Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |
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
Base selection on the likely cause, mechanism of action of the drugs available, the side-effect profile of each drug, interactions and concomitant conditions. The information table is not fully comprehensive, for further information refer to guidance below and/or BNF/manufacturers Summary of Product Characteristics:
DRUG CLASS/ ANTIEMETIC |
CAUTION/ CONTRA-INDICATIONS |
GOOD FOR NAUSEA CAUSED BY/OTHER USES |
|
ANTIHISTAMINES |
|||
CYCLIZINE |
Caution Severe heart failure or acute myocardial infarction; may counteract the beneficial haemodynamic effects of opioids. Anticholinergic** |
Movement, ↑ intracranial pressure, mechanical bowel obstruction, post-operative. |
|
PROMETHAZINEQT |
Caution Strongly anticholinergic** |
Movement |
|
PHENOTHIAZINES AND RELATED DRUGS |
|||
PROCHLORPERAZINEQT |
Caution Balance disturbances in older people; may often lead to drug-induced Parkinson’s disease, postural hypotension and mental confusion. Strongly anticholinergic** |
Contra-indication Prochlorperazine injection is considered inappropriate for patients with reduced consciousness due to its tendency to deepen any state of sedation. |
Movement, post-operative.
Buccal formulation available. |
LEVOMEPROMAZINEQT |
Caution Risk of postural hypotension; avoid in ambulant patients over 50 years, unless a risk of hypotensive reaction has been assessed. Anticholinergic** |
Palliative care. |
|
DOMPERIDONE AND METOCLOPRAMIDE |
|||
DOMPERIDONEQT
|
Caution Does not readily cross the blood brain barrier and less likely to exhibit extra-pyramidal effects and sedation compared with metoclopramide, however caution is still recommended in the young, very old and debilitated. Risk of cardiac side-effects; for short term use only (up to 7 days). |
Contra-indication Cardiac conduction is, or could be impaired, or where there is underlying cardiac disease, when administered concomitantly with drugs that prolong the QT interval or potent CYP3A4 inhibitors, and in severe impairment. Gastro-intestinal obstruction. |
Drug induced (eg emergency hormonal contraception, opioids, chemotherapy).
Only antiemetic advised for use in Parkinson’s disease.
Prokinetic. |
METOCLOPRAMIDEQT |
Caution in young, very old and debilitated, due to extrapyramidal effects. Risk of neurological side-effects (up to 5 days only). Anticholinergic** |
Contra-indicated in gastro-intestinal obstruction, post bowel surgery and in Parkinson’s disease. Avoid where emesis and melaena are present. |
Opioids and gastric/hepatic/biliary disease (not GI obstruction).
Prokinetic. |
5HT3 RECEPTOR ANTAGONIST |
|||
ONDANSETRONQT |
Caution Increased large bowel transit time; constipation can be a problem. |
Post-operative, radiotherapy and chemotherapy, palliative care. |
|
HYOSCINE |
|||
HYOSCINE HYDROBROMIDE |
Caution Sedation can be a problematic side-effect if driving or operating machinery. Strongly anticholinergic** |
Motion sickness, bowel obstruction, palliative care. |
|
OTHER |
|||
DEXAMETHASONE |
Caution if history of peptic ulcer disease/ concurrent NSAIDs. Monitor capillary blood glucose in patients with diabetes. |
Post-operative, chemotherapy, ↑ intracranial pressure. Appetite stimulant. |
|
HALOPERIDOLQT |
Caution Requires a baseline ECG prior to treatment and consider the need for ongoing ECG monitoring. Anticholinergic** |
For palliative care (opioid-induced and metabolic causes). |
|
LORAZEPAM |
Caution Addictive potential. |
Short-term use in anticipatory nausea and vomiting. |
QT Avoid in patients with congenital long QT interval. Prolongs QT interval and/or causes torsades de pointes.
See Credible Meds
** Consider the cumulative anticholinergic burden of all medicines. Anticholinergic side-effects include increased risk of urinary retention, falls, BP reduction, confusion, sedation, dementia, glaucoma etc.
(see http://www.uea.ac.uk/mac/comm/media/press/2011/June/Anticholinergics+study+drug+list).
Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |