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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

 

 

Feverish Illness in Children (< 5 years), Paediatrics (461)

November 2023: This guidance is currently under review as it has gone beyond the standard review date. It reflects best practice at the time of authorship / last review and remains safe for use. If there are any concerns regarding the content then please consult with senior clinical staff to confirm.

Introduction

Feverish illness is a common occurrence in childhood. It is the most frequent reason for parents to consult a doctor about their child, and is the second most common cause of hospital admission in childhood.1 Most are self-limiting, however despite this, infections are the most common cause of death in those aged less than 5 years.1 Therefore it is important to identify those with potentially severe infections and initiate treatment rapidly. 

 

Definition

Feverish Illness is diagnosed in all children (<5years) who present with a temperature over 38°C as measured by the following as advised by NICE guidelines1

  • In those <4weeks of age – electronic thermometer placed in axilla
  • In those >4 weeks of age
    • Chemical dot in axilla
    • Electronic thermometer in axilla
    • Infra-red tympanic thermometer
  • In addition this includes those children who have no recorded fever at triage or assessment but whose parents report fever at home
    • regular temperatures should be taken whilst in the ED to monitor for this

Triage

Observations

All children who present with fever/parental reports of fever at home should have the following recorded at triage1

  • HR
  • BP (if HR is recorded as abnormal)
  • RR
  • Oxygen saturations
  • Temperature
  • CRT (centrally and peripherally)
  • Presence of a non-blanching rash
  • History of recent foreign travel recorded
  • Immunisation history

    In addition, parents should be given urine kit, and asked to collect sample for analysis.

Those children who have any ABC compromise, appear ill to health care professional, or have markedly deranged physiology should be taken immediately to the resuscitation area and a senior doctor should be involved. Treat according to APLS guidance 1,2

The remaining children should continue to be triaged appropriately and if pyrexia is present, one anti-pyretic agent should be administered if not already done so prior to presentation, doses of which can be found in the BNFc3

Clinical assessment

If ABC compromise/ill looking child/markedly deranged physiology the child should be taken to resus and managed according to APLS guidance2

The following should be assessed and documented in all feverish children1

  • History of illness and any features of specific disease (e.g. tonsillitis, UTI)
  • Full examination of child including ENT, inspection of all joints, hernial orifices and exposure of all skin areas.
  • Hydration and circulation status – CRT, extremity temperatures, presence of peripheral pulses, skin turgor, mucus membranes
  • Appearance of skin (e.g. mottled, pale, pink)
  • Activity levels
  • Respiratory pattern
  • Signs of severe illness (non-blanching rash, prolonged fever, neurological signs)

These children should then be assigned to a colour group in keeping with the NICE guidance on feverish children” 2013’s traffic light system1.  This will help determine further management. 

Children will be classified into either into GREEN, AMBER or RED groups depending on their clinical assessment.1  Re-assess the child once anti-pyretic medications have been administered as this may alleviate some clinical features and the child may be grouped into a lower severity group.

 

Assessment table divided by colour

Figure 1: Table taken from NICE Clinical Guideline 160 - Feverish illness in children 2013.

 

Management

Children under 1 month

ALL children under 1 month of age with a documented fever >38° or those that appear unwell should undergo a full septic screen which should consist of:

  • Bloods including blood cultures
  • Urine microscopy, culture and sensitivity
  • LP*
  • CXR

IV antibiotics should be given in accordance with local guidelines.

*Please see RHSC lumbar puncture guideline for contraindications to LP

Children under 3 months of age1

  • with documented fever in ED
    OR
  • apyrexial on assessment but who have parental reports of fever at home
    OR
  • no documented fever but appear unwell on examination

in whom no apparent source is found,  the following investigations are advised1,  and the patient should be admitted under medical paediatrics.

  • FBC
  • Blood Culture
  • CRP
  • Urinalysis and CSU
  • CXR on clinical judgement
  • LP* should be performed on the majority of children in this age group, unless there is a clear reason not to do so and this has been discussed with a senior clinician.

Administer IV antibiotics (refer to local guidance) if

  • 1-3months who appear unwell
  • If WCC <5x109/L or >15x109/L

In addition, children <3 months who have fever with a clear source should be discussed with the ED consultant on duty or medical registrar out of hours for admission to CDU or ARU for an extended period of monitoring +/- further investigation.

Children > 3 months of age1

  • if a source is identified then management should be directed towards that specific illness
  • If no source is found then management should be directed as per NICE traffic light system, described below1
RED1
  • Investigations1
    • FBC
    • Blood culture
    • CRP
    • Urinalysis and CCU
    • On clinical judgement
      • LP
      • CXR
      • U&E
      • Venous gas
  • Admission under medical paediatrics

IMPORTANT: These children are likely to be septic, and should be managed with the early input of a senior clinician and early administration of IV antibiotics considered.
AMBER1
  • Investigations1
    • FBC
    • Culture
    • CRP
    • Urinalysis and CCU
    • On clinical judgement
      • LP (in particular if <1 year)
      • CXR (if fever >39C and WCC >20X109/L
  • If a child remains in the amber category after a period of observation in the ED they should be referred to medical paediatrics.
GREEN1
  • Urinalysis and CCU
    • If <1 year or previous history of UTI then wait for urinalysis in ED/CDU
    • If >1 year and no history of previous UTI the urine sample can be collected at home and handed into GP.
  • As per ED guidance, any child with an abnormality of their triage observations should have a minimum of one further set of observations recorded on a CEWS chart. If the child remains in the green category and there is no additional clinical concern they can be discharged with written advice.

 

Disposition

Children with a clear source of infection should be treated appropriately as per local guidance specific to that febrile illness, with written and verbal advice given to parents. 

Children in the green category with no clear cause of pyrexia may be discharged home after assessment and appropriate investigations are completed. There should be a responsible adult at home and parental anxiety should be addressed.

Children not deemed suitable for discharge home after ED assessment should be admitted either to the CDU or directly to the ARU, following discussion with the senior doctor on the ED floor.

Advice sheet for parents

Advice sheet for parents (pdf):

Discharge advice for carers of children younger than 5 years who have a fever of an unknown cause ENGLISH

Discharge advice for carers of children younger than 5 years who have a fever of an unknown cause ARABIC

Discharge advice for carers of children younger than 5 years who have a fever of an unknown cause ROMANIAN

Discharge advice for carers of children younger than 5 years who have a fever of an unknown cause SIMPLIFIED CHINESE

Editorial Information

Last reviewed: 23/10/2018

Next review date: 30/04/2024

Author(s): Marie Spiers.

Version: 2

Approved By: Paediatric Clinical Effectiveness & Risk Committee

Document Id: 461

References
  1. National Institute for Health and Care Excellence (2013) Feverish illness in children. [160]. London: National Institute for Health and Care Excellence
  2. Advanced Paediatric Life Support The Practical Approach (2005) 5th Edition, ALSG group. Wiley and Sons, Oxford.
  3. Joint Formulary Committee British National Formulary For Children. 55th Ed., London: British Medical Association and Royal Pharmaceutical Society of Great Britain. Joint Formulary Committee (2013) British National Formulary.