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
MHRA advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019) (www.gov.uk).
MHRA advice: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents (June 2020) (www.gov.uk).
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
First line for atrial fibrillation
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
Tablets 15mg, 30mg, 60mg
Embolism prophylaxis for patients with non-valvular atrial fibrillation
Second line for atrial fibrillation
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
Tablets 2·5mg, 5mg
Embolism prophylaxis for patients with non-valvular atrial fibrillation
Prophylaxis of venous thromboembolism following knee and hip replacement surgery, 2·5mg twice daily, refer to SPC.
Treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE): 10mg twice daily for the first 7 days then 5mg twice daily, refer to SPC, also refer to Clinical Decision Algorithm for Suspected Leg DVT.
Second line for atrial fibrillation
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
Capsules 110mg, 150mg
Embolism prophylaxis for patients with non-valvular atrial fibrillation
Prophylaxis of venous thromboembolism following knee and hip replacement surgery, 220mg once daily, refer to SPC.
Treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE): 150mg twice daily, refer to SPC, also refer to Clinical Decision Algorithm for Suspected Leg DVT
First line for prevention and treatment of DVT/PE
Second line for atrial fibrillation
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
MHRA advice: After transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial (October 2018) (www.gov.uk).
MHRA advice: Rivaroxaban (Xarelto): reminder that 15mg and 20mg tablets should be taken with food (July 2019) (www.gov.uk).
Tablets 10mg, 15mg, 20mg
Prophylaxis of venous thromboembolism following knee and hip replacement surgery, 10mg once daily, refer to SPC.
Treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE): Also see Clinical Decision Algorithm for Suspected Leg DVT. Dose is 15mg twice daily for 21 days followed by 20mg daily thereafter. Refer to SPC for dose adjustments, especially in reduced renal function.
Embolism prophylaxis for patients with non-valvular atrial fibrillation
Multiple myeloma to counteract the prothrombotic effect of immune modulating drugs (specialist haematology use only) off-label,10mg once daily.
Tablets 2∙5mg (specialist initiation only as per CAD/PAD guideline)
Third line for atrial fibrillation
MHRA advice: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (October 2020) (www.gov.uk).
If commencing warfarin for treatment of VTE, low molecular weight heparin (LMWH) is usually administered for at least 5 days AND until adequate oral anticoagulation is established (INR in therapeutic range (>2·0) for 48 hours).
Note: warfarin commenced at high dose has an initial pro-coagulant effect, so cover with LMWH is mandatory.
Rapid warfarin induction carries potential risks of over-anticoagulation and bleeding. Slow induction is preferable, commencing with 1 to 2mg daily. Refer to warfarin guideline for more detailed advice and recommended INR ranges for therapeutic control (usually 2·5, range 2·0 to 3·0 for DVT). Take into account patient circumstances (risk of falls, alcoholism, drug abuse etc) when deciding on appropriate range, and seek advice from Haematology, if unsure.
If LMWH is given for more than 5 days, assess renal function and alter dose if impaired. Check baseline platelet count and, if required, monitor for up to 14 days for heparin-induced thrombocytopenia.
INR must be monitored at the start of warfarin therapy, frequently in the initiation phase and regularly thereafter.
Refer to BNF for contraindications or complications.
Tablets 500 micrograms, 1mg, 3mg
Venous thromboembolism (VTE) and pulmonary embolism (PE), see warfarin anticoagulant guidance and for in-patients refer to additional guidance on the NHS Highland In-patient Oral Anticoagulant Prescription Chart (intranet access required)
Deep venous thrombosis (DVT) see Clinical Decision Algorithm for Suspected Leg DVT
Embolism prophylaxis for patients with non-valvular atrial fibrillation
Metal valves – refer to BCSH Guidelines on oral anticoagulation with warfarin – 4th edition
Tablets 5mg (not recommended)
No longer recommended for the general population to avoid confusion with the 500 microgram (0·5mg) tablet. There may however be some patients whose risk/benefit is to continue to use the 5mg tablet.
TAM (Treatments and Medicines) NHS Highland