Important: Therapy
Trimethoprim oral 200mg 12 hourly (3 days)
or
Nitrofurantoin oral 100mg MR 12 hourly (3 days)
Welcome to the Right Decision Service (RDS) newsletter for April 2024.
Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.
Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.
Thank you for your patience and understanding while we achieve a full resolution.
A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.
The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.
The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.
Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.
These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.
Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.
Figure 1: Impact of RDS on direct delivery of care
Key figures
Figure 2 shows RDS impact to date on delivery of health and care services
Key figures
These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.
Saving time and money
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
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.
Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.
Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
See under infection type
Trimethoprim oral 200mg 12 hourly (3 days)
or
Nitrofurantoin oral 100mg MR 12 hourly (3 days)
Trimethoprim oral 200mg 12 hourly (7 days)
or
Nitrofurantoin oral 100mg MR 12 hourly (7 days)
Initial treatment
Amoxicillin 1g IV 8 hourly
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use gentamicin calculator. Max 3 days then review.
Second line: Ciprofloxacin oral 500mg 12 hourly. Consider giving initial dose as 400mg IV.
Adjust therapy on basis of culture results or discuss with microbiology.
Total duration (IV&oral) = 7 days then review.
In Pregnancy, see Specialist Obstetric Guideline via NHSB Intranet.
Catheter Specimens
In catheterised patients, the bladder quickly becomes colonised. Microscopy and/or “dip-stick” testing is unhelpful as WBC, rbc, nitrate and protein may all be positive when the bladder is colonised.
Catheter urine samples should be sent for culture and sensitivities only if patient is febrile or systemically unwell and bladder is the likely source.
If possible, remove catheter. Treat only if systematically unwell. If treating, the catheter should be changed.
Changing of long term urinary catheter
First choice
Gentamicin
Dose: 3 mg/kg (lean body weight) up to a maximum of 320 mg IV single dose
or
Second choice
Trimethoprim
Dose: 200mg orally single dose
Initial treatment of CAUTI
Amoxicillin 1g IV 8 hourly
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use gentamicin calculator. Max 3 days then review.
Penicillin Allergy
Vancomcin IV (Dosing as per guideline. Use vancomycin calculator.)
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use gentamicin calculator. Max 3 days then review.
Adjust therapy on basis of culture results or discuss with microbiology.
Total duration (IV&oral) = 7 days then review
First line: Ciprofloxacin oral 500mg 12 hourly for 14 days. Reassess at 14 days, if symptoms completely resolved stop otherwise complete 28 days total.
or
Second line. Only if urine culture shows sensitivity: Trimethoprim oral 200mg 12 hourly for 14 days
Review antibiotic treatment after 14 days and either stop antibiotics or continue for a further 14 days if needed (based on assessment of history, symptoms, clinical examination, urine and blood tests).
Chronic Prostatitis requires investigation before antimicrobials are started; only 10% of cases are caused by infection
Whenever possible, a specimen of urine should be collected for culture and sensitivity testing before starting antibacterial therapy. The therapy should reflect current local antibacterial sensitivity patterns.
In general asymptomatic bacteriuria in the elderly should not be treated with antibiotics. “Dip-stick” results are only helpful in MSU.
Remember genital tract sites e.g. vagina, prostate, may give rise to WBC on specimen microscopy.
Please contact a Nephrologist immediately if a kidney transplant patient is found to have a urinary tract infection.
Nitrofurantoin is contraindicated in patients with an eGFR<45ml/min. A short course (3-7days) may be used with caution in certain patients with an eGFR of 30-44ml/min. Only prescribe to such patients to treat lower UTI if indicated by Microbiology results and only if potential benefit outweighs risks.
Trimethoprim should be used with caution in patients with eGFR less than 30mL/min/1.73m2, refer to BNF for dose adjustments in renal impairment.
Fluroquinolones
Refer to important safety information for all quinolones prior to prescribing.
See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as: