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
There are now a number of licensed melatonin products, however no melatonin product is licensed for the treatment of sleep onset difficulties in children. Melatonin 3mg tablets have been added to the NHS Highland Formulary as a clinically effective and cost-effective treatment for sleep onset difficulties in children (off-label indication). No other melatonin products are recommended.
Initial referral:
GPs, Community Paediatricians or Child Psychiatrists who have patients with a sleep onset difficulty must, in the first instance, refer the patient to a Health Visitor, School Nurse or Community Nurse, in order that behavioural measures, good sleep hygiene and sleep diaries may be introduced.
See the Sleep Diary and www.sleepscotland.org
Treatment failure onward referral:
Refer to Sleep Councillor for advice, where this is available.
It is well known that improving sleep patterns leads to a general improvement in health, behaviour and wellbeing.
Drug therapy may only be commenced AFTER behavioural interventions and sleep hygiene measures have been carried out.
Behavioural modification and appropriate sleep hygiene measures may require a long period of adherence before benefit is seen and occasionally they are ineffective.
Advice about sleep hygiene should be discussed with the family, backed up with written information (Appendices 3 and 4), and in consultation with the Health Visitor, School Nurse, Community Children’s Nurse or Community Nurse for Learning Disabilities, as appropriate.
If melatonin is being considered, behavioural measures MUST be used first and maintained during the trial. The benefits of behaviour change continue longer over time than drugs.
Appendices
Detailed sleep histories are key to the diagnosis of sleep disorders, which can be a major source of stress for the whole family and limited solutions are available.
Appendices
Melatonin may be viewed as an alternative to sedatives and hypnotics, which have adverse side-effects. It may be prescribed to assist development of improved sleep patterns and behaviours, ONLY WHEN, appropriate behavioural sleep interventions fail.
NICE state that evidence for use of melatonin has shown a total increase in sleep time of only 20 minutes and reduction in time taken to fall asleep of approximately 20 minutes. There are still ongoing concerns over the lack of long-term safety data in children, and there is uncertainty as to the effect on other circadian rhythms including endocrine or reproductive hormone secretion.
For information on side effects, cautions and contra-indications see:
Any serious reaction should be reported to the Commission of Human Medicines (CHM) by whomever they are highlighted to. Use the Yellow Card System to report adverse drug reactions, see: https://yellowcard.mhra.gov.uk/
Any child being considered for a trial of melatonin MUST have:
| NHS Highland recommends: |
Melatonin 3mg tablets are a clinical and cost-effective option. The Ceyesto brand is cost-effective; the tablets can be crushed and given in a small drink or soft food for patients with swallowing difficulties. |
| Medicine status: |
Melatonin 3mg tablets are licensed in the UK for short-term use for Jet lag in adults (this is not a formulary indication). |
| Dosing information | |
|
Route of administration |
Oral |
|
Initial trial: 7 to 14 days
|
3mg tablets daily |
| Assess response and adjust dose |
If non response (delayed time to sleep onset, disturbed sleep, early morning awakening), increase to 6mg or 9mg (maximum dose). |
| Stabilise the patient on therapy |
Supply medicine for one further month after the dose has stabilised |
| Review |
Stop melatonin for 1 week during a non-stressful period; repeat the sleep diary and review. |
| Adjunctive treatment |
Behavioural measures and sleep diaries. |
| Treatment duration |
Indefinite if significant sleep problem persists and patient continues to benefit. |
| Discontinuation |
Discontinue if ineffective. Provide necessary supervision and support during drug discontinuation phase. Withdrawal of melatonin can be immediate. Monitor for recurrence of sleep disorders, depending on the frequency of use. |
As this group of patients move into adult care, consideration should be given to continuation of their therapy. If therapy continues beyond children’s services, care should be transferred to young persons or adult services as appropriate. The principles in this guideline apply equally to this group of patients as they become adults.
TAM (Treatments and Medicines) NHS Highland