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March 2025 newsletter now available - see below.

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Antibiotic Prophylaxis for Paediatric Surgery (228)

Thumbnail of RHC Antibiotic Prophylaxis for Paediatric Surgery PDF

RHC Antibiotic Prophylaxis for Paediatric Surgery (pdf)

Background and purpose

The aim of antibiotic prophylaxis in surgery is to minimise the risk of surgical site infection and associated complications reducing morbidity and mortality. The antibiotic selected must cover the expected pathogens for that operative site.

The timing of the first dose in relation to skin incision is critical. In all cases where antibiotic prophylaxis is indicated, this must be given BEFORE skin incision. For most agents, unless otherwise stated, administration NOT MORE THAN ONE HOUR before skin incision is recommended.

The selected regimen for prophylaxis should maintain adequate antibiotic levels for the duration of the procedure and dosing should reflect standard doses for the treatment of susceptible organisms.

For procedures lasting for longer than 4 hours intra-operative doses of antibiotic may be required if the half-life of the agent used is less than 2 hours.

Where blood loss greater the 25ml/kg (or 1500ml) has occurred an additional intra-operative dose is indicated.

There is little evidence to support prophylaxis past the period of operation and recovery of normal physiology following anaesthesia in most cases. Further details for individual procedures can be found within the guidance.

The scope of this guidance does NOT cover the treatment of post-operative infection. Where treatment is required, please review antibiotic choice, based on cultures and sensitivities where known, and follow BNF for children and/or West of Scotland neonatal guidelines for guidance on treatment doses in neonates.

Indications for prophylaxis

Health Improvement Scotland (HIS) and the Scottish Intercollegiate Guidelines Network (SIGN) include recommendations for surgical antibiotic prophylaxis in children within their guidance, SIGN 104 Antibiotic Prophylaxis in Surgery

Prophylaxis is generally recommended in the following types of surgery:

  • Clean surgery involving the placement of a prosthesis
  • Clean-contaminated surgery
  • Contaminated surgery

Antibiotic prophylaxis should not routinely be used for clean non –prosthetic uncomplicated surgery.

Methicillin Resistant Staphylococcus Aureus (MRSA) and Carbapenemase Producing Organisms (CPOs) and other multi-drug resistant organisms (MDROs)

MRSA:

Patients with a positive skin screen for MRSA should undergo skin and nasal decolonisation therapy according to the NHS GGC MRSA decolonisation pathway and receive surgical prophylaxis as indicated in the regimens below. An antibiotic with activity against MRSA should be selected for prophylaxis, even if MRSA is not detected on re-screening after topical decolonisation therapy has been carried out.

CPO:

Prophylaxis against CPO should be considered for patients undergoing surgery with a current systemic CPO infection. For patients colonised (including history if most recent screen negative) with CPO, targeted prophylaxis should be considered for where the surgical site breaches the lower GI tract (e.g colorectal surgery) or where surgical site infections may be caused by contaminating organisms from the lower GI tract (e.g renal or urological procedures).

In the above instances, please contact Microbiology for advice on antimicrobial choice.

Other MDROs

Patient with a history of an MDRO should be discussed with Microbiology to select appropriate prophylaxis regimens based on known microbiology and type of surgery.

Dosing in obesity

The majority of medicines do not require dose adjustments for obesity, however caution should be exercised when prescribing in extremes of weight. For antimicrobial prophylaxis in children with a BMI >30kg/m2 gentamicin should be dosed based on corrected body weight using a correction factor of 0.4.

Corrected body weight = (correction factor x (Total body weight – Ideal body weight) + Ideal body weight)

IBW = weight at corresponding height centile – see RCPCH growth charts
For further advice on dosing in obesity please contact Pharmacy.

Editorial Information

Last reviewed: 17/11/2021

Next review date: 30/11/2024

Author(s): Susan Kafka, Advanced Pharmacist Paediatric Antimicrobials and Medicine.

Version: 1.3

Author email(s): susan.kafka@ggc.scot.nhs.uk.

Approved By: Antimicrobial Utilisation Committee

Reviewer name(s): Dr Mairi MacLeod.

Document Id: 228