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
Source control through drainage of pus or surgical resection provides optimal treatment; consider referral for surgical assessment.
Organisms:
Community associated diarrhoea – viruses, Campylobacter and C. difficile
Intra-abdominal infections are often polymicrobial with enterobacteriaceae, anaerobes, Streptococci, enterococci.
Investigations:
Stool culture and C.difficile testing if diarrhoea.
Blood cultures if febrile
No antimicrobials recommended (East Region Formulary).
Consider C. difficile as a differential diagnosis in all patients presenting with abdominal pain. Diarrhoea is not always present in severe infection where the white cell count can be raised and abdominal pain and guarding and signs of ileus are present.
Take bloods and use East Region Formulary https://www.formulary.nhs.scot/east/infections/gastro-intestinal/clostridioides-difficile/ for appropriate treatment.
If the patient is a care home resident and has CDI then consult with the health protection team in Public Health for advice regarding reducing the risk of transmission to other residents
Consider hospital admission.
Consider goals of care.
Discuss with senior colleague.
Send blood cultures
Consider C. difficile as a differential diagnosis in all patients presenting with abdominal pain.
Diarrhoea is not always present in severe infection where the white cell count can be raised and abdominal pain and guarding and signs of ileus are present.
Options for effectively treating a severe intra-abdominal infection are limited. Making a diagnosis is a priority to guide effective therapy and future care.
Preferred:
Amoxicillin 1g orally every eight hours
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 400mg orally every 8 hours
Penicillin allergy:
Teicoplanin intravenous (see Appendix 2 for protocol)
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 400mg orally every 8 hours
Alternative/ oral option:
Co-trimoxazole 960mg orally every 12 hours
(see Appendix 1 for dose reduction in renal impairment)
PLUS
Metronidazole 400mg orally every 8 hours
If oral route not available very limited options are available for community management.
If antibiotic therapy deemed appropriate:
Amoxicillin 2g intravenous every 12 hours
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 1g by rectum every 8 hours for 3 days, then 1g by rectum
every 12 hours
Penicillin allergy and no oral option:
Teicoplanin intravenous (see Appendix 2 for protocol)
PLUS
Gentamicin intravenous as per NHS Lothian online calculator
PLUS
Metronidazole 1g by rectum every 8 hours for 3 days, then 1g by rectum
every 12 hours
Gentamicin should not be extended for more than 72 hours in H@H patients without advice from an infection specialist, with consideration of toxicities and monitoring. (Note this differs from advice for patients in acute care settings where up to 5 days may be given).
If the patient is responding and there are no positive culture results, consider oral co-trimoxazole and metronidazole to complete antibiotic course.
Antimicrobial prescribing: NHS Lothian