Nausea and vomiting (Paediatric Guidelines) | Right Decisions

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Nausea and vomiting (Paediatric Guidelines)

Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

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 26^th 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.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

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.

Guide to six stages of RDS toolkit development

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.

Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm

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

What's new / Latest updates

Aug 2024:

Dose of ondansetron changed to 0.15mg/kg (from 0.1mg/kg)
Cyclizine removed as a treatment option
Rescue anti-emetic section and droperidol added.

Nausea and vomiting may occur in the postoperative period and is often associated with the use of opioid analgesics. If this side effect is not treated it may be as unpleasant for the child as ongoing pain. Use of an assessment tool will also allow assessment of the efficacy of any anti-emetics given.

General management

Ensure adequate pain control, warmth and comfort.
Correct hypotension, hypovolaemia and hypoxia.
Ensure adequate hydration.
If there is a nasogastric tube, aspirate it.
If one anti-emetic fails, choose an alternative with a different mechanism of action and if ineffective, seek advice.
Check for any contra-indications to the use of any drugs in the “BNF for Children” publication.

Measuring nausea and vomiting

All children must have nausea scores measured at the same time as their vital signs, using the above scoring tool.
The post-operative nausea and vomiting guidelines within this manual will give advice on anti-emetic prescriptions and other factors which need to be considered.
A nausea score of 3 requires urgent treatment.

0	None
1	Intermittent mild nausea
2	Constant nausea with/without some vomiting
3	Significant, ongoing vomiting

Therapeutic options

Ondansetron

See BNFC
Oral or slow IV injection.
MUST be given slowly IV, over 2 to 5 minutes, as can cause prolonged QT interval.
Dose (by either route):
- 0.15mg/kg up to a maximum of 4mg
- Can be repeated 8 hours later, if necessary.
- Also consider need for regular treatment.

OR Dexamethasone

See BNFC
Intravenously: 0.15mg/kg x 8 hourly

Avoid

Prochlorperazine / metoclopramide
These can cause extrapyramidal effects in children under 12 years of age, and in young people

Rescue anti-emetic:

Droperidol
See BNFC
0.025mg/kg (maximum dose 1.25mg) in high risk children where dexamethasone is contraindicated.

Last reviewed: 13/08/2024

Next review date: 30/09/2027

Author(s): Acute Pain Nurse Specialist.

Version: 2.1

Approved By: TAMSG of the ADTC

Reviewer name(s): L Reid, Clinical Nurse Specialist, Anaesthetics, C Wright, Acute Pain Nurse Specialist.

Document Id: TAM323