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
1. Ensure any equipment required is prepared and ready for use where appropriate. This includes the following:
• HEPMA system
• Ward Controlled Drug Record Book(s)
• Controlled Drug cupboard keys
• Medicine Cups or appropriate receptacles
• Water
• Purple apron and/or signage as per NHSGGC Medicines Administration 1133-24 section 5.1
• Current online BNF
2. Please ensure the designated area for preparation is a clear and uncluttered surface.
Read the appropriate patients HEPMA record carefully
1. Two Registered Nurses must check stock of Controlled Drugs against both the HEPMA record and Controlled Drug Record Book to confirm availability prior to the first patient entering the room.
2. Identify roles for both practitioners as i.e. witness and administrator. The roles should not be swapped throughout the process of administration.
3. Ensure patients prescription is complete, identifying the following:
• Start date
• Medicine form i.e. elixir, tablet, caps
• Dose
• Route
• Time due
• Prescriber
• Allergies
1. Both practitioners check Ward Controlled Drug Record Book to reconcile stock balance of prescribed medicine against amount in the controlled drug cupboard prior to patient entering the room.
2. HCSW (or appropriate other i.e. student nurse or registered nurse) to escort patient to the treatment room as delegated by the registered nurses.
3. Ensure the environment where administration is to take place is clean, tidy and free from interruptions.
4. Confirm the identity of patient following process described in the Policy & Procedures for the Safe Identification of Patients
5. Confirm the patient’s allergy status
6. Both practitioners must accurately confirm the Controlled Drug(s) to be administered to patient from the HEPMA system.
7. Unlock and open drug cupboard and controlled drug cupboard door.
8. Both practitioners check the prescription medicine label i.e. medicine name, form, dose and expiry date.
9. Dispense medicine into appropriate receptacle.
10. Ensure both the witness and the administrator witness the patient ingesting the prescribed medicine.
11. Offer water as required.
12. Ensure Ward Controlled Drug Record Book is updated and signed immediately according to who administered and who witnessed the administration.
13. The administrating practitioner then makes a HEPMA system entry to confirm administration of prescribed medicine.
14. If prescribed medicine refused or not given for any reason this must be documented on recording sheet and the responsible doctor informed, if necessary.
15. Ensure area is left clean and tidy.
1. Both practitioners check Ward Controlled Drug Record Book to reconcile stock balance of prescribed medicine against amount in the Controlled Drug cupboard.
2. Check patient is available within the ward area.
3. Within the treatment room Both practitioners must accurately confirm the Controlled Drug(s) to be administered to patient from the HEPMA record.
4. Unlock and open drug cupboard and controlled drug cupboard door.
5. Check the prescription medicine label i.e. medicine name, form, dose and expiry date.
6. Dispense medicine into appropriate receptacle.
7. Both practitioners should then take the medicine, HEPMA laptop and the Ward Controlled Drug Record Book to the area where the patient is.
8. Confirm the identity of patient following process described in the Policy & Procedures for the Safe Identification of Patients
9. Confirm the patient’s allergy status.
10. Ensure both the witness and the administrator witness the patient ingesting the prescribed medicine.
11. Offer water as required.
12. Ensure Ward Controlled Drug Record is updated and signed immediately according to who administered and who witnessed the administration.
13. The administering practitioner then makes an appropriate HEPMA entry to confirm administration of prescribed medicine.
14. If prescribed medicine refused or not given for any reason this must be documented on recording sheet and the responsible doctor informed, if necessary.
15. Ensure area is left clean and tidy.
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