400 micrograms/ml injection (1ml ampoule)
Welcome to the Right Decision Service (RDS) newsletter for September 2024.
This business case has now been endorsed by the HIS Board and will shortly be submitted to Scottish Government.
To balance increasing demand with available capacity and financial resource, the RDS team and Tactuum are now working together to implement closer management of support tickets. As a key part of this, we want to ensure clear, timely and consistent communication with yourselves as requesters.
Editors will now start seeing new messages come through in response to support ticket requests which reflect this tightening up and improvement of our processes.
Key points to note are:
2.1 Issues confirmed by the RDS and Tactuum teams as meeting the critical/urgent and high priority criteria will continue to be prioritised and dealt with immediately.
Critical/urgent issues are defined as:
Example – RDS website outage.
Please remember to email ann.wales3@nhs.scot and his.decisionsupport@nhs.scot with any critical/urgent issues in addition to raising a support ticket.
High priority issues are defined as:
Example – Build to app not working.
2.2 Support requests that are outwith the warranty period of 12 weeks since the software was originally developed will not be automatically addressed by Tactuum. The RDS team will consider these requests for costed development work and will obtain estimate of effort and cost from Tactuum for priority issues.
2.3 Support tickets for technical issues that are not classified as bugs will not be automatically addressed by Tactuum. The definition of a bug is ‘a defect in the software that is at variance with documented user requirements.’ Issues that are not bugs will also be considered for costed development work.
The majority of issues currently in support tickets fall into category 2 or 3 above, or both.
2.4 Non-urgent requests that require a deployment (i.e a new release of RDS) will normally be factored into the next scheduled release (currently end of Nov 2024 and end of Feb 2025) unless by special agreement with the RDS team.
Please note that we plan to move in the new year to a new system whereby requests all come to an RDS support portal in the first instance and are triaged from there to Tactuum when appropriate.
We will be organising a webinar in a few weeks’ time to take you through the details of the current support processes and criteria.
The next scheduled RDS deployment will take place at the end of November 2024. We are reviewing all outstanding support tickets and feature requests along with estimates of effort and cost to determine which items will be included in this deployment.
We will update you on this in the next newsletter and in the planned webinar about support ticket processes.
Many thanks to those of you who attended our recent webinar on the contingency arrangements being put in place to prevent future RDS outages as far as possible and minimise impact if they do occur. Please contact ann.wales3@nhs.scot if you would like a copy of the slides from this session.
The NES clinical knowledge pathway (CKP) publisher is now retired and the majority of pathways supported by this tool have been transferred to the RDS. Examples include:
NHS Lothian musculoskeletal pathways
NHS Fife rehabilitation musculoskeletal pathways
NHS Tayside paediatric pathways
Include:
Focus on frailty (from HIS Frailty improvement programme)
NHS GGC Money advice and support
If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot
To go live imminently:
We have recently analysed the results of a survey of users of the Scottish Palliative Care Guidelines toolkit. Key findings from 61 respondents include:
Key strengths identified included:
Users highlighted key areas for improvement in terms of navigation and search functionality. The survey was very valuable in enabling us to uncover the specific issues affecting the user experience. Many of these can be addressed through content management approaches. The issues identified with search results echo other user feedback, and we are costing improvements with a view to implementation in the next RDS deployment.
This decision support software, sponsored by Scottish Government Effective Prescribing and Therapeutics Division, is now available for all primary care clinicians across NHS Tayside. Board-wide implementation is also planned for NHS Lothian, and NHS GGC, NHS Ayrshire and Arran and NHS Dumfries and Galloway have initial pilots in progress. The University of Dundee has been commissioned to evaluate impact of this decision support software on prescribing practice.
Ten bite-size (5 mins or less) video tutorials for RDS editors are now available in the “Resources for providers of RDS tools” section of the RDS. These cover core functionality including Save and preview, content page and media management, password management and much more.
10. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
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.)
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
Description: Antagonist for use in severe opioid induced respiratory depression.
400 micrograms/ml injection (1ml ampoule)
Total antagonism will result in severe pain with hyperalgesia and, if physically dependent, severe physical withdrawal symptoms and marked agitation. Opioid withdrawal syndrome: anxiety, irritability, muscle aches; nausea and vomiting; can include life-threatening tachycardia and hypertension. Cardiac arrhythmias, pulmonary oedema and cardiac arrest have been described.
Small doses of naloxone by slow intravenous (IV) injection improve respiratory status without completely blocking the opioid analgesia. Onset of action of intravenous naloxone is 1 to 2 minutes.
Closely monitor respiratory rate and oxygen saturation. Further doses may be needed. The duration of action of many opioids exceeds that of naloxone (15 to 90 minutes) and impaired liver or renal function will slow clearance of the opioid. Opioid depressant effects may return as the effects of naloxone diminish, and additional naloxone doses (or a continuous IV infusion) may be required.
Note: There is wide variation in the recommended initial bolus dose of naloxone reported in the literature from 20 micrograms (American Pain Scociety 2008) to 100 micrograms (PCF-4).
If in doubt, seek advice.
Twycross R, Wilcock A. Palliative Care Formulary PCF4+ (4th edition) 2011.
National Patient Safety Agency. Safer practice notice 2006/12.
Adult Emergencies Handbook. NHS Lothian: University Hospitals Division.
Electronic Medicines Compendium. www.medicines.org.uk/naloxone accessed at http://www.medicines.org.uk/emc/medicine/21095/SPC/Naloxone+400+micrograms+ml+solution+for+Injection+(hameln)/
Miaskowski C et al. (2008) Principles of analgesic use in the treatment of acute pain and cancer pain (6e). American Pain Society, Skokie, Illinois, p. 31.
The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I).
Mercadante.(2003) Naloxone in treating central adverse effects during opioid titration for cancer pain. Journal of pain and symptom management:vol:26 iss:2 691 -693.
Manfredi P, Ribeiro S, Chandler S, et al. Inappropriate use of naloxone in cancer patients with pain. J Pain Symptom Manage 1996;11:131–134.