Bone and Joint Infections (Antimicrobial) | Right Decisions

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MUSCULOSKELETAL AND JOINT (Antimicrobial)
Bone and Joint Infections (Antimicrobial)

Announcements and latest updates

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

Contingency planning for RDS outages

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 26^th 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.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

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.

Guide to six stages of RDS toolkit development

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.

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

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 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 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

The following advice applies to acute osteomyelitis and septic arthritis caused by haematogenous spread. It does not apply to infection by contiguous spread (eg related to chronic ulcers or trauma), to chronic infections, or where prosthetic material is present.

The following advice is for empiric therapy. Definitive therapy should be discussed with an infection specialist or paediatrician. It should usually be guided by joint aspirate or bone biopsy which should be taken before antibiotics are instituted where possible. For osteomyelitis and septic arthritis, consider referral to Outpatient Parenteral Antimicrobial Therapy (OPAT) service. Sodium fusidate must be avoided if the patient has been prescribed a statin due to increased risk of rhabdomyolysis.

SEEK ORTHOPAEDIC AND INFECTION SPECIALIST ADVICE EARLY

For glossary of terms see Glossary.

Drug details

Osteomyelitis
Staph aureus is the most common pathogen in children and adults

IV flucloxacillin 2g 4 times daily

4 to 6 weeks minimum with regular review. For childhood osteomyelitis, consider early oral switch. Choice of oral antibiotic should be individualised.

If penicillin allergy

IV Vancomycin - refer to NHS Highland vancomycin dosing guidelines

4 to 6 weeks minimum with regular review. For childhood osteomyelitis, consider early oral switch. Choice of oral antibiotic should be individualised.

Child

See empirical antibiotic therapy poster

Septic arthritis
Staph aureus and beta-haemolytic streptococci are the commonest pathogens. Seek Microbiology advice if at risk of sexually transmitted disease.

IV Flucloxacillin 2g 4 times daily

4 weeks. Consider possible IV to oral switch after 2 weeks.

Staph aureus requires 3 weeks.

If penicillin allergy or if MRSA is known or suspected

IV vancomycin - refer to NHS Highland vancomycin dosing guidelines

4 weeks. Consider possible IV to oral switch after 2 weeks.

Staph aureus requires 3 weeks.

Child

See empirical antibiotic therapy poster

Last reviewed: 25/06/2024

Next review date: 27/06/2027

Author(s): Antimicrobial management team.

Version: 3

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT146