Case Summary | 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

Patient Details

58 year old woman

Current medical history

Diabetes Type 2 (diagnosed 5 years ago)
Coronary Heart Disease (non-STEMI 1 year ago)
Hypertension
Atrial Fibrillation
COPD
Chronic Back Pain
Depression (2 episodes)
Hypothyroidism

Results

HbA_1C 86 mmol/mol (10%)
BP 150/85 mmHg
BMI 35 kg/m²
Spirometry shows mild obstruction
No urinary protein detected
eGFR 55 ml/min

Lifestyle

Smoking: 10 – 15 cigarettes a day
Alcohol: 20 units/week

Current Medication

Aspirin 75 mg once daily
Metformin 1 g three times daily
Gliclazide 80 mg twice daily
Pioglitazone 30 mg once daily
Salbutamol inhaler as required
Becotide inhaler 100 twice daily
Levothyroxine liquid once daily
- 50 micrograms/5 ml
- 25 micrograms/5 ml
Citalopram 20 mg once daily
Lisinopril 30 mg once daily
Amlodipine 10 mg once daily
Atenolol 50 mg once daily
Furosemide 40 mg once daily
Gabapentin 400 mg three times daily
Co-codamol 8/500 mg 2 tablets up to four times daily
Diclofenac 50 mg up to three times daily
Omeprazole 40 mg once daily
Bendroflumethiazide 2.5 mg once daily

Current Function

Receptionist in local garage. Works 6 half days per week. Provides support for elderly mother who lives alone and has early dementia. Lives with husband who is out of work long term. Two previous acute admissions to hospital. Flu-like illness leading to exacerbation of COPD two years ago. Chest pain 12 months ago - found to be in atrial fibrillation on admission and troponin positive. Angiogram showed widespread coronary artery disease but not severe enough to warrant revascularisation. Echocardiography showed normal left ventricular systolic function. On dual aspirin and clopidogrel for 1 year. Recently moved to aspirin monotherapy.

Most Recent Consultations

Ongoing ankle swelling. Back pain difficult to manage and resistant to several strategies. Occasional palpitations, and persistent indigestion with heartburn. Long-term financial worries. Increasing carer strain. Concerns dominated by the heart attack last year and fear of recurrence, “I don’t know what my mother and husband would do if I got too ill to work or look after her.”