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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

Sialorrhoea (excessive drooling)

 

  • Excessive drooling of saliva is common in neurodegenerative disorders such as motor neurone disease (MND), Parkinson’s disease and multiple sclerosis. The cause is usually impaired swallowing of saliva rather than excessive saliva production.
  • Advice should be given on posture, diet and oral care.
  • For bed-bound patients, consider regular positional changes by carers/nursing staff with advice from a physiotherapist where necessary.
  • Referral with consent to a speech and language therapist should be considered for advice on swallowing techniques.
  • Consider a trial of an antimuscarinic agent for treatment for sialorrhoea:
    • †glycopyrronium bromide – oral dose (as oral solution) 200 micrograms every 8 hours, titrated according to response and tolerability to 1mg every 8 hours. May be given via enteral feeding tube.
    • †hyoscine hydrobromide 1mg/72 hour transdermal patch. If necessary, use 2 patches concurrently. Oral dose (tablets) 300micrograms up to three times daily.
    • †amitripyline 10mg to 25mg at night.
    • †atropine 1% eye drops may also be used, 4 drops on the tongue or sublingually, every 4 hours as required.
  • †Glycopyrronium should be used as first-line treatment in patients who have cognitive impairment, because it has fewer central nervous system side effects.
  • For subcutaneous administration, glycopyrronium or hysocine (as hysocine butylbromide) are preferred because of the lower incidence of central nervous system effects.
  • Medication to manage sialorrhoea may exacerbate dry mouth causing thickened secretions which may be more difficult to clear.
  • Where there is thick, tenacious saliva:
    • review all current medicines, especially any treatment for sialorrheoea
    • consider treatment with humidification, sodium chloride 0.9% nebulisers and carbocisteine
  • If treatment for sialorrhoea is not effective or not tolerated, consider referral to a palliative care specialist or the specialist team looking after the patient.