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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

 

 

Adrenal insufficiency in children: management for children undergoing surgical procedures (238)

Objectives

Standardisation of the management of children with known or suspected adrenal insufficiency undergoing surgical procedures.

 

Scope

This clinical guidance should be used in children with known or suspected adrenal insufficiency who will undergo surgical procedures.

Conditions:

Children on daily replacement hydrocortisone treatment eg

  • Congenital adrenal hyperplasia
  • Congenital adrenal hypoplasia
  • Addison’s disease
  • Hypopituitarism eg congenital, brain tumour and post-radiotherapy

Children on high dose glucocorticoid treatment (Prednisolone, Deflazacort, Dexamethasone, Vamorolone) eg Inflammatory conditions like inflammatory arthritis, inflammatory bowel diseas, dDuchenne muscular dystrophy

Source for guidance

This clinical guidance adopts recommendations from the UK National Paediatric Adrenal Insufficiency Emergency Management Guidance developed by the British Society for Paediatric Endocrinology and Diabetes (2022). The British Society for Paediatric Endocrinology and Diabetes guidance has also been incorporated into the NICE guideline [NG243] Adrenal insufficiency: Identification and management (published 28th August 2024).

MANAGEMENT OF CHILDREN WITH ADRENAL INSUFFICIENCY UNDERGOING MAJOR SURGERY (PROCEDURE EXPECTED TO LAST 90 MINUTES OR LONGER)

Major Surgery is defined as surgery last 90 minutes or longer, with variable recovery periods and expected delay in restarting oral intake.

(A) INDUCTION

At induction, give IV bolus hydrocortisone 2mg /kg (max 100 mg).

For premature infants and neonates < 28 days corrected gestational age, give IV bolus hydrocortisone 4 mg/kg.

(B) INTRAOPERATIVE

Start IV hydrocortisone infusion.

IV hydrocortisone infusion

Weight

Infusion rate
(50 mg hydrocortisone in 50 ml 0.9% saline

≤10kg

1 ml/hour

10.1 to 20kg

2 ml/hour

20.1 to 40kg

4 ml/hour

40.1 to 70kg

6 ml/ hour

Over 70kg

8 ml/ hour

Consider more concentrated infusion in those needing fluid restriction (e.g. 100mg hydrocortisone in 50mls 0.9% saline).

The hydrocortisone infusion can be run alongside 0.9% sodium chloride, 5% glucose and PlasmaLyte solutions

(C) POST-OPERATIVE

Continue hydrocortisone infusion and change to oral sick day hydrocortisone when clinically stable and tolerating oral fluids / diet.

Stop hydrocortisone infusion 30 min after tolerating the first oral sick day dose.

Discuss duration of oral sick day dose with treating medical team.

Oral sick day hydrocortisone

Weight(kg)

Sick day hydrocortisone:
Dose

Frequency

1

0.8 mg

4 x a day

2

1.2 mg

4 x a day

3

1.5 mg

4 x a day

4

2.0 mg

4 x a day

5

2.5 mg

4 x a day

6

2.5 mg

4 x a day

7

3.0 mg

4 x a day

8

3.0 mg

4 x a day

9

3.5 mg

4 x a day

10

4.0 mg

4 x a day

15

5.0 mg

4 x a day

20

6.0 mg

4 x a day

25

7.5 mg

4 x a day

30

7.5 mg

4 x a day

35

10.0 mg

4 x a day

40

10.0 mg

4 x a day

45

10.0 mg

4 x a day

50

10.0 mg

4 x a day

55

12.5 mg

4 x a day

60

12.5 mg

4 x a day

65

12.5 mg

4 x a day

70

15.0 mg

4 x a day

75

15.0 mg

4 x a day

80

15.0 mg

4 x a day

90

15.0 mg

4 x a day

MANAGEMENT OF CHILDREN WITH ADRENAL INSUFFICIENCY UNDERGOING MINOR SURGERY REQUIRING GENERAL ANAESTHESIA (PROCEDURE EXPECTED TO LAST LESS THAN 90 MINUTES)

Minor Surgery is defined as a procedure lasting less than 90 minutes and the patient is expected to be eating and drinking by the next meal. This may include procedures such as MRI scans, endoscopy, dental extractions under general anaesthetic or other day case procedures.

(A) INDUCTION

At induction, give IV bolus hydrocortisone 2mg /kg (max 100 mg).

For premature infants and neonates < 28 days corrected gestational age, give IV bolus hydrocortisone 4 mg/kg.

(B) POST-OPERATIVE

Oral sick day dose for 24 hours

Weight(kg)

Sick day hydrocortisone:
Dose

Frequency

1

0.8 mg

4 x a day

2

1.2 mg

4 x a day

3

1.5 mg

4 x a day

4

2.0 mg

4 x a day

5

2.5 mg

4 x a day

6

2.5 mg

4 x a day

7

3.0 mg

4 x a day

8

3.0 mg

4 x a day

9

3.5 mg

4 x a day

10

4.0 mg

4 x a day

15

5.0 mg

4 x a day

20

6.0 mg

4 x a day

25

7.5 mg

4 x a day

30

7.5 mg

4 x a day

35

10.0 mg

4 x a day

40

10.0 mg

4 x a day

45

10.0 mg

4 x a day

50

10.0 mg

4 x a day

55

12.5 mg

4 x a day

60

12.5 mg

4 x a day

65

12.5 mg

4 x a day

70

15.0 mg

4 x a day

75

15.0 mg

4 x a day

80

15.0 mg

4 x a day

90

15.0 mg

4 x a day

MANAGEMENT OF CHILDREN WITH ADRENAL INSUFFICIENCY UNDERGOING MINOR SURGERY NOT REQUIRING GENERAL ANAESTHESIA

Minor surgery is defined as a procedure lasting less than 90 minutes and the patient is expected to be eating and drinking by the next meal.

For example:

  • Skin biopsy under local anaesthetic
  • Minor dental procedures eg filling tooth, tooth extraction (no general anaesthesia)
  • Non-anaesthetic sedation (eg chloral hydrate) for MRI

Give oral sick day dose on the day of the procedure and continue for 24 hours.

If in pain after 24 hours, patient to contact treating medical team and may need to continue oral sick day dose.

Editorial Information

Last reviewed: 10/01/2025

Next review date: 31/01/2029

Author(s): Jarod Wong, Avril Mason, Roisin Boyle.

Approved By: Paediatric Clinical Guidelines Group

Document Id: 238