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
Long-acting depot injections are used for the patient’s convenience or to improve compliance. They may produce more extrapyramidal reactions than oral preparations. For traditional depot preparations (flupentixol, fluphenazine, haloperidol and zuclopenthixol decanoate) the BNF recommends giving a test dose as some side-effects are prolonged. The drug is dissolved in oil and, when injected into muscle, it slowly comes out of the oil and into the bloodstream over a period of up to 6 weeks. Peak levels are achieved within 10 days. Steady blood levels are achieved by 6 to 12 weeks, depending on which drug is used.
Solution for injection (oily) 20mg/mL, 40mg/2mL,100mg/mL, 200mg/mL
By deep intramuscular injection into the upper outer buttock or lateral thigh, test dose 20mg, then after at least 7 days 20 to 40mg repeated at intervals of 2 to 4 weeks, adjusted according to response; maximum 400mg weekly; usual maintenance dose 50mg every 4 weeks to 300mg every 2 weeks. Older people, initially quarter to half adult dose.
Solution for injection (oily) 50mg/mL, 100mg/mL
By deep intramuscular injection into the gluteal muscle, initially 50mg every 4 weeks, if necessary increasing by 50mg increments to 300mg every 4 weeks; higher doses may be needed in some patients. Older people, initially 12·5 to 25mg every 4 weeks.
Solution for injection (oily) (Clopixol®) 200mg/mL, 500mg/mL
By deep intramuscular injection into the upper outer buttock or lateral thigh, test dose 100mg, followed after at least 7 days by 200 to 500mg or more, repeated at intervals of 1 to 4 weeks, adjusted according to response; maximum 600mg weekly. Older people, quarter to half usual starting dose.
MHRA advice: Aripiprazole (Abilify and generic brands): risk of pathological gambling (December 2023) (www.gov.uk).
Powder and solvent for prolonged-release suspension for injection vial (Abilify Maintena®) 400mg, pre-filled syringe 400mg (s)
By deep intramuscular injection into the gluteal muscle, 400mg repeated at monthly intervals (minimum 26 days between injections). Continue treatment with 10 to 20mg of oral aripiprazole for 14 consecutive days after the first injection. For dose adjustments due to side- effects, concomitant use of interacting drugs or missed depot doses, consult SPC.
MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk)
MHRA advice: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery (December 2014) (www.gov.uk)
Powder and solvent for suspension for injection (Risperdal Consta®) 25mg, 37·5mg, 50mg
By deep intramuscular injection into the deltoid or gluteal muscle, patients taking oral risperidone up to 4mg daily, initially 25mg every 2 weeks; patients taking oral risperidone over 4mg daily, initially 37·5mg every 2 weeks; dose adjusted at intervals of at least 4 weeks in steps of 12·5mg to maximum 50mg (older people 25mg) every 2 weeks.
MHRA advice: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery (December 2014) (www.gov.uk)
Suspension for injection, pre-filled syringe (Xeplion®) 50mg, 75mg, 100mg, 150mg (s)
By deep intramuscular injection into the deltoid muscle, 150mg on day 1, then 100mg on day 8, then adjusted at monthly intervals according to response; recommended maintenance dose 75mg (range 25 to 150mg) monthly.
Prolonged-release suspension for injection, pre-filled syringe (Trevicta®) 175mg, 263mg, 350mg, 525mg (s)
By deep intramuscular injection into the deltoid muscle,
for 3-monthly maintenance treatment in patients who are clinically stable on 1-monthly paliperidone injection; refer to SPC.
TAM (Treatments and Medicines) NHS Highland