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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

 

 

Hypoglycaemia Management in Children, Emergency Department, Paediatrics (507)

Warning

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.

Hypoglycaemia is defined as blood sugar level <2.6mmol/l (commonly referred to as BM). The maintenance of a normal blood sugar level is a complex process.

Hypoglycaemia is a sign of underlying disease that interferes with at least one of the following processes:

  • Carbohydrate intake
  • Carbohydrate absorption
  • Gluconeogenesis
  • Glycogenolysis

Gluconeogenesis is a metabolic pathway that results in the generation of glucose from non-carbohydrate substrates e.g pyruvate, lactate, glycerol. It mainly occurs in the liver but also to some extent in the cortex of the kidneys. The process occurs during periods of fasting, starvation, low-carb diets or intense exercise. It is often associated with ketosis.

Glycogenolysis is the breakdown of glycogen and takes place in the cells of muscle (to provide energy for contraction) and hepatocytes (to release glucose into the bloodstream for uptake by other cells).

Causes of hypoglycaemia

Inadequate glucose
intake/production?
ORExcessive glucose
consumption?
Systemic/Nutrition
  • Starvation
  • Malnutrition
  • Sepsis
  • Malabsorption
Metabolic
  • Ketotic hypoglycaemia “accelerated starvation”
  • Glycogen storage disease
  • Galactosaemia
  • Organic acidaemia
  • Carnitine deficiency
  • Acyl CoA Dehydrogenase deficiency
Endocrine
  • Hyperinsulinism
  • Hypopituitarism
  • Growth hormone deficiency
  • Hypothyroidism
  • Congenital adrenal hyperplasia
Hepatic
  • Hepatitis
  • Cirrhosis
  • Reye Syndrome
Toxic
  • Aspirin
  • Alcohol
  • Insulin
  • Valproate

Signs and symptoms

The signs and symptoms of hypoglycaemia vary greatly between individuals. Autonomic features tend to appear earlier (but are not always present!). Neurological features occur due to impaired glucose supply to the brain.

    Symptoms Signs

 

Arrow going from green to yellow to orange to red

 

Mild

 

Moderate   

 

Severe

Sweating
Headache
Anxiety
Jelly legs
Difficulty concentrating 

 

Dizziness
Visual disturbance

Tremor
Pallor
Tachycardia
Change in behaviour
Lethargy
Slurred speech
Unsteady gait
Confused

Altered consciousness
Convulsions

Important points to cover in patient history

Past history
  • Similar episodes in the past (these may have been unrecognised as being caused by hypoglycaemia e.g seizures)
  • Neonatal hypoglycaemia
Family history
  • Unexplained infant deaths (consider inborn errors of metabolism)
  • Some hormone or insulin problems may be familial

Relation to foods

  • Milk (galactosaemia)
  • Juice (hereditary fructose intolerance)
  • Protein (amino acid or organic acid disorder)
Possible access to medicines/alcohol
  • Oral hypoglycaemia agents
  • Alcohol
  • Aspirin
  • B-Blockers
  • Insulin

Investigations

Bloods

Use Paediatric Hypoglycaemia grab bag - Found on all IV trolleys in RHC, Emergency Department.
Details for Paediatric Hypoglycaemia grab bag also found at end of this document.

These bloods are ideally taken before dextrose is given. Aim for 5ml – but minimum 1.5ml.

Bloods should be sent promptly after collection using the POD system. They should be selected as URGENT on Trakcare. It is not necessary to call the lab or sent samples on ice.

Urine

Urinary ketones & Urinary organic acid.

Management

Hypoglycaemia Management Flow Chart

Hypoglycaemia Management Flow Chart

 

Paediatric hypoglycaemia "Grab Bag"

For all patients requiring a 'hypo screen' for hypoglycaemia

‘PAEDS HYPOGLYCAEMIA ‐ TIME CRITICAL SAMPLES’
(Samples required PRIOR to administration of glucose)
TEST TUBE TYPE VOLUME REQUIRED
Glucose
Free fatty acids (FFAs) 
Fluoride oxalate (GREY) 500 microlitres
(aim for half full)
Insulin
C-peptide
Beta OH butyrate
Cortisol
Lithium Heparin (GREEN screw top) 1ml ideally 2mls
(1 bottle, 2 if possible)
Lactate
(Capillary blood gas)
Capillary blood gas tube
(Processed in ED)
Aim for 1 full capillary tube

***SAMPLES MUST BE IN THE LAB WITHIN 15 MINUTES OF COLLECTION***
CONTACT LAB TO INFORM THEM OF URGENT HYPOGLYCAEMIA SAMPLES

'PAEDS HYPOGLYCAEMIA ADDITIONAL ESSENTIAL'
(Sample can be taken AFTER administration of glucose)

TEST TUBE TYPE VOLUME REQUIRED
Ammonia
U&Es
LFTs
CRP
Acylcarnitine
Lithium Heparin (GREEN screw top) 1ml
(1 bottle)
FBC EDTA (Small PINK screw top) 500 microlitres
(up to mark on bottle)
Blood culture Age and volume dependent  
URINARY organic acids URINE in WHITE top universal container 5mls

How to order on Trakcare

‘PAEDS HYPOGLYCAEMIA ‐ TIME CRITICAL SAMPLES’
(Samples required PRIOR to administration of glucose)

To order the TIME CRITICAL SAMPLES then follow these steps:

  1. Ensure patient highlighted on ED screen then click on 'NEW REQUEST' tab.
  2. Click on "LABS - CHILD"
  3. On the right side of the screen type the requested tests in section titled 'ITEM' then hit 'F6' key
  4. Select appropriate test in pop-up screen

**ALWAYS SELECT THE "-CHILD" OPTION FOR THE TEST REQUESTED (WHEN AVAILABLE)**

HINTS:

  • For FFAs type 'free' then hit the F6 key
  • For C - Peptide ensure there is a space either side of the '-' before hitting F6
  • For Beta OH Butyrate type 'beta' then hit F6 key
  • Remember lactate is taken on a capillary gas tube and processed in the ED

'PAEDS HYPOGLYCAEMIA ADDITIONAL ESSENTIAL'
(Sample can be taken AFTER administration of glucose)

To order the ADDITIONAL ESSENTIAL SAMPLES then follow the same process as above.

**ALWAYS SELECT THE "-CHILD" OPTION FOR THE TEST REQUESTED (WHEN AVAILABLE)**

HINTS:

  • For Acylcarnitine ensure you select the option with 'BS' at the end.
  • For Urinary Organic Acids type 'organic' then hit F6 key

ONLY STICK ONE 'TRAKCARE' LABEL TO THE CORRESPONDING TUBE.
THE REMAINING LABELS SHOULD REMAIN ON THE REQUEST FORM AND ACCOMPANY THE SAMPLES TO THE LAB.

Editorial Information

Last reviewed: 29/03/2021

Next review date: 30/04/2024

Author(s): Dr Gill Campbell, Paediatric Emergency Department.

Approved By: Paediatric Clinical Effectiveness & Risk Committee

Reviewer name(s): gillian.campbell10@nhs.scot, steven.foster@nhs.scot.

Document Id: 507