Editors will now start seeing new messages come through in response to support ticket requests which reflect this tightening up and improvement of our processes.

Reviewer name(s): Louise Reid, Clinical Nurse Specialist, Claire Wright Acute Pain Nurse Specialist .

0 = Full movement1 = Inability to raise extended leg but able to bend knee2 = Inability to bend knee but able to flex ankle3 = No movement

If the blood pressure is less than that stated on the front of the epidural chart or if it is significantly less than the pre-operative value, carry out the following :

Ten bite-size (5 mins or less) video tutorials for RDS editors are now available in the “Resources for providers of RDS tools” section of the RDS.  These cover core functionality including Save and preview, content page and media management, password management and much more.

If a patient receives a “top-up” of levobupivacaine stronger than 0.125%, the patient must have their BP recorded every 5 minutes for 30 minutes.

Also remember to check sensory level if epidural infusion has been stopped for any reason, before re-starting and one hour after increasing rate.

6. Epidural Exit Site: While the epidural infusion is in progress, the exit must be checked on every shift for signs of leakage or infection. Once the epidural catheter has been removed, the exit site must be checked daily until the patient is discharged from hospital. This must be documented on the NEWS chart. Any signs of infection must be reported to the Acute Pain Team or ITU anaesthetist.

2.2 Support requests that are outwith the warranty period of 12 weeks since the software was originally developed will not be automatically addressed by Tactuum. The RDS team will consider these requests for costed development work and will obtain estimate of effort and cost from Tactuum for priority issues.

Please remember to email ann.wales3@nhs.scot and his.decisionsupport@nhs.scot with any critical/urgent issues in addition to raising a support ticket.

Please dispose of levobupivicaine or levobupivicaine and fentanyl bags in appropriate medicines container (large sharps bin with blue lid).

2.1 Issues confirmed by the RDS and Tactuum teams as meeting the critical/urgent and high priority criteria will continue to be prioritised and dealt with immediately.

We have recently analysed the results of a survey of users of the Scottish Palliative Care Guidelines toolkit.  Key findings from 61 respondents include:

Please note that we plan to move in the new year to a new system whereby requests all come to an RDS support portal in the first instance and are triaged from there to Tactuum when appropriate.

8.Pump recordings must be recorded on the epidural chart as per Hospital policy, ensuring that the 'amount delivered' and the 'amount remaining' add up to the original starting total.

7. Temperature must be recorded on the NEWS chart every 4 hours (or more frequently, if the patients condition requires it)

Can be completed by any of the following who have received training in the use of the epidural pump: Anaesthetists; Anaesthetist assistants; Acute Pain Nurses

Oxygen 4 L/min via Hudson mask or 2 L/min via nasal cannula should be given to patients for 48 hours post-operatively and then overnight until the epidural infusion is discontinued, unless prescribed otherwise by the anaesthetist.

The next scheduled RDS deployment will take place at the end of November 2024.  We are reviewing all outstanding support tickets and feature requests along with estimates of effort and cost to determine which items will be included in this deployment.

We will be organising a webinar in a few weeks’ time to take you through the details of the current support processes and criteria.

The NES clinical knowledge pathway (CKP) publisher is now retired and the majority of pathways supported by this tool have been transferred to the RDS. Examples include:

This helps us identify which nerves have been blocked by the local anaesthetic. We assess thermoreceptors at a dermatomal level using a cold stimulus (such as ice) only. It is useful to have a supply of ice cubes in the freezer compartment of your fridge. The ice cube can be placed in either a disposable glove and in a gauze for single patient use.How to perform the sensory level measurement:

10. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

This decision support software, sponsored by Scottish Government Effective Prescribing and Therapeutics Division,  is now available for all primary care clinicians across NHS Tayside. Board-wide implementation is also planned for NHS Lothian, and NHS GGC, NHS Ayrshire and Arran and NHS Dumfries and Galloway have initial pilots in progress. The University of Dundee has been commissioned to evaluate impact of this decision support software on prescribing practice.

If the sedation score is 2: treat as for moderate respiratory depression. If the sedation score is 3: treat with naloxone as for severe respiratory depression.

Unless authorised by a senior anaesthetist, no other opioids should be given by any other route, whilst epidural infusion is in progress.

2.3 Support tickets for technical issues that are not classified as bugs will not be automatically addressed by Tactuum. The definition of a bug is ‘a defect in the software that is at variance with documented user requirements.’  Issues that are not bugs will also be considered for costed development work.

Many thanks to those of you who attended our recent webinar on the contingency arrangements being put in place to prevent future RDS outages as far as possible and minimise impact if they do occur.  Please contact ann.wales3@nhs.scot if you would like a copy of the slides from this session.

Users highlighted key areas for improvement in terms of navigation and search functionality. The survey was very valuable in enabling us to uncover the specific issues affecting the user experience. Many of these can be addressed through content management approaches. The issues identified with search results echo other user feedback, and we are costing improvements with a view to implementation in the next RDS deployment.

Registered nurses who have completed the acute pain service epidural training and have maintained their skills may remove an epidural catheter. If further supervision required contact acute pain nurse (bleep 1003 or 6056).

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

Patients with an epidural infusion may have reduced sensation. All patients must be scored as having a high risk of pressure sores.

Naloxone injection should be readily available on all wards were epidural infusions are managed and registered nurses should know where it is located.

2.4 Non-urgent requests that require a deployment (i.e a new release of RDS) will normally be factored into the next scheduled release (currently end of Nov 2024 and end of Feb 2025) unless by special agreement with the RDS team.

To balance increasing demand with available capacity and financial resource, the RDS team and Tactuum are now working together to  implement closer management of support tickets. As a key part of this, we want to ensure clear, timely and consistent communication with yourselves as requesters.

Epidural infusions used for post-operative pain relief should not cause the patients legs to become weak. The motor nerves are not normally affected by the weak solution of local anaesthetic used.

Epidural catheters should preferably be removed in the morning so that the patient’s neurological condition can be observed.

If the patient’s pain score is higher than 4 for more than one set of observations, follow below. Firstly assess the location of the patient’s pain.

If patient has received a “top-up” of levobupivacaine stronger than 0.125%, the following observations should be carried out.

Most patients will have a urinary catheter in situ. If the urine output drops, check that the urinary catheter is not blocked as patients may not complain of a full and painful bladder.