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
07/07/24 - tirzepatide KwikPen 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg solution for injection in prefilled pen as per SMC2633 added.
MHRA advice: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued (June 2019) (www.gov.uk).
Refer to protocol for use of GLP-1 analogues.
Currently GIP (glucose-dependent insulinotropic polypeptide) receptor and GLP-1 (glucagon-like peptide-1) receptor agonists are NOT recommended to be prescribed in NHS Highland for weight management. Further information can be seen in the Pink One newsletter (NHS Highland intranet access required).
The following medications have been approved by the Scottish Medicines Consortium (SMC) to support weight management in NHS Scotland.
Due to national shortages, NHS Highland is unable to start anyone on this medication.
Saxenda® is NOT recommended to be prescribed in NHS Highland for weight management.
NHS Highland has accepted a formulary submission for this medication and it will become available once local clinical pathways are in place. A national Short Life Working Group has produced recommendations to support Scottish Health Boards develop local clinical pathways. This process is underway in NHS Highland.
Until these pathways have been developed, Wegovy® is NOT recommended to be prescribed in NHS Highland for weight management.
There has been no request to add this medication to the Highland Formulary at this time. Once a clinical pathway has been set up for prescribing these medications, this will enable a formulary submission to be submitted and assessed.
Tirzepatide (Mounjaro®) is NOT recommended to be prescribed in NHS Highland for weight management.
See NHS Highland’s Healthy Weight Pathway
First line once daily option.
MHRA advice: Ozempic (semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products (November 2023) (www.gov.uk).
Injection, pre-filled pen 18mg/3mL
First line once weekly option.
MHRA advice: Ozempic (semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products (November 2023) (www.gov.uk).
Solution for injection, pre-filled pen (Ozempic) 0·25mg, 0·5mg and 1mg
Tablets (Rybelsus) 3mg, 7mg and 14mg
Oral, once daily alternative to subcutaneous semaglutide - when subcutaneous route not suitable.
Second line once weekly option.
Injection, pre-filled pen 750 micrograms/0·5mL, 1·5mg/0·5mL
Caution. For full details see BNF and Manufacturer information
KwikPen 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg solution for injection in prefilled pen (Restricted: Specialist recommendation only)
As per SMC2633: for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise and in addition to other oral anti-diabetic medicines as an option when glucagon-like peptide-1 (GLP-1) receptor agonists would be considered.
Place in therapy:
TAM (Treatments and Medicines) NHS Highland