Intra-abdominal sepsis including hepatobiliary (Antimicrobial) | Right Decisions

Announcements and latest updates

The transfer of ownership of the Right Decision Service from the Digital Health & Care Innovation Centre to Healthcare Improvement Scotland was formally announced in a media release issued on 20th November 2023. This NHS ownership is key to embedding the Right Decision Service as a national asset for Scotland's health and care.

Quotations from this media release below:

Health Secretary, Michael Matheson, said:

“This is a groundbreaking example of a digital service that has been developed and piloted with our partners Digital Health and Care Innovation Centre (DHI) through to delivery. The programme is now transitioning into a national service in support of our workforce to be led by a national NHS Board (HIS) and highlights the success of our collaborative approach.

“I’d like to thank all of those involved in the development of the Right Decision Service and look forward to our health and care workforce being able to make greater use of decision support tools.” “I’d like to thank all those involves in the development of the Right Decision Service and look forward to the programmes future success.”

Safia Qureshi, Director of Evidence & Digital, Healthcare Improvement Scotland, comments:

"We are delighted that the Right Decision Service will be joining us, as it presents a unique opportunity to deliver our advice and guidance at the point of care. This will significantly benefit patient safety, making it easier for health and care professionals to access the information they need to make the right decisions, at the right time. We hope that the future development of the Right Decision Service will have a significant, positive impact for health and care staff, freeing up more of their time and using resources available to them as efficiently as possible.

"I would also like to thank the Digital Health & Care Innovation Centre for their outstanding work in establishing this invaluable service. We are really excited to embark on this exciting project together.”

Dr Ann Wales, Programme Lead for Knowledge and Decision Support, Healthcare Improvement Scotland, said:

“The Once for Scotland Right Decisions app is a step-change in support for evidence-based health and social care decisions. It harnesses the power of evidence and technology to bring decision-making tools to the fingertips of health and social care practitioners. It frees up practitioner time to care, enables safer, more consistent care and support across Scotland, and strengthens the focus on individuals’ needs.

“I am hugely grateful to the Digital Health & Care Innovation Centre for steering and championing the Right Decision Service through its early stages of development. I’m delighted that the service is now moving fully into the NHS with leadership from Healthcare Improvement Scotland. This will consolidate the role of the Right Decision Service as a driving force for evidence-based practice and improvement across Scotland.”

Professor George Crooks OBE, Chief Executive Officer, Digital Health & Care Innovation Centre (DHI), said:

“The transfer of the Right Decision service from DHI into Healthcare Improvement Scotland, where it will continue to flourish and add increasing value to the delivery of high quality, safe health and care services for the people of Scotland, demonstrates how a national innovation centre can support, nurture and grow a new digital service to the point where it can successfully move to national adoption and scale. DHI is a national asset that will continue to support the people of Scotland and importantly those charged with delivering health and care services to access world class digital health and care solutions.”

Right Decisions
TAM (Treatments and Medicines) NHS Highland
THERAPEUTIC GUIDELINES
ANTIMICROBIAL GUIDANCE
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GASTRO INTESTINAL (Antimicrobial)
Intra-abdominal sepsis including hepatobiliary (Antimicrobial)

Timely administration in sepsis is vital, ensure agents covering gram negative pathogens (gentamicin or ciprofloxacin) are given first.

In severe illness, unresponsive to first-line therapy, contact Microbiologist for advice.

For glossary of terms see Glossary.

Drug details

1st Line
See ward poster for sequence of drug administration

IV gentamicin - refer to NHS Highland gentamicin guidelines

PLUS IV amoxicillin 1g 3 times daily

PLUS IV metronidazole 500mg 3 times daily

7 to 10 days

For infections arising within 24 hours of surgery where gentamicin has been given as part of surgical prophylaxis substitute.
IV aztreonam 2g every 6 hours for gentamicin.

1st line if Penicillin allergy

IV ciprofloxacin 400mg IV every 8 hours (see BNF warnings andMHRA Drug Safety Alert)

PLUS IV vancomycin - refer to NHS Highland vancomycin guidelines

PLUS IV metronidazole 500mg 3 times daily

7 to 10 days

Where vancomycin cannot be used, substitute with teicoplanin and follow the doses for use in infections with sepsis.

If no positive Microbiology result, step down to oral.
If a pathogen has been isolated, therapy should be targeted against that organism with advice from Microbiology as necessary.

Oral co-trimoxazole 960mg twice daily

PLUS oral metronidazole 400mg 3 times daily

7 to 10 days

Cautions for co-trimoxazole use: in renal impairment or in combination with other drugs which promote hyperkalaemia, monitor potassium levels if used for longer than 3 days.

In renal impairment (CrCl 30ml/min or less)

Oral co-trimoxazole 480mg twice daily

PLUS oral metronidazole 400mg three times daily

7 to 10 days

Cautions for co-trimoxazole use: in renal impairment or in combination with other drugs which promote hyperkalaemia, monitor potassium levels if used for longer than 3 days.

Last reviewed: 25/08/2022

Next review date: 25/08/2025

Author(s): Antimicrobial Management Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Area Antimicrobial Pharmacist.

Document Id: AMT121