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
14/12/23 - SMC1274/17 indication added to Trimbow monograph.
22/12/23 - Formoterol fumarate with glycopyrronium and budesonide (Trixeo® Aerosphere) pressurised inhalation, suspension (Trixeo® Aerosphere) 5mcg/7.2mcg/160mcg SMC2321 added.
Note: Review the need for inhaled steroids in patients with COPD if an episode of pneumonia has occurred. High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with COPD.
Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card. This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids. For more information, including which patients should receive the card, see HIS for details. Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.• inhaled corticosteroids, in combination with a long-acting bronchodilator, should be prescribed for patients with an FEV1 of 50% or less of predicted, who are having 2 or more exacerbations requiring treatment with antibiotics or oral corticosteroid in a 12-month period. Refer to NICE guidance on the management of COPD in adults in primary and secondary care.
• fluticasone with vilanterol (Relvar® Ellipta® 92/22) is cost-effective and offers the advantage of once-daily dosing.
• in patients with moderate to very severe COPD who are unsuitable for inhaled corticosteroid and in those who remain breathless or have exacerbations despite taking long-acting beta agonist plus inhaled corticosteroid consider a combination bronchodilator inhaler (LAMA/LABA).
See Peri-operative guidelines for patients with or at risk of adrenal insufficiency.
PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.
COPD, by inhalation of powder, 92/22 inhaler, 1 puff once daily.
PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.
COPD, by inhalation of powder (Fostair® NEXThaler), 2 puffs twice daily
ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.
COPD, by aerosol inhalation (Fostair®), 2 puffs twice daily.
PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.
COPD, by inhalation of powder 500/50/blister, 1 blister twice daily.
PREFERRED: Dry Powder Inhaler (DPI) (Inhalation powder)These are more environmentally friendly than MDIs and should be considered first line providing that the patient shows good inhaler technique with the chosen device.
See step-down ICS guidance in COPD.
ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)To be considered in the small proportion of patients who are unable to use a DPI.
See step-down ICS guidance in COPD.
See SMC advice 1274/17.
ALTERNATIVE: Metered dose inhalers (MDI) (Pressurised inhalation)
To be considered in the small proportion of patients who are unable to use a DPI.
Pressurised inhalation, suspension (Trixeo® Aerosphere) 5microgram /7.2microgram /160microgram /dose
As per SMC2321: maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist, or combination of a long-acting beta2-agonist and a long-acting muscarinic antagonist.
SMC restriction: in patients with severe COPD (forced expiratory volume in one second [FEV1] less than 50% predicted normal).
TAM (Treatments and Medicines) NHS Highland