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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

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

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 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.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   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

 

 

Oxycodone

Green – For medicines routinely initiated and used by generalists

Introduction

Description: Potent, synthetic opioid analgesic; used second line.

Preparations

Tables are best viewed in landscape mode on mobile devices

Route Preparation Dosage
Oral Immediate release oxycodone Shortec® capsules other brands also available

Shortec®, OxyNorm® and generic liquid and concentrate		 5mg, 10mg, 20mg

1mg/ml, 10mg/ml
  Modified release (long acting) oxycodone - 12 hourly preparation (twice daily)

Longtec® and other brands available

Note: depending on brand not all strengths available


24 hourly preparation (once daily)

Onexila XL®		 5mg, 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg, 120mg (refer to local guidance for preferred brand - not all strengths may be stocked)

10mg, 20mg, 40mg, 80mg

(non-formulary, risk of wrong preparation being prescribed)
Injection Oxycodone injection

Shortec®, OxyNorm® and generic injection available		 10mg/ml, 20mg/2ml, *50mg/ml (*non‑formulary in some NHS boards)

 

Indications

  • Second line oral and injectable analgesic for moderate to severe opioid responsive pain in patients unable to tolerate oral morphine, subcutaneous morphine or diamorphine due to persistent side effects (for example sedation, confusion, hallucinations, itch).
  • Refer to Pain management and Choosing and changing opioids guidelines.

 

Cautions

  • Immediate release, modified release and injection preparations have similar names. Take care when prescribing, dispensing or administering oxycodone.
  • Frail or elderly patients need smaller doses less frequently and slower titration.
  • Liver impairment - reduced clearance.
    • Avoid in patients with moderate to severe liver impairment.
  • Renal impairment - reduced excretion.
    • Titrate slowly and monitor carefully in mild to moderate renal impairment. Avoid in chronic kidney disease stages 4 to 5 (eGFR less than 30ml/min). 

  • Do not give Oxylan or Oxyact to people with soya or peanut allergy.

Drug interactions

  • No clinically significant pharmacokinetic drug interactions.

Side effects

  • Opioid side effects similar to morphine. Monitor for opioid toxicity.
  • Prescribe a softener+/-stimulant laxative and an anti-emetic as needed (for example metoclopramide).

 

Dose and administration

  •  Immediate release oral oxycodone:
    • Prescribe 4 hourly regularly and use 1/6th to 1/10th of the 24 hour dose as required for breakthrough pain.

or

  • Modified release (long acting) oral oxycodone.
    • Prescribe 12 or 24 hourly depending on preparation, with 1/6th to 1/10th  of the 24 hour dose as immediate release oral oxycodone for breakthrough pain.
    • Biphasic action; a rapid release is followed by a controlled release phase. If the patient has pain when the dose of modified release (long acting) oxycodone is given, wait an hour before giving a breakthrough dose of immediate release oxycodone.

 

  • Oxycodone injection:
    • Continuous subcutaneous infusion in a CME T34 syringe pump over 24 hours.
    • In addition, prescribe 1/6th to 1/10th of the 24 hour infusion dose subcutaneously, 1 to 2 hourly as required for breakthrough pain. If 3 or more doses have been given within 4 hours with little or no benefit seek urgent advice or review.  If more than 6 doses are required in 24 hours seek advice or review.
    • With higher subcutaneous infusion doses, consideration needs to be given to the volume of breakthrough medication. Typically an upper limit of 2ml (for example 20mg oxycodone) is acceptable by the subcutaneous route in a single site. Consider use of the high strength oxycodone injection form if available or an alternative opioid, for example diamorphine for doses greater than 20mg.
    • Dilutent: water for injections.
    • Dose conversions are given below. Seek advice if patient needs more than three ‘as required’ doses in 24 hours for breakthrough pain without acceptable benefit.

 

  • Stability and compatibility – refer to syringe pump subcutaneous infusion tables.

 

Dose conversions

Oxycodone is approximately twice as potent as morphine

Tables are best viewed in landscape mode on mobile devices

Oxycodone dose conversions
≈ oral morphine 30mg ≈ oral oxycodone 15mg ≈ subcutaneous oxycodone 7-8mg
Subcutaneous morphine 30mg ≈ subcutaneous oxycodone 15mg
Subcutaneous diamorphine 20mg ≈ subcutaneous oxycodone 15mg
  • As with all opioid conversions, these are approximate (≈) doses. Opioid conversions and ratios may vary depending on the resource used. These conversions are a consensus of use in practice in Scotland and based on manufacturers’ conversion factor.
  • Dose conversions should be conservative and doses rounded down.
  • Monitor the patient carefully so that the dose can be adjusted if necessary.
  • If the patient has opioid toxicity, reduce the dose by 1/3rd when changing opioid (refer to Choosing and changing opioids guideline).

 

References

King SJ et al. A systematic review of oxycodone in the management of cancer pain. Palliative Medicine 2011;25(5):454-470.

Caraceni A et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EPAC. Lancet Oncology 2012;13:e58-68.

Hanks G et al. The Oxford Textbook of Palliative Medicine (Fourth edition). Oxford University Press, 2010.

Twyross R et al. Palliative Care Formulary (Fourth edition. Palliativedrugs.com, Nottingham, 2011.

Electronic Medicines Compendium, Napp Pharmaceuticals Ltd. Oxynorm capsules, liquid & solution for injection and Oxycontin tablets. Summary of Product Characteristics. Updated September 2009-July 2011.

Shah S, Hardy J. Oxycodone: a review of the literature. European J Palliative Care 2001; 8: 93-96.