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
The frailty assessment and interventions tool is designed to support community health and social care teams to identify and assess people living with frailty and those at risk of falling. It contains interventions to consider, depending on an individual's needs. The tool can be used to help signpost individuals to the right care and support within the community. It can also be used as a checklist to aid assessment of risk factors and prompts for interventions that can reduce risk and improve wellbeing.
Check |
| General health status and skin care |
| Recent decline in function or performance |
| History of recent falls |
| Increased hospital admissions or interaction with community services |
Consider |
| Comprehensive geriatric assessment |
| Multidisciplinary team case review |
| Health and wellbeing interventions (smoking cessation, alcohol, healthy eating, exercise) |
| Pressure ulcer assessment |
| Future care plan |
| Key worker |
| Adult support and protection |
Check |
| Informal support being provided |
| Opportunity for social activities or access |
| Current care package |
| Community connections |
| Willingness to consider lifestyle changes |
Consider |
| Welfare assessment and income maximisation |
| Carer's assessment |
| Community assets (befriending and active health classes) |
| Technology to support health and wellbeing |
| Referral to social work for home assessment |
| Key worker |
| Risk enablement |
| A Local Information System for Scotland (ALISS) |
Check |
| Changes in memory or mood |
| Cognitive assessment |
| Delirium (sudden confusion) |
| Fear of falling |
| Signs of infection |
| Recent medication changes |
| Loneliness and isolation |
Consider |
| Referral to community mental health teams or GP |
| Dementia services |
| Assistive technology assessment |
| Locality support (leisure and day services) |
| Advocacy |
| Counselling and wellbeing services |
| A Local Information System for Scotland (ALISS) |
Check |
| Transfers (bed, toilet and chair) |
| Safety on internal and external stairs |
| Lighting |
| Home hazards |
| Pathways around home are clear |
| Person's interaction with environment (risk taking and balance) |
| Whether housing meets needs |
Consider |
| Occupational therapy, social work and housing |
| Scottish Fire and Rescue Service home safety visit |
| Referral to advise and support around home adaptations and repairs from Care and Repair |
| Fuel poverty check |
| Telecare |
| Housing support |
Check |
| Weight and body mass index (BMI) |
| Dentition |
| Ability to make meals and functional ability to feed self |
| Food and drink normally consumed |
| Ability to swallow |
Consider |
| Carer support for preparing meals |
| Encourage hydration |
| Referral to dietitian for nutritional assessment, Malnutrition Universal Screening Tool (MUST) and supplementation if needed |
| Referral to dentist for issues relating to dentition |
| Vitamin D levels |
| Referral to a speech and language therapist if swallowing difficulty identified |
Check |
| Recent medication changes |
| Manual heart rate |
| Blood glucose |
| Lying and standing blood pressure |
Consider |
| Referral to practice or community nurse |
| Refer to GP if someone has experienced a loss of consciousness recently |
| Medication review |
| Discussing with specialist falls service |
| Telehealth and telecare |
Check |
| Any side effects, particularly dizziness, light-headedness, visual disturbance or hallucinations |
| Recent medication changes |
| Compliance with medication |
| Use of over-the-counter medication |
Consider |
| Seven steps to appropriate polypharmacy |
| Referral for compliance aids and telecare |
| Medication prompts |
| Influenza and Pneumococcal Pneumonia vaccine |
Check |
| Mobility and gait |
| Walking aid use and condition |
| Splints, prosthesis fitting and compliance |
| Foot pain, skin colour, sensation and movement |
| Footwear and trip hazards |
Consider |
| Community physiotherapy |
| Reablement |
| Occupational therapy |
| NHS strength and balance class or leisure class |
| Community connections |
| Assessment of balance |
| Podiatry and orthotics |
| Footwear and foot care advice |
| Encourage physical activity |
Check |
| Urinalysis |
| Clothing easy loosened |
| Catheter bags secured to leg |
| Changes to elimination habits |
| Taking diuretic medication |
Consider |
| Referral to community or practice nurse for continence assessment |
| Provision of commode |
| Fluid intake |
| Medication review |
Check |
| Symptoms of vertigo |
| Hearing aids fitted correctly and working |
| Wearing current prescription glasses |
| Good lighting |
Consider |
| Optometrist for eye check |
| Any domiciliary optometry service |
| Advice from optician on use of multifocal glasses |
| Referral to sensory impairment team |
| Practice nurse for ear assessment |
Focus on frailty