Buccal midazolam information leaflet | Right Decisions

Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

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 26^th 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.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

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.

Guide to six stages of RDS toolkit development

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.

Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm

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

NHS Borders

"Information given on this site is not meant to take the place of a talk with your doctor or health worker."

What is buccal midazolam?

Midazolam is a medicine that can be used to help a person feel more relaxed. Buccal refers to the way the medicine is given and this involves placing small amounts of midazolam liquid between the gums and cheek where it also dissolves and is absorbed into the bloodstream.

When is midazolam used?

Unfortunately some illnesses may mean that someone may have a sudden distressing event which can lead to them becoming unresponsive or even die. In a situation like this midazolam is used to help the person experiencing a sudden, distressing event feel more relaxed and less distressed by what is happening.

If the above situation occurs, please give midazolam following the steps below:

Draw up the medication into a syringe – see dose to administer above
Place the syringe between their bottom teeth and cheek inside their mouth
Push the syringe to release the liquid over 2-3 seconds in the space between their teeth and cheek.
If you cannot open their mouth, the midazolam can be given into their nose using an adapter that can be attached on the end of the syringe

It can feel and be a frightening experience seeing a sudden change in a person’s condition

Please remember the medicine will not be the reason why the person is becoming less well, the reason will be because of their illness.

You can help the person by being there and keeping calm by talking to them.

You can contact 999 if you feel you need help urgently. Please make sure the Ambulance team are made aware of the person’s illness and what is important with their care. There may be documents such as a ReSPECT form or other anticipatory care planning document, or a DNACPR that would be helpful for the Ambulance team to be aware of regarding the person’s care.

Other things that could help and why (examples could be dark towels or positioning of the body):

Name:

Midazolam has been prescribed because:

Midazolam does to administer:

Next review date: 31/12/2026

Author(s): Hogg R.

Author email(s): rachel.hogg3@borders.scot.nhs.uk.

Approved By: Clinical Governance & Quality

Reviewer name(s): Hogg R.