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Right Decision Service newsletter: July 2024

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

1.Redesign and improvements to RDS

There has been a delay in implementing the final phase of the RDS redesign due to Tactuum having to prioritise the recent security and outage issues. Work has now resumed, and the intention now is that external user acceptance testing will start in September 2024.

As a reminder, the key improvements in this release include the following responses to user feedback:

  • Full redesign of search and browse to make it easier for users to go straight to the toolkits specific to their health board or to national toolkits. There is also a Favourites capability which enables users to access their most important toolkits directly without any search or browse requirements.
  • Comprehensive archiving and version control functionality.
  • Capability to customise and edit shared documents, save local version, and receive notification when the parent shared document is updated. The recipient of the shared document can then choose which edits to accept or ignore. This will significantly expand the opportunities for sharing guidance and collaboration across organisations and for localisation of national guidance.
  • Capability to provide a URL or QR code which will take the user direct to a specific downloadable mobile toolkit without requiring them to search and browse within the RDS mobile app. This should make for a simpler user journey. It should particularly help clinicians who want to signpost patients to download a specific mobile toolkit.

2. Migration of standalone apps to new RDS platform

Migration of the final two original standalone apps (NHS GGC paediatrics) was completed in July 2024. This means that the RDS is now truly the Once for Scotland platform for all web and mobile apps created using the RDS toolset. This has streamlined and simplified the processes around fixes, enhancements and release processes. The recent security issues are a case in point – previously these would have had to be addressed across 27 standalone apps as well as the RDS platform.

3. Evaluation - usage statistics

Figures 1 and 2 are derived from the usage statistics reports we generated in July 2024. They show how usage of the RDS has increased over the past 2.5 years. Figure 1 shows combined usage[1] across old standalone apps and the new Once for Scotland RDS platform. 2023 saw a 71% increase in usage over 2022 figures, and the usage in just 6 months of 2024 almost equals total use in 2022. Figure 2 shows use of the new RDS platform only. Usage in just 6 months of 2024 has increased by more than 100% compared with all 12 months of 2023.

             

       

 

As stated in a previous newsletter, there are caveats around comparison of use on the old and new platforms due to the different structures of each. Now that all the old standalone apps have been migrated to the new RDS platform we will focus primarily on usage of the new platform going forward.

 

4. Strategic highlights – supporting NHS Scotland priorities

Neurological Conditions Framework

The RDS will be supporting the SG Clinical Priorities team by delivering regional and national neurology guidance and  shared decision-making resources.

Waiting Well programme

The RDS team has been working with the NHS GGC Knowledge Services team to deliver a national toolkit for the Waiting Well programme. This will provide resources and tools for  services supporting patients to maintain wellbeing while on waiting lists.

Feasibility study for Value-Based Health and Care Action Plan

The RDS team has delivered an evidence review and report of stakeholder interviews to inform consideration by Scottish Government of the potential for a national approach to implementation of Patient Reported Outcome Measures (PROMs) across NHS Scotland. The final component of the feasibility study – a report on target architecture and realistic first steps towards delivery.

Gender Identity Standards

An RDS toolkit for the new Gender Identity Standards, including an interactive self-assessment questionnaire, is being developed in collaboration with the Standards and Indicators team in Healthcare Improvement Scotland. This toolkit should be published as part of a package of resources to be announced by Scottish Government in early October.

Please email ann.wales3@nhs.scot if you would like to know more about any of these developments.

5.National  IV fluid prescribing  calculator

We are now in the final stages of producing the UK CA marking documentation for this calculator and aim to publish it to live at the end of August 2024.

6. Training 

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

  • Wednesday 7 August 4-5 pm
  • Thursday 5 September 1-2 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. New toolkits

The NHS Grampian critical care toolkit is now live.

The following toolkits are due to go live imminently:

  • Care Inspectorate staffing method framework.
  • Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

8. Implementation projects

The RDS team has delivered a report for the SG Realistic Medicine Policy Unit on an implementation framework for digital tools to engage people in decisions about their care. The report was produced to support implementation of the Being a partner in my care: Realistic Medicine together app, but has wider applicability to shared decision-making apps more generally.  Please contact ann.wales3@nhs.scot if you would like to know more about the key findings and recommendations within this report.

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

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

[1] Unique users’ in Google analytics counts individual users to a website. Every time a user visits the website, their IP address assigns a unique identifier which is used to track the number of times they visit the site.

Lidocaine plaster

Amber – For medicines normally initiated by a specialist but may be used by generalists

Introduction

Lidocaine plaster in palliative care.

Description

  • Lidocaine is a local anaesthetic effective in some types of neuropathic pain such as post-herpetic neuralgia.
  • It is available in a topical plaster formulation, with approximately 3% systemic absorption, reducing the risk of systemic adverse reactions and drug interactions.
  • The use of lidocaine plasters in palliative care is outside marketing authorisation and has not been investigated extensively. 
  • It is non-formulary in some NHS boards.

Preparations

  • Medicated plaster (10x14cm) containing 700mg (5% w/w) of lidocaine.
  • Brands include Versatis and Ralvo.

 

Indications

A palliative care specialist may recommend lidocaine plasters for:

  • localised †neuropathic pain (particularly associated with allodynia) that is unresponsive to opioids and adjuvant analgesics
  • locally painful bone †metastases unresponsive to standard treatments (paracetamol, opioids, adjuvant analgesics, radiotherapy) or when standard treatments are inappropriate, poorly tolerated or contra-indicated
  • short term treatment of localised, severe uncontrolled bone or neuropathic pain, while adjuvant analgesics are being titrated.

 

Cautions

  • Do not apply the plaster to inflamed, broken or infected skin or to wounds.
  • Use with caution in patients with severe cardiac disease; elimination may be delayed in patients with severe renal or liver impairment.

 

Drug interactions

Use with caution in patients receiving a Class I anti-arrhythmic drug (for example QTflecainide).

 

Side effects

  • Application site reactions including erythema, rash and pruritus are common.
  • Systemic allergic reactions have been reported but are very rare.

 

Dose and administration

Starting a lidocaine plaster

  • Remove any hairs with scissors; do not shave the area.
  • Plasters can be cut to size before the backing is removed without affecting drug delivery.
  • Apply one plaster directly over the painful area for up to 12 hours in each 24 hour period. The plaster free interval may reduce the risk of skin reactions. However, some patients may benefit from the patch being applied for 24 hours.
  • The plaster site should be specified on the prescription chart and on the monitoring sheet.
  • A new plaster is applied every 24 hours.

 

Titration

  • The dose is titrated to give adequate analgesia (up to a maximum of three plasters) depending on the number and size of the painful site or sites. After initiation of treatment review after 48 hours and document on monitoring sheet.
  • Monitor the patient’s pain and other analgesics; these may need to be reduced if the pain responds well to lidocaine.
  • A used plaster should be folded over and can then be put in the sharps bin or household waste.

 

Practice points

Pain assessment

  • A 0 to 10 pain scale should be used to assess the patient’s pain now and over the past
    24 hours.
  • Record the pain scores on the monitoring sheet before the plaster is applied and after 48 hours.

 

Review of lidocaine plaster

  • There is limited evidence for use of lidocaine plaster. Regular reviews should be undertaken. 
  • Most patients will respond within 2 weeks; discontinue the plaster if no benefit.
  • It is often possible to discontinue the plaster without the pain recurring as the local effect on nerve endings persists after the plaster is removed.
  • If the pain responds, try a plaster-free period after 7 days of plaster use.
  • Remove the lidocaine plaster(s) for at least 24 hours and assess the patient.
  • If the pain returns or worsens, restart the lidocaine plaster.
  • If the patient remains pain free or with stable pain, discontinue the lidocaine plaster.
  • Continued treatment - reassess with a further plaster-free trial on a monthly basis to determine whether the number of plasters needed to cover the painful area can be reduced, or if the plaster‑free period can be extended.

 

Monitoring

  • A monitoring sheet is recommended for each patient started on a lidocaine plaster.
  • If a lidocaine plaster is being used for more than one pain site, a separate monitoring sheet should be completed for each site.
  • The monitoring sheet should be updated each time the patient is assessed.
  • Check the skin site – if a local reaction occurs, the plaster may need to be stopped.

 

References

Derry S, P.J. W, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. 2014 [cited 2018 Oct 08]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010958.pub2/epdf/standard

Galer BS, Rowbotham MC, Perander J, Friedman E. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain. 1999;80(3):533-8.

Gammaitoni AR, Davis MW. Pharmacokinetics and tolerability of lidocaine patch 5% with extended dosing. Ann Pharmacother. 2002;36(2):236-40.

Meier T, Wasner G, Faust M, Kuntzer T, Ochsner F, Hueppe M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain. 2003;106(1-2):151-8.

Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain. 1996;65(1):39-44.