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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

 

 

Carvedilol initiation and dose increase (1176)

Objectives

Royal Hospital for Children Glasgow – Carvedilol initiation and dose increase

Indications

Carvedilol is indicated for patients with Congestive heart failure (CHF), with systemic ventricular dysfunction secondary to cardiomyopathy or congenital heart disease.

In general it is commenced after establishment of therapy with diuretics, ACE inhibitors +/- digoxin (unless contraindicated or intolerant).

Carvedilol is a non-selective beta blocker with alpha blocking action. The beta blocker action reduces heart rate and cardiac contractility by blocking the action of catecholamines on the heart muscle, while the alpha blocking action causes peripheral dilatation by blocking the action of the catecholamines on the peripheral arteries and arterioles.

Contra-indications

Asthma
Cardiogenic shock
Metabolic acidosis
Severe congestive heart failure unresponsive to diuretic and ACE inhibitor
2nd or 3rd degree AV block, Sick sinus syndrome
Hypotension
Marked bradycardia
Severe peripheral arterial disease
Uncontrolled heart failure
Phaeochromocytoma (Adrenal tumour)
Clinically significant hepatic dysfunction

Cautions

Diabetes
1st-degree AV block
Obstructive airways disease (introduce cautiously)
Myasthenia gravis
Portal hypertension (risk of deterioration in liver function)
Psoriasis
Thyrotoxicosis (symptoms may be masked)

Dosing information

Carvedilol is not licensed in <18 years of age

Carvedilol is always initiated by a consultant cardiologist and supervised by a cardiac pharmacist.

 

Initial dose

1st dose increase

2nd dose increase

3rd dose increase

Dose

50 micrograms/kg BD

100 micrograms/kg BD

200 micrograms/kg BD

350 micrograms/kg BD

Maximum dose

3.125mg

6.25mg

12.5mg

25mg

Doses may be increased every two weeks. This requires a day-case admission for each dose increase. However, if adverse effects occur dose increases are made at longer intervals and by smaller increments.

Titrate to maximum tolerated dose. Tolerance is defined as maintaining an acceptable systolic blood pressure 30 minutes and one hour post dose.

Side effects

Dizziness, hypotension, syncope, headache, bradycardia, abdominal discomfort/nausea/vomiting/diarrhoea, tiredness, dyspnoea, oedema, rash, dry eye, sleep disorders

Monitoring

Initiation and dose increase of carvedilol requires inpatient monitoring as hypotension can occur, especially in children with heart failure receiving concurrent diuretic therapy and ACE inhibitors. Dose titration and close monitoring of blood pressure are therefore required.

Complete nursing and medical admission

Baseline Echo, ECG, U&Es and LFTs (D/W consultant cardiologist re: need to check bloods before dose increase).

Ensure baseline observations are within acceptable limits.  This includes:

  • Heart rate (HR)
  • Respiratory rate (RR)
  • Blood pressure (BP)
  • Oxygen saturations
  • Temperature

After dose administration check BP and HR

  • Every 30 minutes for at least 4 hours
  • Continue until stable

  Notify medical staff/ANP: 

  • if significant drop in systolic and mean BP (usually >20mmhg from base line)
  • if child is symptomatic  (e.g dizziness, pale, altered level of consciousness, profoundly hypotensive/bradycardic, tachycardic, capillary refill >3 seconds, cool peripheries)

Discharge criteria:

  • Observations within acceptable parameters for child
  • Child reviewed by Dr/ANP
  • Information given to family/carer re: medicine administration and clear instructions for the adjusted dose.
  • Family / Caregiver has demonstrated competence in drawing up appropriate (adjusted) dose of Carvedilol 
  • Family/carer aware of common side effects and know to contact cardiac nurse specialists if child experiencing these side effects.( Give family PDF of medicines information leaflet)
  • Discharge summary completed and given to family/carer with a follow up plan

Preparations

Carvedilol 3.125mg or 6.25mg tablets (various manufacturers)

Editorial Information

Last reviewed: 22/02/2022

Next review date: 31/05/2023

Author(s): Donna Nelson.

Version: 2

Approved By: Paediatric Cardiology