Welcome to the Right Decision Service (RDS) newsletter for August 2024.
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.
The following toolkits are now live;
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.
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.
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
What’s New
Recommended treatment is 7 day course of metronidazole. Stat dose has a higher rate of
treatment failure.
Introduction
Trichomonas vaginalis (TV) is a flagellated protozoan that is a parasite of the genital tract.
Due to site specificity, infection almost always follows direct inoculation of the organism (intravaginal or intraurethral) and is thus almost exclusively sexually transmitted.
Note: there are other species of Trichomonas which are not sexually transmitted, eg, Trichomonas Faecalis, so it is therefore important to clarify this with the testing laboratory if further differentiation is required.
In adult female cases urethral infection is present in 90% of episodes, although the urinary tract is the sole site of infection in <5% cases.
In men infection is usually of the urethra.
The most obvious host response to infection is a local increase in polymorphs.
Infection is associated with an increased risk of HIV transmission.
There is a spontaneous cure rate in the order of 20/25%.
TV should be managed in local specialist sexual health services or in consultation with.
This guidance is aimed primarily at people aged 16years or older.
Symptoms (10-50% asymptomatic)
Signs (5-15% nil abnormal on examination)
Symptoms (15-50% asymptomatic; Often present as contacts of infected female partners)
Signs
It is important to check with your local laboratory if they have facilities for culture of TV and how to request this is done. Some laboratories will do microscopy alone for TV.
Females – Investigations
NB: Be aware that TV diagnosed on Liquid based cytology may have a false positive rate. If TV-like organisms are reported via SCCRS, a letter is generated via the results service requesting the woman to attend to confirm infection prior to any treatment and/or partner notification.
In practice, treatment is usually epidemiological without identification of the organism, which is difficult - highest yield is from centrifuged first void urine deposit.
Preferred treatment: Metronidazole 400-500mg twice daily for 5-7 days
Alternative treatment: Metronidazole 2g stat (stat dose has a higher risk of treatment
failure)
Advise to avoid alcohol for the duration of treatment and for 48 hours
afterwards with metronidazole
May be due to inadequate therapy, re-infection or resistance.
1. Repeat course of Metronidazole – 400-500 mg twice daily for 7 days
2. For patients failing 1. Try Metronidazole 2g daily orally for 5 to 7 days or 800mg three times daily for 7 days
If patient fails on the above 2 options discuss with a senior colleague in GUM before considering alternative options.
See West of Scotland Managed clinical Network Guideline on Trichomonas vaginalis in Pregnancy
British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021 (cited 2023 May)
Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS. 2023 update to 2018 European (IUSTI/WHO) guideline on the management of vaginal discharge. International Journal of STD & AIDS. 2023;34(10):745-745. doi:10.1177/09564624231179277 (cited 2023 May)
DGRefHelp - NHS Dumfries & Galloway