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
Sick children should not be presented to PRI ED and instead should be directed to Ninewells. This guideline discusses the steps to take in case that a child arrives at PRI ED regardless. There should be no 999 presentations of unwell children to PRI (including Paediatric Cardiac Arrest) due to agreed ambulance bypass arrangements. All these cases should go to Ninewells ED. Unfortunately, there may be situations where there is an injured or unwell child presented to the PRI site.
Early identification and rapid blue light transfer to Ninewells ED is the optimum pathway.
Early discussion with ED Consultant on #6699 is advised after identification of the unwell child.
If the child requires immediate or urgent intubation and ventilation, it may be appropriate to perform this in PRI prior to transfer.
This should be co-ordinated by the ED Consultant (#6699) who can liaise with:
The decision regarding ongoing transfer (Ninewells or SCOTSTAR to Edinburgh/Glasgow) will need to be made on a case by case basis, depending on diagnosis and availability/timing of the SCOTSTAR team.
Early contact with SCOTSTAR is advised tel. 03333 990 222
It may take time to mobilise paediatrics and additional anaesthetic clinicians due to where they are based. In these rare circumstances specialty consultants may choose to mobilise a different member of their team due to locality.
Do not delay transfer to Ninewells for paediatric support if the child is stable enough to be moved. Consideration should be given to using NHS attend 'Near me consult now' function to enable clinical advice to bedside from remote team.
Safe Location:
If Scotstar arrival is not imminent, please consider where the patient may be best cared for safely awaiting the transfer. Options include ED resus or medical HDU
Safe Equipment.
Safe Drugs & Fluid Calculations
Special Considerations
Useful Contacts and links
NHS Tayside ED Guidance