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Announcements and latest updates

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

  1. 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 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.

 

  1. New toolkits

The following toolkits are now live;

  1. 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.

 

  1. 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.

 

  1. 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

Dry/coated mouth care

 

  • Oral care should be offered at least four times daily or as tolerated. Some patients may need more frequent care.
  • Where possible, identify and manage the underlying cause, for example review medication, manage anxiety, treat intraoral infection, humidify oxygen and if appropriate encourage hydration.
  • Gently remove coatings, debris and plaque from soft tissues, lips and mucosa.
  • Failing to remove dried secretions, debris and plaque gently can cause pain, ulceration, bleeding and predispose to infection.
  • Use damp non-fraying gauze (which has been thoroughly wetted in clean, running water) wrapped round a gloved finger to gently soak coated areas, provided it is safe to do so.
  • Damp gauze (as above) or a moistened soft toothbrush can then be used to gently remove coatings and debris. The gauze should be changed when required and several pieces of gauze used to clean the mouth.
  • If sponge sticks are used, they should only be used to moisten the mouth or clean the soft tissues not to remove plaque from tooth surfaces. Always check to ensure the sponge head is secure prior to use. Sponge sticks should be discarded after single use and must never be left to soak as this increases the risk of detachment and subsequent choking.
  • If the patient is likely to bite down on the sponge stick, use a small headed toothbrush with soft bristles or a product with a fixed cleaning head such as “MoutheZe”.
  • Encourage hydration. Cold, unsweetened drinks (such as sips of water) should be taken frequently throughout the day if possible. Sucking crushed ice or frozen tonic water may provide relief.
  • Saline mouthwashes may help to clean the mouth. Patients in hospital may use 0.9% sodium chloride from a vial to be followed by rinsing with cold or warm water. For patients at home, 1 teaspoon of salt may be added to a pint of cold or warm water. A fresh supply should be made daily.
  • Saline nebulisers may help with thick or crusty secretions.
  • Saliva stimulation (for example sugar-free chewing gum, sugar-free boiled sweets, pastilles, mints) should be considered if the patient is able to comply.
  • Saliva substitutes (for example oral gel, spray or mouth rinse) may be used if other measures are insufficient. Refer to local formulary and Chapter 12 of the British National Formulary (BNF).
  • There is no strong evidence that topical therapy is effective for relieving xerostomia but many patients find them useful.
  • The ideal product should be acceptable to the patient, be of neutral pH and contain electrolytes (including fluoride) to correspond approximately to the composition of saliva.
  • Some preparations for dry mouth are derived from animal products and may be unsuitable for vegetarians and people from certain religious groups. AS Saliva Orthana products contain mucin of porcine origin.
  • Some preparations with an acidic pH (for example Glandosane®) should be avoided in dentate patients as long term use of an acidic product may demineralise tooth enamel.
  • If a preparation without fluoride is used, a fluoride mouthwash should also be used daily in dentate patients.
  • Fluoride mouthwash (0.05%) can be used at a different time from brushing.
  • Topical artificial saliva and saliva stimulant products should be used as frequently as needed, including before and during meals.
  • Enough artificial saliva should be used to cover the whole mouth. Applying the artificial saliva under the tongue can help to spread the artificial saliva around the whole mouth.
  • Attention should also be paid to the lips. Applying a water-based product will help to prevent or treat cracked lips.
  • A dry mouth can contribute to tooth decay. Where appropriate, patients should be encouraged to attend their dentist regularly for assessment and necessary treatment.