Welcome to the Right Decision Service (RDS) newsletter for June 2024.
Hopefully you all received the notification on Friday 28th June about the worldwide security vulnerability relating to use of code from the Polyfill.io code library – typically used to enable use of functionality in older browsers and operating systems. This vulnerability has now been addressed within RDS. Thanks to Tactuum for their prompt action on this.
This incident served as a useful reminder about the importance of making sure all devices and desktop/laptop computers have up to date anti-malware installed.
The most recent information is that final fixes and developments will take place during July, with a view to user testing taking place in August 2024.
We will be running the six-monthly usage statistics reports for all RDS toolkits during July. Please contact his.decisionsupport@nhs.scot if you would like to receive the usage report for your toolkit(s).
The Scottish Palliative Care Group is carrying out a value and impact survey of the national Palliative Care Guidelines toolkit on RDS. We would appreciate your help in circulating this survey, available at https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/evaluation-survey/ /
The Palliative Care Guidelines toolkit is using an adapted version of a generic impact evaluation form which the RDS team now encourages all toolkit owners to apply 6-12 months after launch of their toolkit. Please contact ann.wales3@nhs.scot if you would like to find out more.
The RDS Learning working group is in the final stages of developing and uploading new learning resources including:
We have also drafted a communication and training plan to support implementation of the redesigned RDS. The plan aims to reach both end-users and editors, who will benefit from new features such as the archiving and version control functionality.
4.1 Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
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.)
Remember that you can also organise 1-1 training sessions with Olivia on running Google Analytics reports if you want to look at data more frequently than the six-monthly reports.
The following RDS toolkits are now live:
The following toolkits are due to go live imminently:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
HIS is working with the Scottish Library and Information Council and the ALLIANCE to implement the second phase of the Collective Force for Health and Wellbeing Action Plan. This plan aims to strengthen the role of public, health and school libraries in empowering people to use digital tools and health information for self-management and choices about health and wellbeing. A key element of this new phase is supporting public libraries to promote the RDS citizen-facing apps for health and wellbeing.
We held a webinar on 28th June about the implementation challenge for health and wellbeing apps for citizens. This included an overview of the evidence base around implementation, the critical importance of health literacy skills, and the early findings from tests of change of implementing the Being a partner in my care app. Please contact his.decisionsupport@nhs.scot if you would like a copy of the slides or access to the recording of this webinar (NHS staff only.)
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
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Pain is an individual multi-factorial, subjective experience influenced among other things by culture, previous pain experiences, beliefs and mood.
Reliable and accurate assessment of acute pain is necessary to ensure patients experience safe, effective and individualised pain management.
Self-report should always be used whenever appropriate as pain is a subjective experience. When assessing pain our own judgements can affect the assessment of the patient’s pain therefore by using a pain scoring tool, allows for a more objective assessment.
Assessment of the intensity of acute pain at rest after surgery/trauma is important for making the patients comfortable in bed. However, adequate relief of dynamic pain during mobilisation, deep breathing and coughing is more important for reducing risks of complications after surgery/trauma, and to promote the return to normal function.
The Functional activity Scale (FAS) score is a simple three-level ranked categorical score designed to be applied at the point of care (Scott 2008). Its fundamental purpose is to assess whether the patient can undertake appropriate activity at their current level of pain control and to act as a trigger for intervention should this not be the case. Disadvantages of the FAS score are that it has not been independently validated and clinical staff need to be educated in its application.
The pain measurement tool chosen should be appropriate to the individual patient and the clinical context. Developmental, cognitive, emotional, language and cultural factors should also be considered.
Please note this guidance is for in-patients and is not designed for managing patients with chronic pain.
At Raigmore Hospital the Acute Pain Team includes:
Advice can be sought in office hours: 08.00 to 16.00 (page 1003 or 6056)
Out of hours please contact the ITU anaesthetist.
Please note this guidance is for use in in-patients and is not designed for managing patients with chronic pain
This guidance is for adult patients with dementia who cannot verbalise.
There is evidence to suggest that people with dementia are likely to receive less pain relief in hospital than people who do not have dementia and this becomes a greater problem the more severe the cognitive impairment (Scherder et al, 2005). Hence, the more confused and disorientated, a person is the less likely they are to receive effective pain control.
Pain assessment for people with dementia may be more complex and should be based on the principles of effective communication, allowing time to assess pain and using pain assessment tools.
In the same way as assessing the cognitive status of a person, when assessing for pain the room should be well lit and communication aids such as glasses and hearing aids should be in place.
Common behaviours associated with pain are vocalisations, grimacing, flinching, guarding of painful part, aggressive behaviour and restlessness, and pulling out tubes from painful parts of the body.
When attempting to detect pain in those with advanced dementia, nurses need to focus on such areas as noisy breathing, negative vocalisation, absence of relaxed body posture and looking tense and fidgeting.
Many people with cognitive impairment who can report the presence of pain have difficulty in quantifying their pain. This would include pain intensity on a 0-10 scale. There are pain assessment scales specifically designed for people with dementia. The Abbey Pain Scale is pain assessment tool for measuring pain in people with dementia who can not verbalise.
The Abbey Pain Scale can be accessed under resources.
Pain assessment in patients who are unable to communicate/express their pain can be particularly challenging.
For example, patients with dementia or patients with other languages. Observations such as facial expressions, behavioural or vital signs can be useful.
Other pain assessment tools such as verbal rating scale and visual analogue scale can be used.
At Raigmore Hospital the Acute Pain Team includes:
Advice can be sought in office hours - 08.00 – 16.00 (page 1003 or 6056)
out of hours please contact the ITU anaesthetist.
TAM (Treatments and Medicines) NHS Highland