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
Effective assessment is key to successful treatment.
If there is a suspicion of alcohol misuse prior to admission a formal assessment of the patient’s alcohol use must be undertaken (The FAST tool can aid assessment).
Severity of Alcohol Dependence Questionnaire (SAD-Q) should be completed.
The completed SAD-Q will be filed in the patient’s care record and the score obtained will be entered on to the fixed dose Chlordiazepoxide regime.
NICE guidelines recommend the use of fixed or symptom triggered dosing regimens with either chlordiazepoxide or diazepam to manage alcohol withdrawal.
In GG&C mental health services, diazepam is the drug of choice using a fixed dose regime. For patients with known liver impairment, oxazepam is the benzodiazepine of choice. (see chart on page 3-5).
The starting dose chosen will depend on the SAD-Q obtained and the clinical judgement of the prescribing doctor.
Appropriate vitamin supplementation is essential to mitigate the risk of developing Wernicke’s encephalopathy or Korsakoff’s syndrome.
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Wernicke’s Encephalopathy is an acute illness, which may be precipitated by alcohol withdrawal and is often under treated or missed.
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Intramuscular Pabrinex (1 pair once daily for first 5 days) and oral thiamine should be given to all patients undergoing treatment for alcohol withdrawal.
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Pabrinex is contraindicated if the patient is known to have an allergy to any of the components of the product or a previous reaction is noted.
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Thiamine should be prescribed as 50mg four times a day, due to absorption saturation giving large doses less often will result in poorer absorption.
Thiamine should be continued indefinitely for those with a history of significant alcohol abuse and in individuals who continue to engage in problem drinking (chronic alcohol reduces thiamine absorption and these individuals are particularly at risk of developing alcohol-related brain damage).
To help with long term adherence to thiamine:
The patient’s blood pressure, pulse and temperature should be monitored at 4 hourly intervals throughout treatment with close observation for over sedation.
The patient should be medically reviewed as necessary during the course of treatment.
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