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
09/12/21 - Dexamethasone soluble tablets 2mg, 4mg, 8mg removed
Prednisolone has predominantly glucocorticoid activity (anti-inflammatory) and is the most commonly used corticosteroid for long-term administration (see also Inhaled corticosteroids (ICS) for use in asthma/COPD and Drugs used in rheumatic diseases and gout for use in rheumatic diseases). There is no evidence that the use of enteric-coated tablets prevents peptic ulceration. Dexamethasone is mainly used where mineralocorticoid activity is undesirable (eg in cerebral oedema) and for the prevention or treatment of nausea and vomiting induced by chemotherapy or opiates (see Drugs used in nausea and vertigo). Hydrocortisone is used for replacement therapy in adrenal insufficiency.
Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card. This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids. For more information, including which patients should receive the card, see HIS for details. Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.
| Note: Issue steroid cards with long-term therapy. |
See Peri-operative guidelines for patients with or at risk of adrenal insufficiency
Soluble tablets 500 micrograms
For use of betamethasone soluble tablets in oral ulceration or inflammation refer to Drugs acting on the orpharynx off-label.
Injection 4mg/mL
Tablets 500 micrograms, 2mg, 4mg
The tablets can be swallowed whole or dispersed in a little water prior to use off-label.
Oral solution (as sodium phosphate) 2mg/5mL
Injection (as sodium phosphate) 3·3mg/mL, 6·6mg/2mL
For use of hydrocortisone oromucosal tablets in oral ulceration or inflammation, refer to Drugs acting on the oropharynx.
Tablets 10mg, 20mg
By mouth, replacement therapy, 15 to 25mg daily in 2 to 3 divided doses. Take the first dose on waking in the morning and the last dose early in the evening.
Injection (as sodium succinate) 100mg
For routine intravenous use, hydrocortisone sodium succinate injection is preferred as hydrocortisone sodium phosphate injection can cause paraesthesia and pain following intravenous injection.
Injection (as sodium phosphate) 100mg/mL, 500mg/5mL
For routine intravenous use, hydrocortisone sodium succinate injection is preferred as hydrocortisone sodium phosphate injection can cause paraesthesia and pain following intravenous injection.
MHRA advice: Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40mg): do not use in patients with cows' milk allergy (October 2017) (www.gov.uk).
Tablets 100mg
Injection (as sodium succinate) 40mg, 1 gram
MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk).
Tablets 1mg, 5mg, 25mg
Where possible, avoid use of the high-cost prednisolone tablets 25mg.
Soluble tablets 5mg
Liquid 10mg/mL
TAM (Treatments and Medicines) NHS Highland