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
The following are the treatments for poisoning used in NHS Highland; stock in individual hospitals is held in agreement with Accident and Emergency consultant staff. Use will be in accordance with national guidance (www.toxbase.org) or in consultation with staff from the National Poisons Information Service (tel: 0344 892 0111).
MHRA advice: Intravenous N-acetylcysteine (NAC) for paracetamol overdose: reminder of authorised dose regimen; possible need for continued treatment with NAC (January 2017) (www.gov.uk).
Injection 2 grams/10mL (specialist use only)
Injection 600 micrograms/mL (specialist use only)
Pre-filled syringe 600 micrograms/mL (specialist use only)
Injection 10mmol/10mL (specialist use only)
MHRA advice: Calcium gluconate injection in small-volume glass containers: new contraindications due to aluminium exposure risk (December 2014) (www.gov.uk).
Injection 10% (10mL) (specialist use only)
Infusion 20% 500mL (specialist use only)
Tablets 4mg (specialist use only)
MHRA advice: Intravenous dantrolene: risk of undissolved crystals (December 2014) (www.gov.uk).
Injection 20mg (specialist use only)
Injection 500mg (specialist use only)
Powder for reconstitution for intravenous infusion (DigiFab®) 40mg/vial (specialist use only)
The disodium salt of folinic acid is stocked in Raigmore hospital in preference to the calcium salt.
Injection 400mg/8mL (specialist use only)
Injection (snake venom antiserum) unlicensed (specialist use only)
Injection 500 micrograms/5mL (specialist use only)
Injection 1 gram/mL unlicensed (specialist use only)
Injection (GlucaGen® HypoKit) 1mg (specialist use only)
Injection 5mg/5mL, 50mg/50mL (specialist use only)
MHRA advice: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions (December 2023) (www.gov.uk).
Injection (Cyanokit®) 5 grams (specialist use only)
Oral powder sachets 110 grams/sachet (VistaPrep®) (hospital use only)
Whole bowel irrigation (by means of a bowel cleansing preparation) has been used in poisoning with certain modified-release or enteric-coated formulations, in severe poisoning with iron and lithium salts, and if illicit drugs are carried in the gastro-intestinal tract (‘body-packing’). However, it is not clear that the procedure improves outcome and advice should be sought from the National Poisons Information Service.
See BNF - Poisoning, emergency treatment
Injection 1 gram/10mL (specialist use only)
MHRA advice: Methylthioninium chloride (methylene blue): update on central nervous system (CNS) toxicity (December 2014) (www.gov.uk).
Injection 50mg/10mL (specialist use only)
Injection 400 micrograms/mL (specialist use only)
Injection 50 micrograms/mL (specialist use only)
Injection 10mg/mL unlicensed (hospital use only)
Stock held in Raigmore Pharmacy Store.
Injection 1 gram (specialist use only)
Injection 10mg/2mL (specialist use only)
Infusion 1·26%, 8·4% (specialist use only)
NHS Improvement Patient Safety Alert:Risk of death from unintended administration of sodium nitrite (August 2020)
Solution for injection 30mg/ml
Injection 25% (250mg/mL) (specialist use only)
TAM (Treatments and Medicines) NHS Highland