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
Borders General Hospital
Huntlyburn Terrace
Melrose
TD6 9BS
"Information given on this site is not meant to take the place of a talk with your doctor or health worker."
Some of the lowest part of your bowel, the rectum, is diseased and has to be taken out. Because the disease is so near to the opening in the back passage, this has to be taken out as well. If the back passage were left in place, you would be unable to control your bowel motions. You might also get complications from the disease.
A new opening for the bowel is made in the wall of your tummy. This is called a colostomy. The waste runs into a special stick-on plastic bag.
Doing nothing will lead to bleeding, discharge, pain and possibly a complete blockage of the bowel. Taking out the diseased bowel, but leaving the back passage in place in your case is risky. You would end up with little control of the bowels and a risk of the disease causing further problems.
X-ray treatment and drug treatment on their own are not very good. They may be useful if added to the operation. The surgeon can talk to you about this.
if you know that you have problems with your blood pressure, your heart, or your lungs, ask your family
doctor to check these
if you are taking any of the following, check the hospital's advice about taking them:
arrange for a relative or friend to:
You will meet with the stoma nurse, who will arrange to see you in clinic. She will talk to you about your operation and stoma. We usually recommend that five days before your operation you eat a light diet that is low in fibre. For example fish, chicken, rice and mashed potato. Try to avoid vegetables, fruit, cereals and wholemeal bread. You can drink as much as you like.
You will have a drip to give you fluids while you are not allowed to drink. This is a plastic tube attached to your neck. The doctors listen to your bowel through your tummy with a stethoscope. When they can hear sounds from your bowel or you have passed wind they start to give you oral fluids. This can take a few days. This is gradually increased until you are able to drink as much as you want.
The nurses will tell you about things like sick notes and certificates. The stoma nurse will keep in contact with you at home
The anaesthetic drugs will make you sleepy, slow, clumsy and forgetful for about 24 hours. Do not make important decisions during this time.
You are likely to feel very tired and need rests two or three times a day for a month or more. You will gradually improve so that after three months you will be able to return to your usual level of activity. At first discomfort in the wound will stop you from harming yourself by lifting heavy things. After three months you can lift as much as you used to lift before your operation.
You can drive as soon as you can make an emergency stop without discomfort in the wound. This should be after about six to eight weeks.
You can restart sexual relations within three to four weeks when the wound is comfortable enough. There may be some damage to the sex nerves after this operation. Some studies suggest that it happens in up to 50% of cases. The surgeon will talk to you about this.
You should be able to go back to a light job within eight weeks. Some heavy jobs may not be suitable because of the colostomy.
After keyhole surgery the recovery time is much quicker than with the open operation. But caution still should be paid to heavy lifting and driving.
Possible complications
As with any operation under general anaesthetic, there is a very small risk of complications to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way. This brings the risk for such complications very close to zero.
This is a major operation and complications can happen more often compared with other operations of the bowel. When they do happen, they are quickly recognised and dealt with by surgical staff. If you think that all is not well, please let the doctors or nurses know.
You may get a chest infection, particularly if you smoke. To prevent chest infections it is important to:
Wound infection happens more often in any bowel operation compared to other 'clean' operations such as taking out your gallbladder. The reason is that the bowel has many bugs that can cause an infection. This settles down with antibiotics in a week of two.
Very rarely, during the operation, another part of the bowel, bladder or a blood vessel can be damaged. Another operation may be needed to deal with this.
Complications of the stoma are:
You may also have:
Some patients are surprised how slowly they get back their normal stamina. Nearly all patients are back to normal within three months.
Your social life should not be affected by the operation.
The stoma nurses will keep in touch with you when you are home
We hope these notes will help you through your operation. They are a general guide, and do not cover everything.
If you have any questions or problems, please ask the doctors or nurses.
Patient information leaflets