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
If, after consideration of the use of non-pharmacological measures, hypnotics are considered necessary, limit their use to short periods of time only (1 to 4 weeks). Establish cause of insomnia. Be aware of drug and alcohol use and educate on realistic sleep patterns. Patient information leaflets are available from www.rcpsych.ac.uk and www.moodjuice.scot.nhs.uk. In most cases, hospital patients should only be discharged home with a supply of hypnotics if they were admitted on them and there is good reason to continue. This is particularly important for older patients. The use of hypnotics with a long half-life such as nitrazepam (non-Formulary) is not recommended as they often result in a hangover effect and may lead to accumulation, particularly in older people. Sedative antihistamines are not recommended.
Long-term hypnotic use is associated with falls, road traffic accidents and hip fractures. For advice on managing long-term hypnotic use refer to ‘Prescribing of Hypnotics’ GMS prescribing protocol and to BNF.
Be aware or gain reassurance that the person being prescribed benzodiazepines is not diverting or purchasing/acquiring medicines privately.
NICE guidance April 2004 (www.nice.org.uk) recommends that switching from one hypnotic to another should only occur if a patient experiences adverse effects thought to be directly related to a specific agent. Patients who have not responded to one hypnotic should not be prescribed any of the others.
For information on the use of melatonin in children and adolescents see Sleep onset difficulty guidance.
MHRA advice: Zolpidem: risk of drowsiness and reduced driving ability the next day (December 2014) (www.gov.uk)
Tablets 5mg, 10mg
10mg at bedtime. Older or debilitated patients 5mg at bedtime.
Tablets 3·75mg, 7·5mg
7·5mg at bedtime. Older or debilitated patients initially 3·75mg at bedtime increased if necessary.
MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
Tablets 10mg (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Oral solution 10mg/5mL (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Tablets 3mg (specialist recommendation only)
Ceyesto brand is the cost-effective choice. It is licensed for: Insomnia in children and adolescents aged 6-17 years with ADHD, where sleep hygiene measures have been insufficient.
To be used for sleep onset difficulties in children as per Sleep onset difficulty guidance.
In swallowing difficulties the tablets can be crushed and mixed with a small amount of water or soft food for administration.
For patients with enteral feeding tubes, a polypharmacy review should be conducted and, if melatonin is to be continued, advice from the Community Paediatrician should be sought for suitable formulations. See Highland unlicensed/off-label medicines list.
TAM (Treatments and Medicines) NHS Highland