- Reduce incidence of complications (Polypharmacy Guidance8);
- symptomatic hyperglycaemia control (avoidance of polyuria, dehydration, fatigue and renal insufficiency); and
- avoidance of osmotic symptoms and reduced symptomatic hyperglycaemia.
News coverage of the transition of the Right Decision Service to Healthcare Improvement Scotland and launch of the Once for Scotland RDS platform:
Redesign of the Right Decision Service homepage, browse and search capabilities is now underway. This builds on stakeholder feedback and the consultation workshops held in December 2023. The intention is to go live with these improvements in April 2024.
The last three apps are now in the process of migration to the new Right Decision Service platform –
All other apps have now been successfully migrated.
A few examples of toolkits published to live in the last two months include:
Some of the toolkits the RDS team is currently working on:
The toolkits which are published to the RDS are currently password-protected while they undergo testing. Please contact email@example.com if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
We have recently created a learning and support toolkit on the RDS website. This toolkit provides guidance, videoclips and links to tools and resources to support:
The RDS Learning Group is now working on a train the trainer package to support further development of RDS editor skills.
In late November 2023, the RDS team issued a questionnaire based on the quality criteria outlined in the RDS standard operating procedures . Thank you to all of you who responded to the questionnaire. We will be following up with each of you to discuss next steps and will be contacting non-respondents.
Usage statistics to the end of December 2023 have now been produced for all RDS toolkits and apps. Please contact firstname.lastname@example.org if you would like to access the usage stats for your toolkit. There has been a 71% increase in usage of all RDS resources in 2023 compared with 2022.
The RDS team is also working with the Digital Health and Care Innovation Centre on a series of stakeholder interviews and case studies to understand the impact of RDS on knowledge, behaviours and practice.
NHS National Services Scotland has fully tested and approved the most recent update of the high risk prescribing decision support system based on the national polypharmacy guidance. Roll-out of this system across NHS Tayside and NHS Lothian is planned to start from April, with research evaluation by University of Dundee. Initial pilots are also in early stages in NHS Dumfries and Galloway and NHS GGC, and are planned for NHS Forth Valley and NHS Ayrshire and Arran.
The Right Decision Service team is working with partners in NHS Boards and Scottish Government to develop three national calculators:
The RDS team has support from an improvement expert for a few months to help to develop implementation models for our citizen-facing and shared decision-making decision support tools- - including the Manage Medicines toolkit for patients and carers and Being a partner in my care. The implementation models will be based on implementation science methods and tests of change in a number of pilot sites. The approach includes outreach to public libraries to develop their role in signposting and support for use of these toolkits in the community.
If you have any questions about the content of this newsletter, please contact us on email@example.com
The benefits of intensive treatment of T2DM should be balanced against the risk of potential hypoglycaemia and the consequence of falls, fractures and hospitalisation.
A frailty assessment should be a routine component of a diabetes review for all older adults, considering comorbidities, dementia or limited life expectancy.
A number of international guidelines on the management of diabetes in the older and/or frailer adult have been published with recommendations based on consensus opinion.50 This expert working group, together with a review by the polypharmacy short life working group, recommend an assessment of frailty taking a person-centred approach and using the Rockwood Clinical Frailty Scale (CFS)51 to set individualised glycaemic targets. Any targets set should also take into consideration patient safety and the balance of risk and benefit of intensive treatment. In patients with a higher level of frailty tight blood glucose levels may not be appropriate, and a more appropriate target should be set with the individual. This may result in medicines reduced or stopped where they are causing more harmful side effects than the potential for long-term benefits.
See case study 5
There should be a low percentage of those aged 75 years or over prescribed sulfonylureas (SU).
This indicator continues to show that there are high levels of SU prescribing in those aged 75 years or over. Although this has reduced, current data shows that across Scotland a significant proportion of those aged 75 years or over are still being prescribed an SU, increasing their risks of hypoglycaemia and subsequent falls and hospitalization.
Other therapies are available with long term outcome data and lower risk of hypoglycaemia that may be more appropriate.