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
Capsaicin cream unlicensed (Drugs for relief of soft-tissue disorders and topical pain relief) is used in post-herpetic neuralgia, carbamazepine (Antiepileptics) in trigeminal neuralgia and pregabalin (Antiepileptics) in neuropathic pain – see note box below.Note Fibromyalgia: Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain
• Note: Pregabalin should be restricted to use for peripheral neuropathic pain in adults who have not responded to or tolerated conventional first and second-line treatments. Discontinue treatment if the patient has not shown sufficient benefit within 8 weeks of reaching the maximally tolerated therapeutic dose. Optimise tablet strength and use twice-daily dosing to minimise cost. Restrict use of the oral solution to those patients who find it difficult to or are unable to swallow tablets. See Antiepileptics for antiepileptic use.• Note: Gabapentin and pregabalin have the potential for misuse and careful review of some patients’ motivation in asking for them is required; refer to SIGN 136 Management of chronic pain (www.sign.ac.uk).
Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain.
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Oral solution 25mg/5mL, 50mg/5mL off-label
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Tablets 10mg, 25mg off-label
Neuropathic pain if amitriptyline is poorly tolerated: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
The levels of propylene glycol, acesulfame K and saccharin sodium may exceed the recommended WHO daily intake limits if high doses of gabapentin oral solution (Rosemont brand) are given to adolescents or adults with low body-weight (39 to 50kg)—consult product literature.
MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019) (www.gov.uk).
MHRA advice: Gabapentin (Neurontin®): risk of severe respiratory depression (October 2017) (www.gov.uk).
Capsules (CD schedule 3) 100mg, 300mg, 400mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
Tablets (CD schedule 3) 600mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
MHRA advice: Duloxetine: marketed as Cymbalta▼ and Yentreve▼ for different disorders (December 2014) (www.gov.uk).
Diabetic peripheral neuropathic pain after failure of simple analgesics and local measures, and where treatment with amitriptyline (uptitrated) and then with gabapentin has been ineffective or unsuitable: 60mg once daily.
If ineffective, some patients may benefit from 60mg twice daily maximum. Discontinue if inadequate response after 2 months; review treatment at least every 3 months.
TAM (Treatments and Medicines) NHS Highland