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
Treating Your Infection Respiratory Tract Infection (TYI-RTI) patient information leaflet
In patients experiencing self-limiting RTIs consider using this UKHSA leaflet to support good antimicrobial prescribing practice.
Self-limiting illness lasting around 3 weeks.
Consider delayed antibiotic prescribing, which is unlikely to be associated with an increase in symptom or illness duration, except in young children (<5 years old)
Antibiotics of little benefit in absence of co-morbidity
If antibiotics are required, choices as per Primary Care (Lower Respiratory Tract - Community-acquired pneumonia (CAP)) section.
Duration: 5 days
Refer to: NICE: Acute Cough
Refer to: NICE: Acute Bronchitis
Do not prescribe antibiotics routinely unless signs and symptoms suggest bacterial infection. If required, antibiotic choices are as per community-acquired pneumonia.
Refer to: NICE/CKS: Acute Exacerbation of Asthma
Many exacerbations are not caused by bacterial infections.
Consider the need for antibiotics by taking into account the signs/symptoms that suggest potential bacterial infection (e.g. increased sputum volume/thickness beyond normal day-to-day variation, changes in sputum colour) and the risk of complications.
Do not send sputum samples for culture routinely. Consider sending if there is no improvement in symptoms on first choice taken for at least 2-3 days.
Amoxicillin dose
Penicillin Allergy/Second Line: Doxycycline dose or Clarithromycin dose
If already on prophylactic antibiotics, treat with an agent from a different class.Duration: 5 days
Refer to: Hospital: Paediatrics (Respiratory Tract - Lower, Community-acquired pneumonia)
Use CRB-65 in conjunction with clinical judgement to assess pneumonia severity and whether to treat at home or refer to hospital.
Amoxicillin dose
Penicillin Allergy: Doxycycline dose (Pregnant: Clarithromycin dose)
Duration: 5 days
Refer to: NICE/CKS Community Acquired Pneumonia
Antibiotics not routinely required
Send sputum samples prior to starting antibiotics. Clinical details should indicate patient is being treated for an "infective exacerbation of bronchiectasis".
If a pathogen is isolated in sputum culture, antibiotics only require switching if there is no clinical improvement. Antibiotic selection should be guided by sensitivity results.
Amoxicillin dose
Penicillin Allergy/Second Line: Doxycycline dose or Clarithromycin dose
If already on prophylactic antibiotics, treat with an agent from a different class.
Previous sputum bacteriology results can be useful in deciding which antibiotic to use.
Duration: 7-14 days (use a shorter course for mild exacerbations)
Refer to: BTS Guideline for Bronchiectasis in Adults
Refer to: NICE/CKS Infective exacerbation of bronchiectasis
NHS Dumfries & Galloway Antimicrobial Handbook