Nephrotoxicity:
- Dose-dependent
- Ensure good hydration
- Avoid co-prescription of nephrotoxins (e.g. furosemide)
Teicoplanin is considered to be LESS nephrotoxic than vancomycin
Other:
- Drug fever
- Skin reactions
- Ototoxicity
- Eosinophilia
- Leucopenia
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
This guidance is for OPAT and ward staff initiating thrice-weekly dosing of teicoplanin.
It is only approved for ward use in patients who have been accepted by the OPAT service. Other regimens/target trough levels are used in other services (e.g. oncology, paediatrics, Hospital@Home etc).
Exclusions and contraindications
Caution: Non-anaphylactic allergy to Vancomycin
A prior history of "red man syndrome" with vancomycin is NOT a contraindication to the use of teicoplanin
Required monitoring
If renal function changes significantly, re-calculate creatinine clearance & dose.
Nephrotoxicity:
Teicoplanin is considered to be LESS nephrotoxic than vancomycin
Other:
Where possible, double check your calculations with the ward pharmacist before prescribing.
1. Calculate the patient's creatinine clearance
2. Decide on using Ideal or Actual body weight
3. Prescribe Teicoplanin loading doses (Daily for first 3 days)
Using the table below, based on the calculated creatinine clearance, to choose the mg/kg dose that applies to your patient.
Prescribe the recommended dose daily for 3 days.
|
Creatinine Clearance (ml/min) |
Ideal/Actual body weight |
||
40-59 kg |
60-79 kg |
>80 kg |
||
Teicoplanin loading dose |
<60 |
1000 mg |
1200 mg |
1400 mg |
Teicoplanin loading dose |
≥60 |
1200 mg |
1400 mg |
1600 mg |
Choose which day you want maintenance doses to start (Monday is preferred):
Loading doses to be given on |
First trough level & maintenance doses start day |
Wed/Thurs/Fri |
Monday |
Fri/Sat/Sun |
Wednesday |
Sun/Mon/Tues |
Friday |
4. Prescribe Teicoplanin maintenance dosePrescribe maintenance dose based on Creatinine Clearance from table below on Monday, Wednesday & Friday:
Creatinine Clearance (ml/min) | Teicoplanin maintenance dose |
<25 | 400 mg |
25-40 | 600 mg |
41-54 | 800 mg |
55-74 | 1000 mg |
75-89 | 1200 mg |
90-104 |
1400 mg |
105-120 | 1600 mg |
>120 | 1800 mg |
5. Document on TRAK the calculation
TRAK short code \teicopat
-----------------------
TEICOPLANIN DOSING CALCULATIONS
Height (cm):
Weight (kg):
Creatinine (mmol/L):
IDEAL or ACTUAL (specify) body weight used in calculations (kg):
Loading doses (give once daily for 3 days):
Loading days:
Maintenance dosage:
Day of first maintenance dose:
Teicoplanin trough level is 20-30 mg/L
Teicoplanin Trough |
Advice |
<15 | Very low; discuss with pharmacist |
15 - 20 | Low; increase maintenance dose by 200mg |
20 - 30 | In range |
30 - 35 | High; decrease maintenance dose by 200mg |
>35 | Very high; discuss with pharmacist |
Additionally, consult with pharmacist if:
Lamont et al. Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187
Summary of Product Characteristics, Targocid 400mg