PLUS OPIOID |
||
PLUS NSAID |
PLUS NSAID | |
PARACETAMOL |
PARACETAMOL | PARACETAMOL |
MILD PAIN |
INCREASING PAIN |
MODERATE TO SEVERE PAIN |
- See dosing range charts, below.
- ALL prescriptions MUST be reviewed every 24 hours.
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
PLUS OPIOID |
||
PLUS NSAID |
PLUS NSAID | |
PARACETAMOL |
PARACETAMOL | PARACETAMOL |
MILD PAIN |
INCREASING PAIN |
MODERATE TO SEVERE PAIN |
Age |
Dose |
Interval |
Max Daily Dose |
Pre-term neonate 28 to 32 weeks corrected gestational age |
10mg/kg |
8 hourly up to three times daily |
30mg/kg/day |
Neonate over 32 weeks corrected gestational age |
15mg/kg |
6 hourly up to four times daily |
60mg/kg/day |
1 month to 18 years |
15mg/kg up to a max of 1g |
4 hourly up to four times daily |
75mg/kg/day |
Age |
Dose |
Interval |
Max Daily Dose |
1 to 3 months |
60mg |
Every 4 hours |
75mg/kg/day |
3 to 12 months |
60 to 120mg | Every 4 hours |
4 doses in 24 hours (or 75mg/kg/day) |
1 to 5 years |
120 to 240mg | Every 4 hours |
4 doses in 24 hours (or 75mg/kg/day) |
5 to 12 years |
240mg to 500mg |
Every 4 hours |
4 doses in 24 hours (or 75mg/kg/day. Maximum 4g daily) |
12 to 18 years |
12 to 18 years |
Every 4 hours |
4 doses in 24 hours |
Patient | Dose | Interval | Max Daily Dose |
Pre-term Neonate over 32 weeks corrected gestational age |
7.5 mg/kg | 8 hourly | 22.5mg/kg/day |
Term Neonate |
10 mg/kg | 4 hourly, up to three times daily | 30mg/kg/day |
Child under 10kg |
10 mg/kg | 4 hourly, up to three times daily | 30mg/kg/day |
Child 10 to 50kg |
15 mg/kg | 4 hourly, up to four times daily | 60mg/kg/day |
Child over 50kg |
1g | 4 hourly, up to four times daily | 4g/day |
NSAIDs may have adverse effects so care should be taken when determining if NSAIDs are suitable for patients and when prescribing/ reviewing therapy. Please check through the list below before prescribing NSAIDs.
Cautions: see list on NSAID flowchart.
Age |
Standard Dose |
Standard Interval
|
Maximum Dose |
1 to 3 months |
5mg/kg |
6 to 8 hourly |
up to four times daily |
3 months to 18 years |
5mg/kg up to 400mg |
6 to 8 hourly, up to three times daily |
7.5mg/kg as a single dose up to 30mg/kg/day |
Age |
Dose |
Interval |
Comment |
6 months to 18 years |
0.3 to 1mg/kg up to 50 mg |
8 hourly | The dose must be adjusted according to the suppository strength available |
Age
|
Dose |
Interval
|
6 months to 17 years |
Oramorph |
Up to 2 hourly |
Over 12 years |
Dihydrocodeine |
Up to 4 hourly |
Oral opioids have the same side effects as parenteral opioids and the following need to be carried out:
Oral opioids have the same side effects as parenteral opioids and the following need to be carried out:
Age |
Breaths per minute |
Less than 6 months | below 20 breaths per minute |
6 months to 2 years | below 16 breaths per minute |
2 years to 7 years | below 14 breaths per minute |
8 years and over | below 10 breaths per minute |
Age |
Breaths per minute |
Less than 6 months | below 18 breaths per minute |
6 months to 2 years | below 14 breaths per minute |
2 years to 7 years | below 12 breaths per minute |
8 years and over | below 8 breaths per minute |
Constipation
Nausea and Vomiting
Itching
Oxycodone oral solution (1mg/ml) can be used as an alternative strong opioid when morphine is contraindicated. This is not a stock medication and must be ordered in advance through pharmacy. The dosing regimes in the BNFc are for moderate to severe oncological pain and a 30 to 50% dose reduction may be more appropriate for treatment of moderate post-operative pain.