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
During either carbimazole or propylthiouracil treatment, advise patients to report signs and symptoms of infection, especially sore throat, which may indicate bone marrow suppression, and to discontinue medication pending further investigation. The drug should only be recommenced once neutropenia has been excluded following a blood count. Routine monitoring of white blood cell count is unnecessary. If sensitivity (eg rash) occurs with carbimazole then propylthiouracil is an alternative. Propylthiouracil is the drug of choice in pregnant women. For information on the treatment of thyrotoxic crisis, refer to BNF.
MHRA alert: Carbimazole: risk of acute pancreatitis (February 2019) (www.gov.uk).
MHRA alert: Carbimazole: increased risk of congenital malformations; strengthened advice on contraception (February 2019 (www.gov.uk).
Risk minimisation materials
Tablets 5mg, 20mg (specialist use only)
Initially 20 to 40mg once daily. Repeat TFTs after 4 to 6 weeks and adjust the dose following specialist advice.
Tablets 50mg (s)
Initially 200mg daily in divided doses. Repeat TFTs after 4 to 6 weeks and adjust the dose following specialist advice.
MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk).
Modified release capsules 80mg, 160mg
By mouth, for the relief of thyrotoxic symptoms modified release capsules 80 to 160mg daily.
Requires extemporaneous preparation unlicensed.
Solution total iodine (Lugol’s Solution) 130mg/mL (s)
TAM (Treatments and Medicines) NHS Highland