400 micrograms/ml injection (1ml ampoule)
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
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.