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
For a copy of this information in:
telephone: 01896 826832
"Information given on this site is not meant to take the place of a talk with your doctor or health worker."
The bowel is a tube of intestine, which runs from the stomach to the back passage. The lower half of the bowel is called the colon. This runs up to the right ribs and loops across the upper part of the belly. Then it passes down the left side to run backwards into the pelvis towards the back passage. This is called the rectum.
In your case, the problem lies in the left side of the colon or upper rectum. The left side of the colon is taken out, and the ends are joined up whenever possible.
Sometimes the ends are joined up at the first operation, but a short term stoma is made as well. This keeps the bowel waste away from the join while it is healing. Usually this is reversed three months after the first operation.
If the problem area is in the lower part of the rectum, the back passage may need to be removed as well. This is rare. You would be warned about this before the operation.
You should plan to be in hospital for a week after the operation.
Simply waiting and seeing is not a good plan. The trouble you are having with your bowel will simply get worse and may lead to very serious problems. Tablets and medicines will not help, neither will X-ray and laser treatment.
You will meet with the stoma nurse, who will see you in a 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.
The day before we would like you to take clear fluids. This means that you should not eat solid foods and only take drinks you can see through - no milk or fruit juices. Clear soup or squash are fine, as are black tea and coffee. Sweet drinks will help to keep up your strength and calorie intake.
if you are not sure about anything, please ask a doctor or nurse for more details.
You will have a drip to give you fluids while you are not allowed to drink. This is a plastic tube attached to either your arm or 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.
Once you are drinking normally the drip will come out and you will be able to eat a light diet.
The wound will have a dressing, which may show some staining with old blood in the first 24 hours. There may be stitches or clips in the skin. Stitches and clips are removed after about 7 to 10 days. The drain tube is removed after about 2-4 days.
You can shower and bath as often as you want.
You will be given an appointment to visit the outpatient department for a check-up about six to eight weeks after you leave hospital.
The nurses will advise about things like sick notes and certificates.
Recovery from keyhole surgery is much quicker than with open surgery but caution should be paid to heavy lifting and driving.
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 to rest two or three times a day for a month or more. You will gradually improve so that by the time three months have passed 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 two or three weeks when the wound is comfortable enough. There may be some damamge to the sex nerves after the operation. The surgeon will talk to you about this.
You should be able to return to a light job within eight weeks and any heavy job within twelve weeks.
Recovery after keyhole is much quicker than the open method but caution should be paid when heavy lifting and driving.
As with any operation under general anaesthetic, there is a very small risk of complications related 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.
Complications are unusual but are quickly recognised and dealt with by the surgical staff. If you think that all is not well, let the doctors or the nurses know.
You may get a chest infection, particularly if you smoke.
To prevent chest infections it is important to:
The bowel can be slow to start working again.
There can be some discharge from the drain by the wound, but this stops given time.
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 your bowel, your bladder or a blood vessel can be damaged.
Another operation may be needed to deal with this.
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.
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.
To start with your bowel actions are likely to be very loose, unpredictable and quite urgent. It can take several months for this to settle and for you to develop a predictable pattern. Your bowel function is unlikely to be exactly the same as before your operation.
The expectation of what is "normal" for you might need to be adjusted. If loose bowels become a persistent problem, discuss this with your doctor. There are medicines that can help to firm the stool up.
Some people have sexual difficulties after major abdominal surgery. It is normal to feel wary and anxious at first. If difficulties last, please discuss this with your doctor, as help may be available.
Patient information leaflets