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
Sanofi the manufacturer of Modecate injection (Fluphenazine decanoate) ceased production of the preparation in 2018 and all licensed stock will cease to be available by August 2020. An unlicensed version can be imported from Germany to enable treatment to be maintained for those legacy patients unable to switch to a licensed alternative long acting injection.
Fluphenazine decanoate was licensed for the treatment and maintenance of patients with schizophrenia and paranoid psychoses5.
Informed consent
Due to its unlicensed status, explanation for the rationale of treatment choice should be given at a suitable time during the patient’s treatment. Patient information explaining unlicensed medication in general terms is available via the Choice and Medication, as is a specific fluphenazine decanoate leaflet.
Documentation
The consultant psychiatrist must make a clear record of the rationale for prescribing an unlicensed medication within the patient’s case notes and document the discussion with the patient1. Nursing staff in the ward must be informed of the medicine’s unlicensed status and ward clinical pharmacists must ensure that staff are aware of the unlicensed status.
When ordering fluphenazine decanoate injection, the patient’s initials and CHI should be included on the requisition as well as the phrase “as per protocol” for the order to be processed.
A record of administration of unlicensed medication must be kept (as per unlicensed medication policy3). When entering administration on HEPMA, the drug batch number and expiry date should be recorded when prompted. It is the responsibility of the nurse in charge to ensure this occurs.
When supplying fluphenazine decanoate injection from pharmacy, pharmacy staff must ensure that batch numbers are documented on the requisition.
Patients must be reviewed and monitored in accordance with NHS GG&C Policy, MHS 30 Good Practice Statement for the use of Depot and Long Acting Antipsychotic Injections4.
Adults: a test dose of 12.5mg should be administered by deep intramuscular injection into the gluteal region.
Elderly: elderly patients may be particularly susceptible to extra-pyramidal reactions. Consequently a reduced initial dose (6.25mg) and a lower maintenance dose may be required.
The onset of action generally appears between 24 and 72 hours after injection and the effects of the drug on psychotic symptoms become significant within 48 to 96 hours.
Subsequent injections and the dosage interval are determined in accordance with the patient’s response. When administered as maintenance therapy, a single injection may be effective in controlling schizophrenic symptoms for up to four weeks or longer.
It is desirable to be as flexible in the dose as possible to achieve the best therapeutic response with the least side effects. Most patients are successfully maintained within the dose range 12.5 – 100mg given at an interval of 2 to 5 weeks.
Patients suffering a relapse following cessation of fluphenazine decanoate may be restarted on their previous dose although the frequency of injections may need to be increased in the early weeks of treatment until satisfactory control is obtained.
Very common (>1 in 10) 2,5
Common (> 1 in 100)
Rare (> 1 in 1000)
Contraindications5
Cautions5
Interactions5
MyPsych App