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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 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.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   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

 

 

Nitric Oxide administration in MRI (1095)

Objectives

Nitric oxide delivery systems cannot be taken into the MRI scanner room, this document explains the configuration required for scanning a patient receiving inhaled NO.

Scope

This document applies only to patients who are intubated & ventilated receiving inhaled Nitric Oxide (NO) in PICU or NICU in RHC. NO can only be delivered in the 1st floor MRI scanner 

Audience

All NICU, PICU and anaesthetic staff within RHC Glasgow 

Administration of nitric oxide within the MRI scanner will be an uncommon procedure but cases will occasionally arise. Experience with patients in the past is that the delivery systems are awkward and the ergonomics have been poor in terms or equipment arrangement at the entrance to the scanning room. Alterations have been made in order that we can now use standard administration equipment and configure this in a way that will closely resemble a routine anaesthetic administration in MRI 

Before the scan

Planning of potential cases MUST involve the anaesthetic department. It is possible to set up the entire breathing system in with NO at the required concentration running through the breathing system prior to collecting the patient from PICU / NICU. This will allow an easy transfer at the scanning room door with a simple switch of the patient breathing system connection.

Set up

The Nitric Delivery system can sit in the control room next to the monitor.

The Nitric delivery system should go through the lower wave guide (pass the tubes from the scanning room backwards towards the machine – they don’t fit the other way round). Blue plugs are for medical equipment, plug the nitric delivery system in here.

The nitric delivery & monitoring tubing are connected into the circle system as we would do in theatre i.e. delivery attachment directly onto the inspiratory limb of the circle and the monitoring  / sampling line further up the inspiratory limb.  Different types of soda lime have different effects in reducing both NO and NO2 within the circle system, whilst most of these are minor we do not recommend using low flow anaesthesia. [1]

We have put the sampling line in-between 2 tube extensions in this example.

2 or 3 sets of tubing extensions are required (depending of the position of your patient in the scanner) – work out the maximum distance when setting up the kit prior to calibration of the NO delivery system.

The gas tubes are long enough to move the anaesthetic machine all the way to sit on the left of the door at the internal side of the wave guides. Suction and scavenging have not been connected in this image – use the extension tubes hanging on the rear of the anaesthetic machine.

Once the system is assembled, put a test lung on the patient end, set up the ventilator to your patient’s requirements & run the calibration of the Nitric delivery system. You will need a flow of 10lpm of O2 through the circle system for this.

There is  usually no need to set up a t-piece system for bagging. If the patient requires manual ventilation e.g. for ETT suction then this can be accomplished by switching to the bag on the circle system.

If a t-piece is required, it can be set up in advance & passed through the wave guide, but the user will be in scan and the selection of breathing system is in the control room, so it requires additional personnel & potentially awkward communication so it is recommended that the manual ventilation bag on the circle is used whenever possible.

Useful contacts

MRI 1st Floor (main paediatric scanner) radiology Ex 84270  0141 452 4270

If you require further advice please contact Dr Graham Bell, graham.bell@ggc.scot.nhs.uk or mobile via switchboard

Editorial Information

Last reviewed: 12/07/2023

Next review date: 31/07/2026

Author(s): Dr Graham Bell, Consultant Anaesthetist; Dr Pauline Hall-Barrientos, Hospital Physics; Ms Marie Pirie, Superintendent Radiographer; Mr Kevin Jerome, Senior ODP.

Approved By: Paediatric Guidelines Group

Document Id: 1095

References

PICKETT, A.H. et al. The role of soda lime during administration of inhaled nitric oxide, British Journal of Anaesthesia, 72(6):683-685.