Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |
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
Base selection on the likely cause, mechanism of action of the drugs available, the side-effect profile of each drug, interactions and concomitant conditions. The information table is not fully comprehensive, for further information refer to guidance below and/or BNF/manufacturers Summary of Product Characteristics:
DRUG CLASS/ ANTIEMETIC |
CAUTION/ CONTRA-INDICATIONS |
GOOD FOR NAUSEA CAUSED BY/OTHER USES |
|
ANTIHISTAMINES |
|||
CYCLIZINE |
Caution Severe heart failure or acute myocardial infarction; may counteract the beneficial haemodynamic effects of opioids. Anticholinergic** |
Movement, ↑ intracranial pressure, mechanical bowel obstruction, post-operative. |
|
PROMETHAZINEQT |
Caution Strongly anticholinergic** |
Movement |
|
PHENOTHIAZINES AND RELATED DRUGS |
|||
PROCHLORPERAZINEQT |
Caution Balance disturbances in older people; may often lead to drug-induced Parkinson’s disease, postural hypotension and mental confusion. Strongly anticholinergic** |
Contra-indication Prochlorperazine injection is considered inappropriate for patients with reduced consciousness due to its tendency to deepen any state of sedation. |
Movement, post-operative.
Buccal formulation available. |
LEVOMEPROMAZINEQT |
Caution Risk of postural hypotension; avoid in ambulant patients over 50 years, unless a risk of hypotensive reaction has been assessed. Anticholinergic** |
Palliative care. |
|
DOMPERIDONE AND METOCLOPRAMIDE |
|||
DOMPERIDONEQT
|
Caution Does not readily cross the blood brain barrier and less likely to exhibit extra-pyramidal effects and sedation compared with metoclopramide, however caution is still recommended in the young, very old and debilitated. Risk of cardiac side-effects; for short term use only (up to 7 days). |
Contra-indication Cardiac conduction is, or could be impaired, or where there is underlying cardiac disease, when administered concomitantly with drugs that prolong the QT interval or potent CYP3A4 inhibitors, and in severe impairment. Gastro-intestinal obstruction. |
Drug induced (eg emergency hormonal contraception, opioids, chemotherapy).
Only antiemetic advised for use in Parkinson’s disease.
Prokinetic. |
METOCLOPRAMIDEQT |
Caution in young, very old and debilitated, due to extrapyramidal effects. Risk of neurological side-effects (up to 5 days only). Anticholinergic** |
Contra-indicated in gastro-intestinal obstruction, post bowel surgery and in Parkinson’s disease. Avoid where emesis and melaena are present. |
Opioids and gastric/hepatic/biliary disease (not GI obstruction).
Prokinetic. |
5HT3 RECEPTOR ANTAGONIST |
|||
ONDANSETRONQT |
Caution Increased large bowel transit time; constipation can be a problem. |
Post-operative, radiotherapy and chemotherapy, palliative care. |
|
HYOSCINE |
|||
HYOSCINE HYDROBROMIDE |
Caution Sedation can be a problematic side-effect if driving or operating machinery. Strongly anticholinergic** |
Motion sickness, bowel obstruction, palliative care. |
|
OTHER |
|||
DEXAMETHASONE |
Caution if history of peptic ulcer disease/ concurrent NSAIDs. Monitor capillary blood glucose in patients with diabetes. |
Post-operative, chemotherapy, ↑ intracranial pressure. Appetite stimulant. |
|
HALOPERIDOLQT |
Caution Requires a baseline ECG prior to treatment and consider the need for ongoing ECG monitoring. Anticholinergic** |
For palliative care (opioid-induced and metabolic causes). |
|
LORAZEPAM |
Caution Addictive potential. |
Short-term use in anticipatory nausea and vomiting. |
QT Avoid in patients with congenital long QT interval. Prolongs QT interval and/or causes torsades de pointes.
See Credible Meds
** Consider the cumulative anticholinergic burden of all medicines. Anticholinergic side-effects include increased risk of urinary retention, falls, BP reduction, confusion, sedation, dementia, glaucoma etc.
(see http://www.uea.ac.uk/mac/comm/media/press/2011/June/Anticholinergics+study+drug+list).
Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |