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
Use beta-blockers with caution in patients with asthma or with a history of obstructive airways disease. Combinations with diltiazem or verapamil (Nitrates, calcium-channel blockers and other antianginal drugs) may produce excessive bradycardia and should only be used under specialist advice.
Beta-blockers (bisoprolol or carvedilol) for stable heart failure are used under specialist advice. Warn patients that heart failure symptoms may worsen for up to 3 days following dose initiation/titration and consider extra diuretic cover for 3 days.
Beta-blockers appear protective if taken for 1 to 2 years following a myocardial infarction (MI); note NICE CG172 ‘Myocardial infarction: cardiac rehabilitation and prevention of further MI’.
Refer to guidance on the use of beta-blockers in hypertension and as secondary prevention post-MI. Bisoprolol is preferred to atenolol due to a reduced incidence of side-effects.
Tablets 1·25mg, 2·5mg, 3·75mg, 5mg, 7·5mg, 10mg
Adjunct in stable heart failure, initially 1·25mg once daily (in the morning) then if tolerated, double the dose at a minimum of two-weekly intervals to 10mg once daily [off-label].
Hypertension, initially 5mg increased to 10mg once daily.
Tablets 25mg, 50mg, 100mg
By mouth,
Hypertension, 50mg daily.
Angina, 25 to 100mg daily, in 1 or 2 doses.
Arrhythmias, 50 to 100mg daily.
Post-myocardial infarction, 25mg initially increasing to 100mg daily.
Oral solution 25mg/5mL
By mouth,
Hypertension, 50mg daily.
Angina, 25 to 100mg daily, in 1 or 2 doses.
Arrhythmias, 50 to 100mg daily.
Post-myocardial infarction, 25mg initially increasing to 100mg daily.
Injection 5mg/10mL
Tablets 3·125mg, 6·25mg, 12·5mg, 25mg
Adjunct in stable heart failure, initially 3·125mg twice daily (with food), dose increased at intervals of at least 2 weeks to 6·25mg twice daily, then 12·5mg twice daily, then to 25mg twice daily; increase to highest dose tolerated, maximum 25mg twice daily in patients with severe heart failure or bodyweight less than 85kg and 50mg twice daily in patients over 85kg.
For assuring bradycardia during CT coronary angiography.
Tablets 50mg (Specialist initiation only)
Injection 5mg/5mL (Hospital use only)
Anxiety (Hypnotics and anxiolytics)
Essential tremor (Drugs used in Parkinsonism and related disorders)
Thyrotoxicosis (Thyroiod and antithyroid drugs)
Prophylaxis of migraine (Analgesics)
Tablets 10mg, 40mg
Modified release capsules 80mg, 160mg
Tablets 40mg, 80mg (s)
Initiated only under direct hospital advice for the treatment of arrhythmias.
Injection 100mg/10mL (for specialist use in High Dependency Units only)
Tablets 100mg, 200mg (Specialist initiation only)
Hypertension in pregnancy, refer to guidance (internet access required).
Injection 100mg/20mL (Specialist initiation only)
Hypertension in pregnancy, refer to guidance (internet access required).
TAM (Treatments and Medicines) NHS Highland