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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

 

 

Adrenaline Auto Injector Prescription, Paediatric Allergy Service (142)

Objectives

The document provides guidance on the prescription of adrenaline auto injectors (AAI) for children.

Scope

The guidance should be used by healthcare professionals managing children at risk of severe allergic reactions/anaphylaxis.

Introduction

The prescription of an adrenaline auto injector should be on the basis of a risk assessment which indicates a significant risk of anaphylaxis. This should only be considered;

  • As part of a full allergy assessment including identification of triggers, education on avoidance, assessment of risk and the provision of an allergy management plan or whilst a full assessment is awaited if risk deemed considerable
  • Where adequate training in appropriate usage has been given
  • Where referral or follow-up has been arranged and where rationale for prescription can be reviewed and/or training re-enforced

The British Society of Allergy and Clinical Immunology has published a detailed guideline for prescribing an AAI and it is available on line for further information (Adrenaline Auto-Injector - BSACI).

Definitions

Mild to moderate allergic reaction is characterized by one or more symptoms or signs of skin and/or gastrointestinal tract involvement without respiratory and/or cardiovascular involvement.

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterized by potentially life-threatening compromise in airway, breathing and/or the circulation, and may occur without typical skin features or circulatory shock being present.

Indications for Adrenaline Auto injector

Absolute indications for AAI:

  • Previous anaphylaxis* triggered by food, latex or aeroallergen
  • Previous exercise-induced anaphylaxis
  • Previous idiopathic anaphylaxis
  • Co-existing unstable or moderate-to-severe persistent asthma and a food allergy*
  • Hymenoptera venom (bee and wasp stings) allergy in untreated patients (not receiving immunotherapy) with more than cutaneous/mucosal systemic reactions or high risk of re-exposure.

*Excluding oral allergy syndrome (OAS or pollen food allergy syndrome) unless patient has previously experienced systemic symptoms. The OAS is generally considered to be a mild form of food allergy; mild irritant symptoms such as itching of the mouth, lips and throat when eating raw fruits and vegetables.

Relative indications are (especially if more than one is present):

1) Previous mild-to-moderate allergic reaction to traces of food*

2) Previous mild-to-moderate allergic reaction* to foods known to be associated with anaphylaxis (e.g. peanut and/or tree nut, cow's milk etc.).

3) Teenager or young adult with a food allergy with previous mild-to-moderate reactions*

4) Remote from medical help or prolonged travel abroad in the context of previous mild-to-moderate allergic reactions to a food, hymenoptera venom (bee and wasp stings), latex or aeroallergens   

*Excluding OAS unless patient has previously experienced systemic symptoms

Targeted advice on AAI prescription for allergy specialists; Additional absolute and relative indications

Absolute indications

  • During and after venom immunotherapy, in patients with more than cutaneous/mucosal systemic reactions if risk factors for relapse are present.
  • Underlying systemic mastocytosis; children with very severe skin involvement (>50% body surface) and increased basal serum Tryptase levels (>20 ng/ml) and with blistering in the first three years of life.

Relative indications

  • Oral immunotherapy for food allergy
  • Hymenoptera venom or drug allergy in patients with more than cutaneous/mucosal systemic reactions and cardiovascular disease                                                                                                                            

Age and Weight based prescription of AAI

* Infants at HIGH risk of accidental exposure and who weigh more than 7.5 kg can be issued with a junior AAI (0.15mg). For infants less than 6 months of age, allergen avoidance measures should be effective in most cases.

** Product not available, see BNFc important Safety Information 

*** if > 60 kg; if small or pre-pubertal offer 0.3 mg

Number of AAIs

Patients should be given a prescription for 4 devices; two in the emergency bag (giving the option of administering 2 doses) and two for the nursery/school.

Editorial Information

Last reviewed: 01/11/2022

Next review date: 30/11/2026

Author(s): George Raptis.

Approved By: Stakeholders: Specialist Allergy Nurses; Medical Team; Pharmacy; Respiratory Team

Document Id: 142

References