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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

Management of oral infections

Fungal infections

The most common types are candidiasis, denture stomatitis and angular cheilitis (soreness, redness and fissures at corners of mouth). Risk factors include wearing dentures, concomitant antibiotic or steroid use and xerostomia.

  • Maintain oral hygiene.
  • Systemic treatments are likely to be more effective than topical treatments. In many cases, a systemic antifungal such as fluconazole (capsules or suspension) 50mg daily for 7 days will be indicated with review and extension as necessary. Higher doses may be necessary in immunocompromised patients. Doses may need to be reduced in renal impairment. Topical miconazole oral gel 2% may also be used. Apply 2.5ml topically four times daily, retained near lesions before swallowing. Continue use for at least a week after lesions have healed. Topical miconazole should be considered for treating angular cheilitis.
  • In patients where this treatment is contra-indicated, or for mild oral candidiasis in non‑immunocompromised patients, nystatin oral suspension 100,000 units/ml can be considered. Prescribe 1ml four times daily after food, usually for 7 days. Rinse around mouth and hold in contact with affected areas as long as possible. Continue use for 48 hours after lesions have healed. Some patients may be unable to comply with the administration instructions for nystatin and require a systemic antifungal.
  • Always check the BNF or seek advice from a pharmacist before prescription of antifungal medication as there is a risk of serious drug interactions. Fluconazole and miconazole (including topical route) should be avoided in patients prescribed warfarin and statins.
  • Swab angles, tongue and nostrils to investigate possible Staphylococcal infection. If present, adjust treatment accordingly.
    • If a fungal infection is present, dentures must be cleaned thoroughly – soak in chlorhexidine 0.2% mouthwash (if dentures have metal components) or dilute sodium hypochlorite for 20 minutes twice a day. Toothbrushes should also be replaced.
    • If symptoms persist, consider referral to a dentist with consent or a palliative care specialist.

 

Viral infections

Herpes simplex is the most common viral infection.

  • Treat infections inside the mouth with oral aciclovir: 200mg five times a day for at least 5 days (or until healing is complete). Soluble preparations are available.
  • The dose of aciclovir may be doubled or intravenous treatment considered if the patient is immunocompromised or if absorption is impaired. In this case seek advice. Doses may need to be reduced in renal impairment.
  • The use of antimicrobial mouthwashes (either chlorhexidine 0.2% mouthwash or hydrogen peroxide mouthwash, 6%) controls plaque accumulation if toothbrushing is painful and also helps to control secondary infection in general.
  • Immunocompetent patients in the early stages of an uncomplicated herpes simplex infection in the lips (cold sore) should receive a topical antiviral preparation, for example acyclovir 5% cream applied 5 times a day for 5 days.
  • Provide supportive therapy: encourage fluid intake, keep mouth moist, apply water-based lubricant, antipyretic medication and analgesia.
  • Viral infections are highly contagious. Strict adherence to infection control measures is essential.

 

Bacterial infection

  • The mouth may become infected and malodorous particularly if there is an oral cancer infected with anaerobic organisms. Poor dental hygiene may also encourage infection. Oral metronidazole (400mg every 8 hours for 3 to 7 days or longer if necessary) is recommended to control anaerobic infection and the associated odour.