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
For preseptal or periorbital cellulitis see Ophthalmology guidance: periorbital or preseptal cellulitis
Treatment
Flucloxacillin (IV or oral)
If true penicillin allergy:
Clindamycin (IV or oral)
Duration: 7 days
Seek surgical review. Urgent surgical debridement is crucial.
Theatre specimens should be sent for microscopy and culture to help determine aetiology. Contact microbiology labs to arrange urgent examination.
Meropenem IV (Maximum dose)
Plus
Clindamycin IV (Maximum dose)
The primary treatment for this condition is urgent surgical debridement.
Antibiotics have only a secondary role in therapy.
Gangrene develops in anaerobic areas with limited blood flow. Therefore, antibiotics do not penetrate and only protect contiguous areas.
Benzylpenicillin IV
Plus
Clindamycin IV
If true penicillin allergy:
Vancomycin IV
Plus
Clindamycin IV
Give antibiotic prophylaxis in all human, cat, dog and puncture bites, especially when hand, foot, face, joint, tendon, ligament involved; or when patient immunocompromised, diabetic, asplenic, cirrhotic, presence of prosthetic valve or prosthetic joint
If accompanied by marked cellulitis consider parenteral antibiotic therapy and seek plastic surgery advice.
Wound care and irrigation is very important
Consider tetanus prophylaxis
Assess risk of tetanus; HIV; hepatitis B&C; in human bites and rabies in animal bites
If bite was sustained abroad or if any other animal was involved, seek Microbiology advice
Co-amoxiclav IV or Oral
If true penicillin allergy:
Co-trimoxazole Oral
Plus
Metronidazole Oral
Duration: 7 days
Clean procedure
Flucloxacillin IV
If true penicillin allergy:
Clindamycin IV
If MRSA risk:
Vancomycin IV
Contaminated procedure
Co-amoxiclav IV
If MRSA risk:
Add Vancomycin IV
If true penicillin allergy:
Vancomycin IV
Plus
Ciprofloxacin IV (before prescribing review MHRA Safety Advice )
Plus
Metronidazole IV
Send a wound swab for culture prior to initiating treatment. Further therapy should be guided by laboratory results.
Take blood cultures and send joint aspirates for culture before starting empirical antibiotic therapy.
Cefotaxime IV
If true penicillin allergy:
Contact Microbiology
Initial intravenous therapy for 14 days, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav
Flucloxacillin IV
Plus
Clindamycin IV
If true penicillin allergy:
Clindamycin IV
Initial intravenous therapy for 72 hours, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav
In all cases seek specialist orthopaedic advice at the outset.
Do not start antibiotic therapy until appropriate samples have been obtained for culture.
In children >3 months to 5 years of age consider Kingella kingae. If unresponsive to initial therapy consider changing to ceftriaxone.
Seek specialist orthopaedic advice.
Appropriate specimens should be taken for culture prior to starting therapy
Antimicrobial prescribing: NHS Fife