Nephrotoxicity:
- Dose-dependent
- Ensure good hydration
- Avoid co-prescription of nephrotoxins (e.g. furosemide)
Other:
- Drug fever
- Eosinophilia
- Neutropenia (after cumulative dose of 25g)
- Tinnitus (discontinue)
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 NHS Lothian staff wishing to use Vancomycin for adults.
DO NOT USE UNLESS ONLINE CALCULATOR IS UNAVAILABLE
Document doses and plan in TRAK using \vanc. If possible double-check with ward pharmacist. When online calculator is available, transcribe calculations onto chart.
Exclusions and contraindicationsDo not use this guidance in the following groups:
Contraindication:
Cautions:
Required monitoring
Nephrotoxicity:
Other:
1. Calculate Loading dose
This is based on the patient’s actual body weight.
Prescribe as a STAT dose
Actual body weight (kg) |
Dose (mg) |
Volume of sodium chloride 0.9% (Maximum concentration 5mg/ml) |
Duration of infusion |
<40 |
750 |
250ml |
1.5 hours |
40–59.9 |
1000 |
250ml |
2 hours |
60–90 |
1500 |
500ml |
3 hours |
>90 |
2000 |
500ml |
4 hours |
2. Calculate the patient's creatinine clearance
3. Calculate Maintenance doses
Maintenance dose depends on the patient’s Creatinine Clearance (Cockcroft-Gault)
CrCl (ml/min) |
Dose, volume of sodium chloride 0.9%*, duration |
Dosing Interval |
Time for 1st Trough level |
<20 |
500mg in 250ml over 1 hour |
48 hours |
Before 1st maintenance dose |
20-29 |
500mg in 250ml over 1 hour |
24 hours |
Before 2nd maintenance dose |
30-39 |
750mg in 250ml over 1.5 hours |
24 hours |
Before 2nd maintenance dose |
40-54 |
500mg in 250ml over 1 hour |
12 hours |
Before 3rd maintenance dose |
55-74 |
750mg in 250ml over 1.5 hours |
12 hours |
Before 3rd maintenance dose |
75-89 |
1000mg in 250ml over 2 hours |
12 hours |
Before 3rd maintenance dose |
90- 110 |
1250mg in 250ml over 2.5 hours |
12 hours |
Before 3rd maintenance dose |
>110 |
1500mg in 500ml over 3 hours |
12 hours |
Before 3rd maintenance dose |
3. Missed/delayed doses
If Dose delayed <1 hour after prescribed time, nursing staff can administer
Length of delay |
Recommended action |
More than 1 hour; Less than halfway to next dose (i.e. <6h if on if on 12h dosing) |
Re-prescribe missed dose as once only/STAT. Give the next vancomycin dose at the ORIGINALLY PRESCRIBED TIME |
More than 1 hour; More than halfway to next dose (i.e. >6h if on if on 12h dosing) |
Re-prescribe missed dose as once only/STAT. Seek advice from pharmacy for further dosing. |
4. Review ongoing need
If vancomycin is to be continued, monitor trough every 48-72 hours or as advised by the pharmacist
Recommended target trough levels:
10-15 |
15-20 |
|
Typically “deep seated” infections
|