Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
The following toolkits are now live;
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the 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.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
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
Loose body
A loose body may be present following trauma or direct blow to the elbow. There may be a history of pain, swelling, heat, +/- loss of ROM. The patient may report a catching, locking or clicking sensation with intermittent pain and swelling.
This condition is common in people who undertake sports or occupations that involved repeated over head activity or heavy lifting (forced elbow extension) (Quinn et al, 1994).
Range of Movement
AP and lateral X-ray of the elbow. In case of normal XR with persistent symptoms, MRI can be considered (see escalation).
Treatment should take into account individual patient needs, preferences, expectations and functional status. Clinical reasoning should inform treatment based on subjective and objective findings. Good communication between therapist and patient is essential if a successful outcome is to be achieved.
Treatment options should be clearly explained so that patients can make informed decisions with regard to their care and management.
‘Cyriax loose body technique’ with Grade A mobilisation.
https://www.youtube.com/watch?v=eXYc5qPFWgc
Non-evidence based strategies
CSI is not indicated (Quinn et al, 1994).
Progressing as expected (up to 3 Rxs) before discharge or onward referral.
Refer to ortho, GP, other
Referral to orthopaedics can be considered for orthopaedic opinion if the patient is not progressing and would consider orthopaedic intervention.
Kesson, M. and Atkins E. 1998. Orthopeadic Medicine: A practical approach. Butterworth-Heinemann.
Quinn, S.F., Haberman, J.J., Fitzgerald, S.W., Traughber, P.D., Belkin, R.I. and Murray, W.T. 1994. Evaluation of loose bodies in the elbow with MR imaging. Journal of magnetic resonance imaging, 4(2), pp. 169-172. Link Here (link correct as of 16/08/19).
GGC - MSK Index