Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
The following toolkits are now live;
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.
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.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
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
The 2019 Scottish Health Survey highlights inequalities in the prevalence of doctor diagnosed diabetes in Scotland.4
Socio-economic inequalities in prevalence have increased progressively since 2003. Compared to those living in areas of lower deprivation, people with diabetes living in areas of higher deprivation in Scotland were more likely to develop fatal or critical care unit-treated COVID-19.63 In the UK, T2DM is approximately 3-5 times higher in ethnic minority groups.64
It is also important to note that people from deprived communities take more medicines than those from less deprived communities and therefore the medication treatment burden for these individuals is higher. The figure below shows comparison of medication burden across age groups, by level of deprivation.
A number of cultural barriers have been identified that impact on minority ethnic groups accessing diabetes services, which will include regular review of prescribing and monitoring. These include:
The design and delivery of T2DM services can advance equity and inclusion for those most disadvantaged. As reported in Diabetes: my information, my support, digital access may not be suitable for all.
“Variable access to the internet and weak telephone signal mean that I can have difficulty in getting online or using a video call. The question of alternatives to digital access have to be available for those in digital poverty.” Person with lived experience, from Diabetes; my information, my support11
The following table outlines approaches that can support improved care and outcomes for disadvantaged groups.
Approach |
Principle |
Actions |
|
Human Rights Based Approach (HRBA) |
Adapted from Scottish Human Rights Commission Aligns to the values of realistic medicine and person-centred care |
Service design targeted at the people who need it most, through:
|
|
Cultural competency |
Understanding the key issues relating to culture, influencing the access to and experiences of care |
Health workers should gain culturally competent knowledge of different cultures Information should be available in individuals' first language to support their treatment Discussion of medication taking during Ramadan. Consider adaptations to ethnic foods to empower patients to adopt healthy lifestyles rather than to abandon familiar foods |
| Trauma-informed service design68 | Traumatic events are more frequently experienced by people in low socio-economic groups and from black and minority ethnic communities | Everyone in the Scottish workforce has a role to play in understanding and responding to people affected by trauma. Some will be specialists/ enhanced workers, but all should be informed or skilled to respond to those affected by trauma. |
| Co-designed services | Co-designed services are more likely to be acceptable to both providers and end users, and therefore adopted and sustained | Ensuring underrepresented and disproportionately affected groups are part of this process and development |
|
Digital inclusion |
In line with the Digital Health and Care Strategy69 Availability of digital services, such as MyDiabetesMyWay will undoubtedly improve service access, engagement and self-management |
Include individuals at the heart of digital transformation of services Ensure the infrastructure exists in health boards to digitize services |
|
Others |
Impact assessments Links to wider determinants of health |
Type 2 diabetes prescribing