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
(Amitriptyline, Nortriptyline or Imipramine)
Chronic Pain Service
Borders General Hospital
Melrose TD6 9BS
Telephone: 01896 826323
For a copy of this information in:
contact us on tel: 01896 826335
"Information given on this site is not meant to take the place of a talk with your doctor or health worker."
The Consultant in Pain Management has recommended a trial of amitriptyline, nortriptyline or imipramine for pain relief and, or sleep difficulties. These are from the family of medicines called tricyclics antidepressants.
This leaflet has:
We also advise you to read the patient information leaflet included with your medicine.
Tricyclics are used to treat neuropathic pain. This type of pain is often not relieved by conventional painkillers.
Yes, they are. However, research has shown that they are also effective in helping pain. The doses used for improving pain and sleep patterns are smaller than those used for depression.
Remember, the aim of treatment is to:
These drugs are usually started at a low dose and then increased slowly to find the best dose. Your GP or pain clinic doctor will advise you of this.
If you are having side effects do not continue to increase the dose. Continue at the dose you were able to tolerate for one week, then try to increase it again.
It may take two to four weeks before you feel pain relief.
You should take this medicine as a single dose in the evening. They should be taken regularly every evening.
They will not work as well if only taken now and then.
If you feel drowsy first thing in the morning you should take the tablets earlier in the evening- at least 12 hours before you need to wake up.
All drugs have side effects, but not everyone will get them. They will usually appear soon after starting taking the medicine. However, they should become less troublesome by the end of the first week.
The most common side effects are:
Other common side effects are:
These effects are often mild and may go away during treatment. If they are severe or last for more than a few days, you should get advice from your GP, especially if you have either blurred vision or difficulty passing urine.
Rare side effects:
Tell your GP straight away if you have:
Will it help?
Precautions
Be very careful if driving or operating machinery. Avoid doing so if you feel drowsy at all.
If you forget to take a dose take it as soon as you remember, unless it is time to take the next dose. Do not take two doses at the same time
If you take too many tablets please contact your GP or go to accident and emergency
Stopping medicines. Do not suddenly stop taking your medicine. The dose should be lowered gradually.
Call your doctor or pain clinic nurse specialist for advice.
Follow up
You may not need to attend the hospital for a review. The pain clinic nurse specialist can ring you at home to assess your response.
Can I drink alcohol whilst taking Tricyclics?
If the Tricyclics makes you feel tired or give you other side effects, drinking alcohol may increase these. Because of this, we advise you not to drink alcohol if these side effects are troublesome.
Is it safe for me to drive whilst I’m taking Tricyclics?
Tricyclics may cause drowsiness. If you feel affected by this, we advise you not to drive until the effects have worn off.
Is it safe for me to take other medicines whilst taking a Tricyclic?
Before you take or buy any new medicines – including herbal remedies – tell your doctor or Pharmacist that you are taking a Tricyclic and ask their advice.
What should I do if I forget to take a dose?
You should take it as soon as you remember. However, if it is almost time for your next usual dose, wait until then to take your medicine and skip the missed dose. Do not try to double up to make up for your missed dose.
The information in this leaflet is not intended to replace your doctor’s advice. If you need more information or have any questions, please speak to your doctor or pain clinic.
tel: 01896 826335 Telephone: 01896 826323
Patient information leaflets