Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |
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
Base selection on the likely cause, mechanism of action of the drugs available, the side-effect profile of each drug, interactions and concomitant conditions. The information table is not fully comprehensive, for further information refer to guidance below and/or BNF/manufacturers Summary of Product Characteristics:
DRUG CLASS/ ANTIEMETIC |
CAUTION/ CONTRA-INDICATIONS |
GOOD FOR NAUSEA CAUSED BY/OTHER USES |
|
ANTIHISTAMINES |
|||
CYCLIZINE |
Caution Severe heart failure or acute myocardial infarction; may counteract the beneficial haemodynamic effects of opioids. Anticholinergic** |
Movement, ↑ intracranial pressure, mechanical bowel obstruction, post-operative. |
|
PROMETHAZINEQT |
Caution Strongly anticholinergic** |
Movement |
|
PHENOTHIAZINES AND RELATED DRUGS |
|||
PROCHLORPERAZINEQT |
Caution Balance disturbances in older people; may often lead to drug-induced Parkinson’s disease, postural hypotension and mental confusion. Strongly anticholinergic** |
Contra-indication Prochlorperazine injection is considered inappropriate for patients with reduced consciousness due to its tendency to deepen any state of sedation. |
Movement, post-operative.
Buccal formulation available. |
LEVOMEPROMAZINEQT |
Caution Risk of postural hypotension; avoid in ambulant patients over 50 years, unless a risk of hypotensive reaction has been assessed. Anticholinergic** |
Palliative care. |
|
DOMPERIDONE AND METOCLOPRAMIDE |
|||
DOMPERIDONEQT
|
Caution Does not readily cross the blood brain barrier and less likely to exhibit extra-pyramidal effects and sedation compared with metoclopramide, however caution is still recommended in the young, very old and debilitated. Risk of cardiac side-effects; for short term use only (up to 7 days). |
Contra-indication Cardiac conduction is, or could be impaired, or where there is underlying cardiac disease, when administered concomitantly with drugs that prolong the QT interval or potent CYP3A4 inhibitors, and in severe impairment. Gastro-intestinal obstruction. |
Drug induced (eg emergency hormonal contraception, opioids, chemotherapy).
Only antiemetic advised for use in Parkinson’s disease.
Prokinetic. |
METOCLOPRAMIDEQT |
Caution in young, very old and debilitated, due to extrapyramidal effects. Risk of neurological side-effects (up to 5 days only). Anticholinergic** |
Contra-indicated in gastro-intestinal obstruction, post bowel surgery and in Parkinson’s disease. Avoid where emesis and melaena are present. |
Opioids and gastric/hepatic/biliary disease (not GI obstruction).
Prokinetic. |
5HT3 RECEPTOR ANTAGONIST |
|||
ONDANSETRONQT |
Caution Increased large bowel transit time; constipation can be a problem. |
Post-operative, radiotherapy and chemotherapy, palliative care. |
|
HYOSCINE |
|||
HYOSCINE HYDROBROMIDE |
Caution Sedation can be a problematic side-effect if driving or operating machinery. Strongly anticholinergic** |
Motion sickness, bowel obstruction, palliative care. |
|
OTHER |
|||
DEXAMETHASONE |
Caution if history of peptic ulcer disease/ concurrent NSAIDs. Monitor capillary blood glucose in patients with diabetes. |
Post-operative, chemotherapy, ↑ intracranial pressure. Appetite stimulant. |
|
HALOPERIDOLQT |
Caution Requires a baseline ECG prior to treatment and consider the need for ongoing ECG monitoring. Anticholinergic** |
For palliative care (opioid-induced and metabolic causes). |
|
LORAZEPAM |
Caution Addictive potential. |
Short-term use in anticipatory nausea and vomiting. |
QT Avoid in patients with congenital long QT interval. Prolongs QT interval and/or causes torsades de pointes.
See Credible Meds
** Consider the cumulative anticholinergic burden of all medicines. Anticholinergic side-effects include increased risk of urinary retention, falls, BP reduction, confusion, sedation, dementia, glaucoma etc.
(see http://www.uea.ac.uk/mac/comm/media/press/2011/June/Anticholinergics+study+drug+list).
Abbreviation | Meaning |
ECG | Electrocardiogram |
QT | Q and T are 2 points on an electrocardiogram |
BP | Blood pressure |