continue treatment for at least three months then review 
  • Consider 3-weekly cryotherapy in non-responders, occlusion under waterproof plaster, and use in combination with topical therapy 
  • Cryotherapy may be distressing and therefore inappropriate for young children 

Deep plantar wart / mosaic plantar warts 

  • Self treatment with daily salicylic acid paint (up to 50%) 
  • Paring of plantar warts with single-use file enhances treatment response 
  • Consideration of cryotherapy three weekly for up to 10 treatments: single or double freeze thaw cycle(s) 
  • Patients with painful plantar warts can be treated with corn plasters 

Plane warts 

  • Plane warts often resolve spontaneously 
  • Avoid cryotherapy 
  • Apply topical retinoic acid if persistent 

Filiform facial warts 

  • Do not apply wart paints 
  • Treat filiform facial warts with careful cryotherapy for 5-10 seconds to the wart but avoid surrounding skin 
  • Repeat every 2 or 3 weeks 

Referral Management

  • Symptomatic warts persistent for at least two years and unresponsive to topical agents and cryotherapy 
  • Diagnostic uncertainty especially in the elderly 
  • Multiple recalcitrant warts in the immunosuppressed 
  • If you need support for a patient with anogenital warts, seek advice from your local genito-urinary medicine team 

Clinical tips

  • Do not use salicylic acid on the face 
  • Cryotherapy should be administrated by appropriately trained staff 
  • Diagnostic doubt over solitary wart: remove by curettage for histopathology 
  • Children with verrucae should not be banned from swimming pool but can wear verruca socks 

Patient information resources

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

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