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.
Welcome to the February 2025 update from the RDS team
A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:
The release will also incorporate a number of small fixes, including:
We will let you know when the date and time for the new release are confirmed.
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.
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.
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 .
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.
Some important toolkits in development by the RDS team include:
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.
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
06/01/2025 Addition of Maxijul (all concentrations) to the list of types of fluid to be treated as clear liquids.
This guideline aims to:
The risk of pulmonary aspiration must be balanced with the risk of discomfort, hunger, thirst, dehydration and hypoglycaemia. These guidelines are written in the context of recent national and international publications and recommendations (1).
This guideline is for all patients prior to surgery / general anaesthesia.
Patient exclusions from this protocol include children who require longer for gastric emptying to occur. Such patients may include:
If you have any doubts about the fasting times for a patient, please contact their anaesthetist. The anaesthetist can be identified from the weekly rota or by phoning theatre reception on 84344/84345.
*Fasting guidance for patients undergoing emergency surgery should be decided by the anaesthetist on-call for Theatre 6. Their suitability for this guidance will depend upon their surgical and clinical condition. The on-call anaesthetist can be contacted on:
This guideline is for use by all health professionals in the Royal Hospital for Children, Glasgow who are involved in preparing patients for surgery. Administrative staff involved with communicating with patients and carers prior to procedures should also be familiar with this guideline.
Patients undergo fasting to minimise the risk of aspiration of gastric contents under anaesthesia. Over-fasting, especially in neonates and young infants, can lead to hypoglycaemia, thirst, hunger, irritability and dehydration. This can reduce patient comfort and make building rapport or securing venous access more difficult. Patients and parents should actively be encouraged to maintain hydration up until the requested fasting time for clear fluids to minimise these side effects. Ensuring a child is adequately hydrated prior to a procedure is as important as correct fasting.Hydration with a glucose-containing juice should be strongly encouraged. Water should only be used if glucose-containing juice is refused.
These guidelines balance the risk of aspiration with the risk of over-fasting. Children should be fasted for the minimum time possible. Although traditional guidance recommended 6 hours for solids, 4 hours for breast milk and 2 hours for clear fluids, recent evidence has shown that drinking clear fluids until 1 hour before surgery does not increase the risk of aspiration (2). Breast milk fasting times have been reduced to 3hours, and all other milk can be consumed up until 4 hours pre-operatively. Gastric content reduces exponentially after clear fluids with the median half-time less than 30min (3, 4). When glucose is included in the clear fluid, then gastric emptying is significantly quicker (2).
Clear fluids include water, diluting squash, ready diluted juice (e.g. Fruit Shoot®, Ribena®). Selected ice lollies are also allowed (not milk- or chocolate-based).
Clear fluids do not include milk, formula milk, pure fruit juice and fizzy drinks.
On admission to the Day Surgery Unit or ward, patients should be offered a clear drink or ice lolly of their choosing. An equivalent volume of ‘Slushie’ ice is also be permitted.
*’Sip until send’ means that sips of juice can continue up until the point that they are sent for. This is the default position of our hospital unless specific instructions are given otherwise by the anaesthetist. ‘Sip until send’ volumes should be explicitly limited to less than 5ml/kg.
*’Sip until send’ means that sips of juice can continue up until the point that they are sent for. This is the default position of our hospital unless specific instructions are given otherwise by the anaesthetist. ‘Sip until send’ volumes should be explicitly limited to less than 5ml/kg.
Patients under the age of 18 months can be offered a few drops of 24% sucrose orally or onto a dummy to assist with pacification if required. The Oral Sucrose guidelines can be accessed here.
Chewing gum is regarded as requiring a 6 hour fasting time.
These are considered to be a food.
Families and staff should be given accurate and consistent information relating to fasting. Written guidance should be given to patients and parents when they attend pre-assessment clinic, and/or when their booking letter is sent out. The importance of providing food up until the fasting time (where practical) and clear fluids containing sugar until sending must be clearly explained to parents & guardians.
Trauma and acute illness can delay gastric emptying, and so fasting guidance for patients on the emergency list will be defined by the on call emergency anaesthetist. The running of the emergency list often changes throughout the day and the theatre staff must be mindful of avoiding unnecessary over-fasting of these patients “just in case” a slot becomes available. Patients with minor trauma (e.g. lip laceration, finger laceration) who will not be attending theatre imminently should be encouraged to drink clear fluids. If uncertain, contact the on-call team in theatre 6.
