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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

 

 

Ingested foreign bodies, ED, Paediatrics (535)

Objectives

*** IF SUSPECTED OR KNOWN INGESTION OF BUTTON BATTERY &/OR MAGNET(S) THEN DISCUSS WITH ED SENIOR IMMEDIATELY***

Guidance for the assessment and management of ingested foreign bodies, including a management algorithm.

Scope

Children that have ingested a foreign body.

Audience

Medical and nursing staff in the Emergency Department. 

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.

*** IF SUSPECTED OR KNOWN INGESTION OF BUTTON BATTERY &/OR MAGNET(S) THEN DISCUSS WITH ED SENIOR IMMEDIATELY ***

Background

History of foreign body ingestion is a common presenting complaint. Metallic foreign bodies are more commonly implicated than non-metallic. Coins are the most common.

Most ingested foreign bodies will pass harmlessly through the GI tract. However oesophageal impaction is a recognised complication even in the asymptomatic [1] with potentially serious sequelae such as oesophageal perforation, mediastinitis and ulceration.

Metal detectors have been used to detect metal foreign bodies in several studies. They have been proven to be both sensitive and specific in confirming presence of coins in particular, and localising them to above or below the diaphragm [2].

Assessment and Management

  • In children who have a history of swallowing a radiolucent FB and are asymptomatic with normal examination reassure and discharge with advice to return if significant symptoms appear.
  • In children who have a history of swallowing a radiolucent FB who are symptomatic i.e. drooling, FB sensation, dysphagia refer surgical team.
  • For metallic FB see flow chart below. Good evidence exists for localisation of coins with a metal detector. The evidence for non-coin metal FBs is not as strong so if metal detection were negative we would advise confirmation with a CXR.
  • If FB metal detector positive above diaphragm but not visible on CXR retry with metal detector. Consider aluminium FB (radiolucent).
  • Several case studies have highlighted the danger of swallowing multiple mini magnets (used on notice boards etc).
  • Sharp objects should be treated in the same way as other metal foreign bodies although complication rates increase from less than 1% to 15 to 30%

Management of ingested foreign bodies in the ED - algorithm

Management of ingested foreign bodies in the ED - algorithm

Editorial Information

Last reviewed: 24/02/2017

Next review date: 01/12/2023

Author(s): Steve Foster.

Version: 1

Approved By: Clinical Effectiveness

Document Id: 535

References

1. Litovitz T & Schmitz BF. (1992) Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 89, pp. 747–757. 

2. Lee JB, Ahmad S, & C P Gale CP. (2005). Detection of coins ingested by children using a handheld metal detector: a systematic review. Emerg. Med. J. 22: 839 - 844.

3. Choudhery V & Maurice S. (2000) BEST EVIDENCE TOPIC REPORTS: Signs and symptoms of oesophageal coins. Emerg. Med. J., Mar 2000; 17: 126 – 127.