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
29.09.23
What’s New: Review in line with NICE Guidance published 22 June 2023. Widened scope to include dosing for children. Clarified duration of therapy – advice is to stop treatment on discharge from hospital, if this is before 10 days. Removed text relating to agents no longer used (sarilumab and casirivimab/imdevimab).
NHS Highland Guidance on use of corticosteroids (dexamethasone, prednisolone and hydrocortisone) for adults with confirmed SARS-CoV-2 infection.
Corticosteroids, and in particular dexamethasone, prednisolone and hydrocortisone, have been demonstrated to have a place in the management of patients with COVID-19. Following recent publication of the REMAP-CAP trial for hydrocortisone and a meta-analysis of corticosteroids, the World Health Organization (WHO) has issued interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease.
The approach to utilisation of corticosteroids in COVID-19 is informed by the extensive experience of the use of this class of medicines for other indications and the information from the REACT meta-analysis where a clinical benefit was demonstrated. The REACT study includes results from seven randomised controlled trials (RCTs), including the RECOVERY and REMAP-CAP trials. The majority of evidence in the published meta-analysis emanates from the assessment of dexamethasone in the RECOVERY trial. Currently, there are no data directly comparing dexamethasone with hydrocortisone.
This guidance document has been updated with information from NICE COVID-19 rapid guideline: Managing COVID-19
Note: For information on use and doses in children, pregnant or breast-feeding women, please see:
the full NICE guidance, Royal College of Obstetrics and Gynaecology guidance and risk criteria set out in Royal College of Paediatric and Child Health Guidance for assessing children admitted to hospital with COVID-19.
Note: guidance applies to all patients whether in hospital or other setting
Corticosteroids can be prescribed in the community if the above criteria are met.
As this is a sign of a deteriorating patient, please contact an acute hospital consultant.
Adults 6 mg (oral or intravenous) once daily for 10 days. If there is a clear indication to stop early, including discharge from hospital, the 10 day course need not be completed.
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Available formulations |
Dose |
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6mg = 3 tablets |
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6mg = 15mL |
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6.6mg = 2mL (dose rounded up for ease of measurement) |
IV administration should only be used where tablets or oral solution are not appropriate or not available.
Once the oral route is available, re-prescribe the drug with the oral dose (i.e. cannot prescribe the same dose as oral/IV ).
When prescribing dexamethasone, consult the manufacturer’s information.
Prednisolone:
40mg orally once daily for 10 days (preferred in pregnancy – see link to RCOG guidance below)
Hydrocortisone:
Adults: 50mg given intravenously every 8 hours for 10 days. A longer duration (up to 28 days) can be considered in patients with septic shock (as per REMAP-CAP trial).
Follow Royal College of Obstetrics and Gynaecology guidance
Dosage for children with a greater than 44-week corrected gestational age
Dosage for preterm babies with a corrected gestational age of less than 44 weeks
Seek specialist advice.
Co-administration of dexamethasone, prednisolone or hydrocortisone with tocilizumab or remdesivir has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely (University of Liverpool COVID-19 Drug Interactions).
See separate TAM guidance for tocilizumab
Any suspected adverse drug reactions (ADRs) for patients receiving dexamethasone for this indication can be reported directly to the MHRA via the new dedicated COVID-19 Yellow Card reporting site at: https://coronavirus-yellowcard.mhra.gov.uk/
The Deputy Chief Medical Officer recommends that data on all patients with COVID-19 should be captured through the ISARIC 4C Clinical Characterisation Protocol (CCP) case report forms (CRFs), as coordinated by the COVID-19 Clinical Information Network (CO-CIN).
TAM (Treatments and Medicines) NHS Highland