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May 2025 RDS newsletter now available. Expand this announcement to view.

Welcome to the May 2025 update from the RDS team

1.     RDS deployments

Three small-scale releases took place during April and May, including the following fixes and improvements:

  • Applying moderate severity security patch to Umbraco.
  • Fixes to:
    • Random ordering of tiles on mobile app
    • Simultaneous issuing of multiple copies of content review alerts
    • Content display on mobile app for the left hand menu navigation option
  • Whitelisting of Jotforms outcomes pages so that recommendations for action can be displayed following completion of a form or calculation.

2.     RDS performance

Two short outages took place on the mornings of 12th and 22nd May. Tactuum is still investigating the root cause and will report on this shortly.

3.     Redesign of Gentamicin and Vancomycin calculator interfaces

New designs have been produced which make the health board name and calculator title clear to the user on these calculator pages, with a warning message and link to ensure users access the right calculator for their board. These designs have been implemented in a test environment and are now under review.

4.     RDS Redesign, archiving and version control

We now plan to release at end of July 2025 the following major enhancements:  redesigned Right Decision Service homepage, new search and browse interface, upgraded archiving and version control, and capability to edit content adopted from the Shared Content Library. We will provide slides and demos in advance of the release to introduce users and editors to the new functionality.

5. Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Monday 16 June 12.30-1.30 pm
  • Tuesday 24 June 3.45-4.45 pm

Running usage statistics reports using Google analytics

  • Wednesday 11th June: 2-3pm

 To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

6.New RDS toolkits

The following toolkits were launched during March 2025:

7.New RDS developments

Work is progressing on a number of decision support systems that are part of the wider Right Decision Service platform, beyond the web and mobile apps:

  • The Patient Reported Outcome Measures system. A minimum viable product version will be available for functional testing by key stakeholders at end of July.
  • Pharmacogenomics decision support as an extension of the current high risk prescribing decision support integrated with primary care electronic health record systems. This is part of a European research and innovation project.
  • Planned Date of Discharge decision support system to be tested in NHS Lanarkshire. Will undergo user acceptance testing in July with a view to piloting from November.

8. Implementation projects

Public library services in Inverclyde, East Renfrewshire, Glasgow Life, Angus, Falkirk and Stirling have come forward to work with the RDS team, the Scottish Library and Information Council and local Realistic Medicine leads, to develop their role in engaging citizens in Realistic Medicine. This includes promoting the Being a partner in my care app: Realistic Medicine Together. This provides tools and resources to support conversations about what matters to the person,  shared decision-making and self-management.

 

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.

 

 

 

Tranexamic acid in paediatric surgery and trauma (1178)

Objectives

To standardise the administration of intravenous tranexamic acid within RHC Glasgow

Scope

This guideline applies to all patients within RHC. The authors would like to highlight there is limited evidence applicable to neonates. Tranexamic acid is available as an oral medicine, this guideline does not apply to oral use.

Audience

Healthcare staff within RHC Glasgow

Summary

  • Tranexamic acid (TXA) is a synthetic lysine analogue that inhibits fibrinolysis and reduces bleeding.
  • TXA has been shown to reduce blood loss and transfusion requirements in both cardiac and non-cardiac surgery.
  • There is currently a wide variety of dosage regimes being used in clinical practice with high cumulative doses (>80mg/kg) correlated with increased risks of post operative seizure without evidence of better haemostasis.
  • Doses used should meet the threshold for clinical efficacy whilst avoiding unnecessarily high concentrations. The doses given below will be <80mg/kg even if continued for 24 hours.

Recommendation

Based on current literature, modelling studies and guidance from the RCPCH, separate dosing regimes are recommended for cardiac surgery involving cardiopulmonary bypass (CPB) and all other indications associated with potential significant blood loss.

Tranexamic acid in cardiac surgery with CPB or any extracorporeal circulation

At induction

10mg/kg tranexamic acid over 10 minutes

and commence

2mg/kg/hr infusion

until closure

CPB

10mg/kg tranexamic acid
into prime volume

After protamine

10mg/kg tranexamic acid over 10 minutes

If ECMO/VAD consider

2mg/kg/hr infusion

 


If patient in PICU going onto ECMO/VAD

Tranexamic acid up to 20mg/kg over 10 minutes
then 2mg/kg/hr infusion

 

Intravenous tranexamic acid in non-cardiac surgery  / major trauma / other use

At induction / presentation

15mg/kg tranexamic acid (max 1g) over 10 minutes

and commence

2mg/kg/hr infusion

until closure or reduction of risk of haemorrhage

Editorial Information

Last reviewed: 11/10/2022

Next review date: 31/10/2025

Author(s): Dr Graham Bell Consultant Anaesthetist; Dr Jonathan Coutts, Neonatologist / ECMO Team; Dr Mark Davidson, Paediatric Intensivist.

Version: 2

Reviewer name(s): Lesley McKee; Claire Murnaghan; Stephen Bowhay.

Related guidelines
Related resources

NHSGGC Staffnet Monograph: Tranexamic Acid

Medusa Injectable Medicines Guide (search for tranexamic. Access via Paediatric Intravenous Monographs page on Sharepoint )

BNFC - Tranexamic Acid

 

References

Basta MN, Stricker PA, Taylor JA. A systematic review of the use of antifibrinolytic agents in pediatric surgery and implications for craniofacial use. Pediatr Surg Int, 2012; 28(11): 1059-69

Faraoni D, Willems A, Melot C, De Hert S, Van der Linden P. Efficacy of tranexamic acid in paediatric cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg, 2012; 42(5): 781-6

Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic Acid–Associated Seizures: Causes and Treatment. Ann Neurol., 2016; 79(1): 18-26

The Royal College of Paediatrics and Child Health. Evidence Statement: Major trauma and the use of tranexamic acid in children. November 2012.

Centre for Perioperative Care. Guideline for the Management of Anaemia in the Perioperative Pathway. September 2022.