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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

 

 

N-Acetylcysteine (NAC) for the prevention of aminoglycoside associated ototoxicity in children with cystic fibrosis (1007)

Aminoglycoside antibiotics are used in the management of infection in children with Cystic Fibrosis.  Associated adverse effects include renal and ototoxicity, the risks of which are increased with prolonged or repeated exposure.  A number of strategies are embedded in to practice at RHC to minimise the risk, including regular audiological screening, routine monitoring of renal function and therapeutic drug levels. More recently a screening programme for m.1555G>A change has also been introduced to identify patients at increased risk of developing aminoglycoside induced ototoxicity.  Various CF treatment centres around the UK also now include the use of N-acetylcysteine (NAC) in the routine management of patients’ receiving aminoglycosides due to the oto-protective action. 

N-acetylcysteine belongs to the thiol group of medications. It serves as a precursor of intracellular free cysteine, used by the cells to synthesise glutathione peroxidase (GSH-Px). Although the exact mechanism of action is unknown, it is thought that the increase in GSH-Px aids in the removal of free radicals, reducing resultant oxidative stress associated with aminoglycoside ototoxicity.

Use of N-Acetylcysteine in RHC

The use of N-acetylcysteine should be encouraged in all CF patients receiving intravenous (IV) aminoglycosides at RHC.  NAC should be administered with each course of treatment for the duration of the IV aminoglycoside course. 

Dosing and administration for patients on IV aminoglycoside therapy:

Age

Dose

Frequency

Duration

Formulation

Comments

< 12 years

300mg

Twice daily

 

Administer for the duration of the IV aminoglycoside course

1st line:

Effervescent tablets, 600mg

Tablets can be dispersed in water, orange or blackcurrant cordial.

Alternatively they can be split and swallowed without dispersion.

12 years and over

600mg

2nd line:

Injection 200mg/ml

Injection can be given orally.  Mix with water, orange or blackcurrant cordial to a concentration of 50mg/ml.

NAC for patients on nebulised aminoglycoside therapy

Routine administration of N-acetylcysteine during courses of nebulised aminoglycoside therapy is NOT recommended.

Serum concentrations following nebulised therapy are generally negligible and this route of administration is not associated with risk of ototoxicity.  There may be some clinical situations where NAC is offered to patients during prolonged courses of nebulised aminoglycoside therapy.  The following clinical scenarios require consideration:

  • Prolonged nebulised aminoglycoside therapy where the patient has reported signs of cochlear or vestibular toxicity
  • Patients requiring nebulised aminoglycoside therapy, where a degree of ototoxicity has been identified through audiology screening
  • Patients requiring prolonged nebulised aminoglycoside therapy where an m.1555G>A mutation has been identified

The decision to offer NAC to patients on nebulised aminoglycoside should be discussed and agreed by the CF MDT.

Dosing and administration guidance for patients requiring NAC during nebulised aminoglycoside therapy is the same as that for IV therapy.

Editorial Information

Last reviewed: 22/01/2025

Next review date: 31/01/2028

Author(s): Shahad Abbas, Advanced Pharmacist Paediatric Antimicrobials and Medicine.

Version: 2

Approved By: RHC Cystic Fibrosis Department

Document Id: 1007