Phenobarbital sodium 200mg/ml injection: 1ml ampoules. Excipients include propylene glycol 90%.
This formulation is classified as Controlled Drug Schedule 3.
Welcome to the Right Decision Service (RDS) newsletter for August 2024.
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.
The following toolkits are now live;
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.
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.
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
Specialist palliative care involvement essential.
Description:
Phenobarbital is classed as a sedative anti-epileptic that has an overall effect of depressing the central nervous system. This is achieved by a dual action of prolonging the opening of chloride channels on GABA receptor complex and inhibiting glutamate transmission at non-NMDA receptor channels.
High doses of Phenobarbital can result in general anaesthesia.
Phenobarbital sodium 200mg/ml injection: 1ml ampoules. Excipients include propylene glycol 90%.
This formulation is classified as Controlled Drug Schedule 3.
Licensed indications - all forms of epilepsy except typical absence seizures and status epilepticus.
In palliative care phenobarbital may be considered by specialist palliative care practitioners for the following:
These are not absolute contra-indications if the patient is in the last days of life. Careful titration is however necessary.
Phenobarbital is metabolised by CYP2C19. CYP2C19 Inhibitors may enhance the effect of phenobarbital.
Examples of CYP2C19 inhibitors:
Phenobarbital induces various cytochrome P450 enzymes (CYP1A2, CYP2B6, CYP2C8/9, CYP2C19 and CYP3A4) that can cause many clinically significant drug interactions. As enzyme induction may take up to two weeks to develop, dose adjustments of concurrently administered drugs, that are predominantly metabolised by the cytochrome pathway or undergo glucuronidation, may be necessary.
Phenobarbital may decrease the effect of the following (the list is not exhaustive):
Corticosteroids - (dexamethasone, methylprednisolone, prednisolone):
Be aware of the potential for interactions: doses may need to be adjusted
Terminal refractory agitation: generally third line with specialist palliative care input.
Epilepsy: Refer to guideline for treating seizures.
Status epilepticus: Refer to local guidance.
Patient and carer advice point
Report any signs of skin reactions.
Dickman A, Schneider J. The Syringe Driver. 4th ed: Oxford University Press; 2016.
Twycross R, Wilcock A, Howard P. Palliative Care Formulary PCF6. 6th ed. England: Pharmaceutical Press; 2017.