TAM guideline updates

New Guidance:

• TRANSFUSION | Right Decisions: Patient information ordering details added (awaiting ratification)

Major updates: 

See the 'What's new' section of each guideline.

• Penthrox (methoxyflurane) (Guidelines) | Right Decisions
  Amendment: product licence has changed from adults only to 6 years and above; guidance updated accordingly.
  Amendment: place of therapy includes Out of Hours Prehospital Immediate Care and Trauma (PICT) team.
  Amendment: place of therapy includes 'and areas conducting chest drains'
  Amendment: statement changed from: 'This guideline covers the use of Penthrox (methoxyflurane) for analgesia in moderate to severe pain in acute trauma and burns', to: 'This guideline covers the use of Penthrox (methoxyflurane) as per its licensed indication: Emergency relief of moderate to severe pain in conscious patients aged 6 years and older with trauma and associated pain. For NHS Highland this includes: analgesia in moderate to severe pain in acute trauma and burns, and traumatic pleural procedures, including chest drains.'
  Amendment: Emergency Department analgesic pyramid poster has been updated. Changed from 'for use in ADULTS with traumatic pain' to 'for use in patients aged 6 years and over with mod/severe traumatic pain'

• Breast disorders in primary care (Guidelines) | Right Decisions Some of the criteria for USC referral have been changed. Please do read the Good practice Points section. There is an extended section on breast pain including a video – Breast pain is now rarely seen in secondary care

• Digital psychological therapies (Guidelines) | Right Decisions: 'TAM805 Digital mental health therapies' and 'TAM450 Computerised cognitive behavioural therapy (cCBT)' guidelines have been combined to create 'TAM450 Digital psychological therapies'

Minor updates: 

See the 'What's new' section of each guideline.
These items will be ratified at the next TAMSG. 

• Suspected urine infection (UTI) in older adults >65 years | Right Decisions:  Added: link to Diagnosis of UTI Urology Guidelines

• Patient information - Stroke (Guidelines) | Right Decisions New patient information links added

• Cellulitis in patients with lymphoedema (Guidelines) | Right Decisions Changed Diprobase to Zerobase, and Epaderm to Zeroderm

• Chlamydia (uncomplicated) in Primary Care (Guidelines) | Right Decisions Added: Full STI screening, including chlamydia, gonorrhoea (urine/swab(s)), HIV and syphilis (serum blood sample) should be offered to everyone presenting with symptoms or risk of STI, or requesting STI screening

• Age-related macular degeneration (Guidelines) | Right Decisions Contact details updated

• Polycythaemia erythrocytosis (Guidelines) | Right Decisions added: Results will be available on NHS Highland SCI store after 21 days, currently reported promptly in the 'documents' section.  Alternatively results will be available after 21 days via NHS Grampian SCI store.

• Thrombocytosis (Guidelines) | Right Decisions added - If no obvious cause is identified following this assessment, please send EDTA blood sample via Blood Sciences for molecular testing as indicated above.  This should be requested on ICE by GPs with a view to informing the need for Haematology referral or otherwise.  It will need to arrive for testing in Aberdeen before Thursday (and avoiding public holidays) and as such is best sent on a Monday or Tuesday.  Results will be available on NHS Highland SCI store after 21 days, currently reported promptly in the 'documents' section.  Alternatively results will be available after 21 days via NHS Grampian SCI store.

• Acute Coronary Syndrome (ACS) (Guidelines) | Right Decisions added:

  Criteria for thrombolysis -

  • 'LBBB with STEMI equivalent' changed to 'LBBB with ≥ 1 positive Smith-modified Sgarbossa criteria (discuss with CCU)'

  Ischaemic symptoms - 

  • Removed wording 'posterior MI'

  • Added: Left bundle branch block with occlusive MI changes defined by ≥ 1 of 3 Smith-modified Sgarbossa criteria:
    - concordant ST elevation ≥ 1 mm
    - concordant ST depression ≥ 1 mm in V1 - V3
    - discordant STE ≥ 25% depth of preceding S-wave  (https://litfl.com/sgarbossa-criteria-ecg-library/)

• Traumatic Brain Injury (TBI) (Guidelines) | Right Decisions Patient resources added and referral form added

• TRANSFUSION  link to student nurse participation form

• Lyme disease: Statement added under flowchart 'Pathway for neuroborreliosis investigation and referral for patients presenting with cranial neuropathy or radiculitis': 'If patient presents over a weekend, and there is a very high suspicion of neuroborreliosis (for example, facial palsy with recent tick bite to head or neck), then option to start treatment pending ID consultation.'

• COPD (Chronic obstructive pulmonary disease) Added: Section on rescue medication

• MSK (Musculoskeletal) physiotherapy (Guidelines) | Right Decisions

  • Name changed from: 'MSK (Musculoskeletal) physiotherapy' to: 'MSK (Musculoskeletal) referral pathway'

  • Audience changed from 'Patients aged 12 years and older' to 'Adults only'.

• TIA / NVC referral form for Neurovascular Clinic - Raigmore (Guidelines) | Right Decisions updated referral form

• Suspected ischaemic chest pain (Guidelines) | Right Decisions Change from refer via Raigmore clinic to refer via SCI gateway

• TRANSFUSION | Right Decisions: Added: MHRA device alert: Risk of severe harm from use of incorrect giving (administration) set for blood transfusion.

• HOW TO ACCESS MICROBIOLOGY ADVICE (Antimicrobial) | Right Decisions 

  • Removed: 'When calling out-of-hours, junior medical staff should consider whether the query can be resolved through discussion with senior members of their team. If the query cannot be resolved, the senior clinician should decide whether the case should be discussed urgently with the On Call Microbiologist or whether non-urgent cases can be discussed the following morning.'

  • Added: 'AFTER 5PM (7 DAYS A WEEK) ONLY CONSULTANTS OR REGISTRAR-LEVEL DOCTORS TO CALL MICROBIOLOGY FOR ADVICE'

• Asthma in children aged 2 to 5 years (Paediatric Guidelines) | Right Decisions: The brand Clenil removed and replaced with the generic name, beclometasone. This is because Clenil modulite 50 microgram pMDI is due to be discontinued. 

• Osteoporosis (Guidelines) | Right Decisions: DXA scan referral information added

• Chronic Leg Oedema Referral Pathway (Guidelines) | Right Decisions Change NHS Highland Lymphoedema Service email address: nhsh.highland-lymphoedema@nhs.scot

• Lower limb lymphoedema (Guidelines) | Right DecisionsThis pathway was produced in line with SIGN 120 guidance which was subsequently withdrawn and replaced by NICE guidance (last revised in May 2026) https://www.rightdecisions.scot.nhs.uk/vascular-surgery-pathways/venous-leg-ulcer/venous-leg-ulcer-national-pathway/

• Recurrent Cellulitis (Guidelines) | Right DecisionsThe choice of antibiotics to treat and reduce the risk of cellulitis has changed to take into account the WHO AWaRe guidance on antibiotic stewardship (WHO AWaRe 2023). Macrolides are included in the “watch” category and therefore have been moved from the first line alternative to penicillin and been replaced by doxycycline (in “access” category).

  www.thebls.com/documents-library/guidelines-on-the-management-of-cellulitis-in-lymphoedema

• MSK (Musculoskeletal) adult referral pathway (Guidelines) | Right Decisions Name changed from: 'MSK (Musculoskeletal) physiotherapy' to: 'MSK (Musculoskeletal) referral pathway' and Audience changed from 'Patients aged 12 years and older' to 'Adults only'. 

• Pulmonary embolism (Guidelines) | Right Decisions Error correction. Simplified Geneva scoring for HR ≥95 amended from 2 to 1. 

Reviewed with no changes: 

• Primary hip and knee arthroplasty, post-operative ERAS bundle 

• Eating disorder in-patient admissions: Children and young people (Paediatric Guidelines) | Right Decisions

• Eating disorder in-patient admissions: Children and Young people (OOH) (Paediatric Guidelines) | Right Decisions

• Lymphoedema home page: Diagnosis, Treatment and Care (Guidelines) | Right Decisions

• Lower limb lymphoedema (Guidelines) | Right Decisions

• Lower limb inflammatory pathway (Guidelines) | Right Decisions

• Wet legs / Lymphorrhoea (Guidelines) | Right Decisions

Removed Guidance:

• Confirmation of death - This content is now available on the policy library Protocol for Verification of Expected Death by nurses in Community Hospitals

• Age-related macular degeneration (Guidelines) | Right Decisions no longer needed

• TAM805 Digital mental health therapies (Guidelines) content combine with and moved to Digital psychological therapies (Guidelines) | Right Decisions

• Blood Sciences and Microbiology blood test tube guide (Guidelines) replaced with Labs Test Directory | Right Decisions

• Saliva management: sialorrhoea (Guidelines) - mouth care guidance can be accessed via Scottish Palliative Care Guidelines link.

New Guidance:

• Musculoskeletal Physiotherapy | Right Decisions (Ratified TAMSG April 2026)

Major updates: 

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Malignant spinal cord compression (Guidelines) | Right Decisions (Ratified TAMSG April 2026)
  • Updated: Link to NICE guideline
  • Updated: Link to Scottish palliative care guidelines
  • Updated: Minor rewording for use of dexamethasone to reflect NICE guidelines.
  • Added: Dexamethasone tapering schedule
• Prolonged seizure / status epilepticus in adults (Secondary care) (Guidelines) | Right Decisions (Ratified TAMSG April 2026)
  • Amendment: Initial management (t=0 to 5 minutes)
  • The amount and strength of glucose has changed to include 10% glucose.
  • The order of administration of glucose and vitamin B has been reversed. Vitamin B should be given as soon as possible after initial glucose replacement.
  • High potency vitamins B and C has been changed to IV vitamin B1.
  • Changed from: 
    • Obtain blood glucose.
      If the patient is hypoglycaemic: give 75 mL of 20% glucose immediately.
      If there is any suspicion of alcohol excess or impaired nutrition: commence intravenous infusion of high potency vitamins B and C, 1 pair as soon as possible.
      If patient is hypoglycaemic and still fitting despite first glucose administration: repeat IV glucose bolus then start a glucose infusion (10% glucose at 100 mL/hr).
  • Changed to: 
    • Obtain blood glucose.
      If the patient is hypoglycaemic: give 150 to 200 mL of 10% glucose or 75 mL of 20% glucose immediately.
      If the patient is hypoglycaemic and still fitting despite first glucose administration: repeat IV glucose bolus and then start a glucose infusion (10% glucose at 100 mL/hr)
      If there is any suspicion of alcohol excess or impaired nutrition: commence IV vitamin B1 (thiamine) 500 mg as soon as possible AFTER initial glucose replacement)
  • Detail re sodium valproate prescribing considerations amended: 
    • Changed from: Sodium valproate is contraindicated in pregnancy and in people with childbearing potential.
    • Changed to: Sodium valproate is highly teratogenic, use in pregnancy can lead to neurodevelopmental disorders and congenital malformations. It can also potentially cause infertility in males and neurodevelopmental disorders in children born to males treated with valproate in the 3 months prior to conception. See: Valproate-containing medicines▼ prescribing guidance (Formulary: Medicines management) to ensure regulatory requirements are met when prescribing and dispensing valproate.
• Delirium (Secondary Care) (Guidelines) | Right Decisions(Ratified TAMSG April 2026)
  • Quick reference guide:
    • Removed: 'Delirium in COVID-19 is a recognized symptom and in vulnerable patients, notably care home residents, can lead to a severe and prolonged delirium'
    • Removed: 'Is the person at risk of developing delirium, and how will I reduce that risk?'
    • Added: 'Medicines can directly cause delirium'
    • Amended: From: 'Patients may need an explanation of their delirium after it has resolved.'  To: 'Explain clearly to patients their diagnosis of delirium and its consequences, as patients are often frightened about their experiences and have concern that they are developing a mental health disorder.'
  • Emergency detention certificate: 5 criteria added
  • Medication: 
    • Added: 'When using medication on an ‘as required basis’, if more than 2 doses are required in a 24 hour period, then regular oral low dose antipsychotic should be considered,
      with the maximum daily doses as listed (including when required doses)
    • Added: 'If more than 2 doses of IM medication are required, antipsychotic at low dose should be prescribed to limit further IM usage.'
    • Amended: IM; Lorazepam changed to first line
    • Amended: In unmanageable agitation / distress review changed from 72 hours to daily. 

Minor updates: 

To view the changes to the guidance, see the 'What's new' section of each guideline.
These items will be ratified at the next TAMSG. 

• MSK (Musculoskeletal) physiotherapy (Guidelines) | Right Decisions
  • Urgent referral criteria content clarified, no change to clinical practice. 
  • Audience changed from 'Adults only' to 'Patients aged 12 years and older'.
  • Title changed to include the term 'MSK'.
  • Listing page created 'PHYSIOTHERAPY' for this guideline to sit under. 
  • Link added to this page from Paediatric Guidelines. 
• DMARD monitoring in Primary Care (Guidelines) | Right Decisions
  • Link to NICE CKS updated. NB: NICE CKS content has been updated and this has yet to be reviewed locally. 
• Subcutaneous fluid in Primary Care (Guidelines) | Right Decisions
  
  • Links to the Scottish Palliative Care Guidelines and the Royal Marden Manual have been updated. 
• Major haemorrhage and emergency invasive procedures in patients on direct oral anticoagulants (DOACs) (Guidelines) | Right Decisions
  
  • Reversal Agents: Idarucizumab and Andexanet alfa: Changed from: Andexanet alfa (Ondexxya®) is used for the rapid reversal of apixaban or rivaroxaban, in adults ≥18 years who have taken either drug in the past 48 hours and present with life-threatening or uncontrolled bleeding. There is no licensed antidote available yet for edoxaban. Changed to: Andexanet alfa (Ondexxya®) is used for the rapid reversal of apixaban or rivaroxaban, in adults ≥18 years who have taken either drug in the past 18 hours and present with life-threatening or uncontrolled bleeding. There is no licensed antidote available yet for edoxaban.
    This is based on the data from the Annexa-4 trial.

• Andexanet alfa: administration quick reference guide (Guidelines) | Right Decisions
  
  • Please note that table 1 formatting was incorrect, the less and more than 8 hours row had slipped 2 columns to the left. This has now been corrected
    

• Highland Council Allied Health Professionals (Paediatric Guidelines) | Right Decisions
  • All content removed and replaced with direct link to Highland council website page.
• Urinary tract (UTI) (Antimicrobial) | Right Decisions
  • added link to guidance for Suspected urine infection (UTI) in older adults >65 years.
• Acute lower urinary tract infection in adults (no fever or flank pain) (Antimicrobial) | Right Decisions
  • added link to guidance for Suspected urine infection (UTI) in older adults >65 years.
• Acute urinary tract infection – catheter-associated (Antimicrobial) | Right Decisions
  • added link to guidance for Suspected urine infection (UTI) in older adults >65 years.
    • changed 'for care home staff' to 'for staff'.
• Acute Prostatitis and Epididymitis (Antimicrobial) | Right Decisions
  • Removed: The European Medicines Agency's Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system (press release October 2018), but they are an option in acute pyelonephritis, which is a severe infection.
  • Added: NOTE: Avoid ciprofloxacin due to MHRA restrictions (updated January 2024) on the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system. Whilst these antibiotics should generally be avoided unless all other oral antibiotics are unsuitable, they are effective in treating acute bacterial prostatitis, which is a severe infection.

• Thromboprophylaxis discharge risk assessment for lower limb immobilisation (Guidelines) | Right Decisions
  • Training video for clinical teams added.

Reviewed with no changes: 

• Vancomycin in haemodiafiltration (HDF) (Guidelines) | Right Decisions
• Anal fissures (Guidelines) | Right Decisions
• Pilondial disease (Guidelines) | Right Decisions
• Pruritis ani (Guidelines) | Right Decisions

Removed Guidance:

• COVID-19: Vaccine (Guidelines) | Right Decisions Content moved to: Vaccines and antisera (Formulary: Immunology & Vaccines) | Right Decisions

New Guidance

Items will be added as published. 

• Cardiac devices (Guidelines) | Right Decisions
• Asthma in children aged 6 to 15 years old (Paediatric Guidelines) | Right Decisions
• Single unit transfusion of red cells (Guidelines) | Right Decisions

Major updates

To view the changes to the guidance, see the 'What's new' section of each guideline.

Influenza Treatment (Antimicrobial) | Right Decisions

• UKHSA updated national guidance on influenza treatment and prophylaxis on 4th November 2025 from which many of these changes have been taken. 
• The list of patients at risk of severe influenza or hospitalisation along with examples of patients regarded as being immunosuppressed have been expanded. 
• Recommendation for use of antibiotics for secondary bacterial infection in a patient with influenza should be based on clinical assessment. 
• IV zanamivir has been in short supply in recent years so should only be considered if oral or enteral oseltamivir or inhaled zanamivir cannot be administered, noting the evidence for efficacy of antivirals in severe influenza is based on oseltamivir.   
• NHS Highland Renal Team recommend using Renal Drug Database dosing advice for oseltamivir in renal impairment or renal replacement therapies. 
• Dosing in renal impairment has been added to the guidance.   

Warfarin, DOACs and antiplatelets in adults undergoing surgery or invasive procedures (Guidelines) | Right Decisions

Amendment to table: Time between administration of DOAC and performance of block/catheter insertion; and between removal of catheter and next dose of DOAC:

• Time between last dose of DOAC and catheter insertion: specific timings have been removed and replaced with statement: 'This information is currently under review. Leave at least a minimum of 48 hours (72 hours for dabigatran). If in doubt, contact consultant anaesthetist for advice.'

Acute treatment and secondary prevention of transient ischaemic attacks (TIA) and ischaemic stroke (Guidelines) | Right Decisions

• From the 2nd of February 2026 patients diagnosed with a TIA or ischaemic stroke will undergo genetic testing for CYP2C19 variants, and therefore clopidogrel resistance. Patients who are identified as poor metabolisers of clopidogrel will require alternative antiplatelets to be prescribed as part of their acute and long term stroke treatment. Guidance on the prescribing of antiplatelets has been updated on TAM. Patients and prescribers will be informed of any change to treatment and their metaboliser status recorded on their records alongside allergies. 

Minor updates

To view the changes to the guidance, see the 'What's new' section of each guideline.
These items will be ratified at the next TAMSG. 

Refugee and Asylum seeker support (Resources) | Right Decisions

• Point of Contact details updated
• Links added: WHO, Third Sector Organisations

Hyperkalaemia: Primary Care (Guidelines) | Right Decisions

• Removed: Note regarding renal patients tolerance to high potassium levels. 
• Reworded information re potassium-containing laxatives as a cause of hyperkalaemia acknowledging instead their potassium content: 'To note that macrogol laxatives (Laxido/Movicol) have <1mmol K+ per sachet'. 

Dietetic service referral (Guidelines) | Right Decisions

• Removed as no longer available:Active Health — Velocity Café & Bicycle Workshop (velocitylove.co.uk)
  A free and confidential one-to-one advice service for people (aged 16+) living in the NHS Highland area who would like to become more active to help their physical and/or mental health. GPs or other healthcare professional can refer, or patients can self-refer
• email address updated to: northhighlandcommunitydietetics@nhs.scot

Assessment of carotid artery stenosis following TIA and minor stroke and referral for carotid endarterectomy (Guidelines) | Right Decisions

• Removed retired doctors contact details

Anticoagulant switching (Guidelines) | Right Decisions

• The term 'unfractionated heparin' is changed to 'heparin' as per BNF update. 

Parkinson's disease (Guidelines) | Right Decisions

• Added: recommendation of ipratropium bromide spray for sialorrhea [off-label] 
• Link to SIGN157 guideline and Annex 4

Cardiac rehabilitation (Guidelines) | Right Decisions

• Updated phone number for the department
• Updated CR Discharge letter/booklet
• Addition of new website link under "Patient information" section

Exercise after Stroke Pathway (Guidelines) | Right Decisions

• Updated from The Stroke Improvement Programme (2021) to The Stroke Improvement Programme (2024)
• Added link to The Stroke Association : www.stroke.org.uk 

Rape and sexual assault (Guidelines) | Right Decisions

• Added: Signposting for under 16s to the national child protection guidance. 

Sodium zirconium in chronic hyperkalaemia (Guidelines) | Right Decisions

• Prescribing guidance for SZC in chronic hyperkalaemia flow chart formatted: no changes to content.

Abnormal liver blood results referral pathway (Over 16’s) (Guidelines) | Right Decisions

• The term 'Pathway A' and ‘referral pathway for abnormal liver bloods in over 16s’ is replaced with: Abnormal LFTS related to alcohol (Guidelines) 
• The term 'Pathway B' is replaced with:
  • MASLD: Secondary Care (Guidelines) 
  • MASLD: Primary Care (Guidelines)

High consequence infectious disease (HCID) pathway (Guidelines) | Right Decisions

• Minor modifications for clarity, including to action cards.
  • Action card source document is now HCID-NHSH patient pathway version 1.2_210126
  • HCID clinical pathway: Quick reference guide: Suspected HCID next steps: Added: 'Key personnel informed of the patient', 'See: communication cascade'. Removed: 'Arrange transfer' & duplication of information.
  • Infection specialist assessment: Details added re communication with lead clinician
  • Removed as duplication: 'NHS Highland triage algorithm or national resources High consequence infectious diseases (HCID) can be used to assess risk for HCID'.
  • Patient designated as 'suspected HCID': next steps: Added: List of roles who have action cards. Removed as duplication: 'Roles and responsibilities'
  • Section removed as duplication: 'Ongoing management of suspected HCID Roles, responsibilities and actions'
  • Action Card 1: Name changed from: Suspected HCID ongoing management: Attending Health Care Professional, To: Suspected HCID ongoing management: Lead clinician for the patient (Usually GP or Consultant)
•  Minor modifications made to improve the readability of the guidance:

• • Direct contact details for Argyll & Bute Infection and Control nurses have been removed. Generic contact details to be added. 
  • Advice regarding patient with suspected HCID using ward phone (to be wrapped in plastic) has been added. 
  • Advice added under 'History taking and 'remote assessment' on when to leave the pathway (if no concern re HCID).
  • Additional face to face assessment information has been removed as extraneous information. 
  • Separate section on patient transportation removed as this information is elsewhere in the guidance. 
  • Section: 'Ongoing management of suspected HCID: Roles, responsibilities and actions' has been amended with explanatory text included for the terms used. 
  • Terms 'clean' and 'dirty' have been removed as these terms are obsolete. 

Community Acquired Pneumonia (CAP) (Antimicrobial) | Right Decisions

• added under Duration Note section: 'Oral switch should be guided by positive Microbiology results, if available.  Options given are empiric.'
• corrected dosing for CAP with history of recent foreign travel from Oral/IV azithromycin 500mg twice daily to once daily.
• added in duration section of CAP Severe Level 2 or 3 CARE:  '(empiric)' after oral switch.
• added in duration section of CAP Severe in non-severe penicillin allergy:  '(empiric)' after oral switch.

Prevention of skeletal-related events in cancer patients (Guidelines) | Right Decisions

• The term, sodium clodronate, has been changed to clodronate disodium throughout as per BNF update.

Termination of pregnancy (Guidelines) | Right Decisions

• Email address on guideline updated to nhsh.unplannedpregnancy@nhs.scot 

Depot and long-acting antipsychotic injections (Guidelines) | Right Decisions

 Olanzapine LAI protocol has been updated.

• Section 1: Circumstances where olanzapine LAI may be considered for use in NHSH changed to include any patient transferred as continuation of treatment rather than only transfer from a medium/low secure facility
• Section 2: Authorisation process changed from IPTR to PACS as per the updated access to medicine procedure and clarity regarding what needs specified on a T3, which was confirmed by the Mental Welfare Commission in 2022.
• Section 3: New training site details following manufacturer move from Eli.Lilly to Neon HC. Bullet points added
• Section 4.1: Definition of healthcare facility expanded, as per information from the manufacturer.
• Section 4.3: Added information on what should be done if a patient refuses to stay for the three hour monitoring period and updated links to rapid tranquilisation policy and toxbase monograph.
• Appendix 1: reviewed to include the most recent data about the incidence of post injection syndrome and how this presents

Highland Eating Disorder Service (HEDS) & Medical Emergency Eating Disorder (MEED) (Guidelines) | Right Decisions

• Referral pathway to HEDS: Quick reference guide flow chart re-formatted

CT scanning in acute stroke patients (at home or Community Hospital) (Guidelines) | Right Decisions

• Admission for scan time reduced from 12 hours to 4 hours in line with Stroke Standard of 2026 Guidance.  Change from Jan 2026
• Line added to now read "A CT scan is used to distinguish between ischaemic and haemorrhagic stroke. Making this distinction is important to enable appropriate, suitability for thrombolysis / thrombectomy treatment and  secondary prevention"
• Under "Referral for CT scan" option for "own transport" added.

Catheter maintenance solutions (Guidelines) | Right Decisions

• Catheter maintenance solutions flowchart uploaded as a printable version

Stable angina management (Guidelines) | Right Decisions

• Changed from: Referrals to the RACPC can be made either through CCU directly or via SCI gateway
  Changed to: Referrals to the RACPC are made via SCI gateway
• Patient letter added

Heart failure (Patient information) | Right Decisions

• Links reviewed by author and updated.

Armed forces and veterans (Resources) | Right Decisions

• Added: Section on Training
• Added: Information about Veterans In-Service Injury Network
• Added: List of policy areas that the AFC duty is to be extended to.
• Updated: Veterans welfare scheme email

Silver diamine fluoride (Dental Guidelines) | Right Decisions

• Silver diamine fluoride use aligns with the SDCEP guidelines on management of dental caries in children
• Guideline reflects the use of the aqueous version of the silver diamine fluoride
• Statement added re: potassium iodide being optional to silver diamine fluoride 
• Statement added: While silver diamine fluoride is an off label treatment for dental caries in the UK, it is approved for this use in other countries, which provides a stronger justification for its use.

Treatment of bacterial meningitis following admission to secondary care (Antimicrobial) | Right Decisions

• The section has been reviewed with the additional note to consider risk factors for TB meningitis and clarification of some doses, in line with BNFc.

Smoking cessation (Guidelines) | Right Decisions

• Community pharmacy link updated
• PGD information updated as there is now a National Patient Group Direction (PGD) for Varenicline: https://www.communitypharmacy.scot.nhs.uk/nhs-highland/pages/pgds/varenicline-v1/

Reviewed with no changes

• Post-operative problems (Guidelines) | Right Decisions
• Acute treatment and secondary prevention of transient ischaemic attacks (TIA) and ischaemic stroke (Guidelines) | Right Decisions
• Management of Nutrition (In-Patient) (Guidelines) | Right Decisions
• Further information for healthcare professionals (Guidelines) | Right Decisions
• Antibiotic prophylaxis for infective endocarditis (Dental Guidelines) | Right Decisions
• Lid trauma (Guidelines) | Right Decisions
• Ocular trauma (Guidelines) | Right Decisions
• Pro B-type Natriuretic Peptide (NT-proBNP) (Guidelines) | Right Decisions

Removed Guidance

• COVID-19: High Flow Nasal Oxygen (Raigmore Hospital) (Guidelines)
• COVID-19: Maternity and Obstetrics (Guidelines)
• COVID-19: Diabetes in Pregnancy (Guidelines)

New Guidelines

• Examination of the cervix: Common findings (Guidelines) | Right Decisions

Major updates

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Termination of pregnancy (Guidelines) | Right Decisions
• Early Medical Abortion at Home (EMAH) (Guidelines) | Right Decisions
• Colorectal Primary Care guidance (Guidelines) | Right Decisions

Minor updates

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Short synacthen test protocol (Primary Care, HHSCP only) (Guidelines) | Right Decisions
• Spinal opioids (Guidelines) | Right Decisions
• Local anaesthetic infusion (Guidelines) | Right Decisions
• Naloxone and managing opioid complications (Guidelines) | Right Decisions
• Patient controlled analgesia (PCA) (Guidelines) | Right Decisions
• Post-operative nausea and vomiting (Guidelines) | Right Decisions
• Epidural analgesia (Guidelines) | Right Decisions
• Adult oral analgesia (Guidelines) | Right Decisions
• Major haemorrhage protocol: Argyll & Bute HSCP (Guidelines) | Right Decisions
• Antibiotic posters: Common, community-acquired infections in adults (Antimicrobial) | Right Decisions
• Community Acquired Pneumonia (CAP) (Antimicrobial) | Right Decisions
• Developmental concerns for preschool aged children (Paediatric Guidelines) | Right Decisions
• Head injury (Guidelines) | Right Decisions
• Transfusion special requirements (Guidelines) | Right Decisions
• Hypoglycaemia in hospital (Guidelines) | Right Decisions
• Hyperkalaemia: Secondary Care (Guidelines) | Right Decisions
• Hyperkalaemia: Primary Care (Guidelines) | Right Decisions

Reviewed with no changes

• Covid-19 the green book chapter 14 (Guidelines)
• Ketamine (Guidelines) | Right Decisions
• Subcutaneous opioid (Guidelines) | Right Decisions
• Naloxone and managing complications of opioids (Paediatric Guidelines) | Right Decisions
• Ophthalmology emergency admission protocol: Raigmore & NTC (Guidelines) | Right Decisions

Removed Guidance

• Amputation pain (Raigmore in-patient) (Guidelines)

New Guidance: 

• Radiology referral: Walk-in for chest imaging (Guidelines) | Right Decisions
• Continuous glucose monitoring (CGM): Inpatient (Guidelines) | Right Decisions
• Eating disorder: Children and young people (Paediatric Guidelines) | Right Decisions
• Eating disorder: Children and young people (OOH) (Paediatric Guidelines) | Right Decisions
• Sudden onset sensorineural hearing loss (<72 hours) (Guidelines) | Right Decisions
• Depot and long-acting antipsychotic injections (Guidelines) | Right Decisions
• Infectious diseases: Management of contacts (Guidelines) | Right Decisions
• Identifying patients at risk of adrenal suppression (Guidelines) | Right Decisions
• Anticoagulant reversal (Guidelines) | Right Decisions
• Diabetes referral pathways (Guidelines) | Right Decisions
• Neutropenic sepsis: Antifungal treatment (Antimicrobial) | Right Decisions

Updated Guidance: 

To view the changes to the guidance, see the 'What's new' section of each guideline.

• ARMED FORCES AND VETERANS (Resources) | Right Decisions
• Management of device-detected atrial fibrillation (Guidelines) | Right Decisions
• Diagnosis unclear, infection source likely respiratory or urinary-tract (hospital in-patients) (Antimicrobial) | Right Decisions
• Severe Sepsis - Unknown Focus (Antimicrobial) | Right Decisions
• Abnormal liver blood results referral pathway (Over 16’s) (Guidelines) | Right Decisions
• Cardiac rehabilitation (Guidelines) | Right Decisions
• Flu (Guidelines) | Right Decisions
• Vitamin D deficiency (Guidelines) | Right Decisions
• Achieving control in type 2 diabetes (guidelines)
• Pulmonary embolism (Guidelines) | Right Decisions
• Suspected seizure: ED / AMAU (Guidelines) | Right Decisions
• Bone and Joint Infections (Antimicrobial) | Right Decisions
• Complex bronchiectasis referral pathway (Guidelines) | Right Decisions
• Major haemorrhage and emergency invasive procedures in patients on direct oral anticoagulants (DOACs) (Guidelines) | Right Decisions
• Clostridioides Difficile (Antimicrobial) | Right Decisions
• Clostridioides Difficile (CDI) Information pack for general practitioners (Antimicrobial) | Right Decisions
• Peri-operative guidance for patients with or at risk of adrenal insufficiency (Guidelines) | Right Decisions
• COVID-19: Long covid (Guidelines) | Right Decisions
• Raised triglycerides (Guidelines) | Right Decisions

Removed guidance:

• SGLT2 inhibitors in type 2 diabetes (T2D) (Guidelines) removed and incorporated in Achieving control in type 2 diabetes (Guidelines)
• Glucagon-like peptide-1 (GLP-1) analogues (Guidelines) removed and incorporated in Achieving control in type 2 diabetes (Guidelines)
• Pioglitazone prescribing algorithm (Guidelines) removed and incorporated in Achieving control in type 2 diabetes (Guidelines)
• Diabetes regular follow up. Replaced with: Diabetes referral pathways (Guidelines)
• Referral to Community Diabetes Specialist Nurses. Replaced with: Diabetes referral pathways (Guidelines)

Updated Guidance 

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Palpitation (Guidelines) | Right Decisions
• Red eye (Guidelines) | Right Decisions
• INTERPRETATION GUIDANCE (Resources) | Right Decisions
• Palliative Care resources (Guidelines) | Right Decisions
• Asthma in adults (Guidelines) | Right Decisions
• Syphilis referral pathway (Guidelines) | Right Decisions
• Referral pathway for Deep Subdermal Implant (SDI) removal (Guidelines) | Right Decisions
• Emergency Contraception (Guidelines) | Right Decisions
• Chlamydia (uncomplicated) in Primary Care (Guidelines) | Right Decisions
• Protected antimicrobials (Antimicrobial) | Right Decisions
• Unplanned alcohol withdrawal (Guidelines) | Right Decisions
• Polypharmacy | Right Decisions
• Post-menopausal bleeding and endometrial cancer (Guidelines) | Right Decisions
• Flu (Guidelines) | Right Decisions
• Lyme disease (Antimicrobial) | Right Decisions
• Parkinson's disease (Guidelines) | Right Decisions

New Guidance

• Metabolic dysfunction-associated steatotic liver disease (MASLD): Primary Care (Guidelines) | Right Decisions (Replacing Pathway B MASLD)
• Lyme disease (Guidelines) | Right Decisions

Removed guidance

• Neutropenic sepsis: Ongoing management: in-patients with febrile neutropenia: Day 2 to 3 (Antimicrobial)
• Urokinase with blocked central venous access device (Paediatric Guidelines): Moved to CWard Formulary

New Guidance

• Legionnaires' disease: information for clinical team | Right Decisions (scot.nhs.uk)
• Fluid balance (Guidelines) | Right Decisions
• Mental Health Assessment Unit (MHAU) (Guidelines) | Right Decisions
• Head injury (Guidelines) | Right Decisions
• Optic neuritis (Guidelines)

Updated Guidance 

To view the changes to the guidance, see the 'What's new' section of each guideline.

• SOCIAL PRESCRIBING | Right Decisions (scot.nhs.uk)
• Transfusion special requirements | Right Decisions
• Highland Eating Disorder Service (HEDS) & Medical Emergency Eating Disorder (MEED) (Guidelines) | Right Decisions
• Stroke thrombolysis pathway - Raigmore (Guidelines) | Right Decisions
• Palpitation (GUIDELINES) | Right Decisions
• Pre-Diabetes and type 2 diabetes referrals (Guidelines) | Right Decisions
• Asthma in adults (Guidelines) | Right Decisions
• Asthma in children aged 2 to 5 years (Paediatric Guidelines) | Right Decisions
• Major haemorrhage protocol: Argyll & Bute HSCP (Guidelines)
• Amikacin (Antimicrobial) | Right Decisions
• Rapid tranquilisation (Guidelines) | Right Decisions

New Guidance: 

• INFECTION PREVENTION & CONTROL | Right Decisions (scot.nhs.uk)
• SNBTS Handbook | Right Decisions (scot.nhs.uk) 
• Food Allergy Service (Paediatric Guidelines) | Right Decisions
• Hyperkalaemia: Primary Care (Guidelines) | Right Decisions
• Parenteral nutrition (Guidelines) | Right Decisions
• Vascular access in adult patients (Guidelines) | Right Decisions

Updated Guidance:

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Outpatient Antibiotic Therapy (OPAT) | Right Decisions (scot.nhs.uk)
• Post-fall medication review (Guidelines) | Right Decisions (scot.nhs.uk)
• Pulmonary embolism (Guidelines) | Right Decisions (scot.nhs.uk)
• Computerised cognitive behavioural therapy (cCBT) (Guidelines) | Right Decisions (scot.nhs.uk)
• Aerosol generating procedures (AGP) (Guidelines) | Right Decisions (scot.nhs.uk)
• Testosterone replacement in menopausal women (Guidelines) | Right Decisions (scot.nhs.uk)
• Hypertension (Guidelines) | Right Decisions (scot.nhs.uk)
• Food allergy referral (Paediatrics Guidelines) | Right Decisions (scot.nhs.uk)
• Sleep pathway (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Hypercalcaemia (Secondary Care) (Guidelines) | Right Decisions (scot.nhs.uk)
• Chronic kidney disease (Guidelines) | Right Decisions (scot.nhs.uk)
• Anaphylaxis (Guidelines) | Right Decisions (scot.nhs.uk)
• Sleep pathway (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Stroke thrombolysis pathway - Raigmore (Guidelines) | Right Decisions
• Sore throat (Guidelines) | Right Decisions (scot.nhs.uk)
• Resuscitation (Guidelines) | Right Decisions
• Smoking cessation (Guidelines) | Right Decisions (scot.nhs.uk)
• Incorrect use of combined hormonal contraception (CHC) (Guidelines) | Right Decisions
• Orbital cellulitis (Guidelines) | Right Decisions (scot.nhs.uk)
• Unscheduled bleeding on HRT (Guidelines) | Right Decisions
• Sayana press (Guidelines) | Right Decisions
• PALPITATION (Guidelines) | Right Decisions
• Abnormal liver blood results referral pathway (Over 16’s) | Right Decisions (scot.nhs.uk)
• Secondary prevention post myocardial infarction (Guidelines) | Right Decisions
• Lower limb lymphoedema (Guidelines) | Right Decisions
• Wet legs / Lymphorrhoea (Guidelines) | Right Decisions 
• Ophthalmology diagnosis/triage flowcharts (Guidelines) | Right Decisions
• Hypertension (Guidelines) | Right Decisions (scot.nhs.uk)
• Bell's Palsy (Guidelines) | Right Decisions
• Community Mental Health Team (CMHT) (Guidelines) | Right Decisions (scot.nhs.uk)

Guidance reviewed with no changes:

• COVID-19: Fingers & Toes (Guidelines) | Right Decisions (scot.nhs.uk)
• Seroma drainage following breast surgery (Guidelines) | Right Decisions
• Diagnosing familial hypercholesterolaemia (guidelines) | Right Decisions
• SOCIAL PRESCRIBING | Right Decisions
• Suspected blood transfusion reaction (Guidelines) | Right Decisions
• ICDs - home page (Implantable cardioverter defibrillators) (Guidelines) | Right Decisions
• Acute Coronary Syndrome (ACS) (Guidelines) | Right Decisions
• Stable Angina Management (Guidelines) | Right Decisions
• Emergency Medical Retrieval Service (EMRS) (Guidelines) | Right Decisions
• Penthrox (methoxyflurane) (Guidelines) | Right Decisions
• Emergency Department (Guidelines) | Right Decisions
• Paracetamol overdose (Guidelines) | Right Decisions
• Blood Sciences and Microbiology blood test tube guide (Guidelines) | Right Decisions
• Lipid lowering therapy in the prevention / treatment of atherosclerosis (Guidelines) | Right Decisions
• Suspected ischaemic chest pain (Guidelines) | Right Decisions
• Upper limb lymphoedema (Guidelines) | Right Decisions
• Prevention and treatment of post-operative vomiting in children (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Erectile Dysfunction (Guidelines) | Right Decisions
• PSA (prostate-specific antigen) Testing and Male Lower Urinary Tract Symptoms (LUTS) (Guidelines) | Right Decisions
• Diagnosis of UTI (Guidelines) | Right Decisions
• Recurrent UTI in females (Guidelines) | Right Decisions
• Recurrent UTI in males (Guidelines) | Right Decisions

Guidance removed and archived:

• COVID-19: When to refer to Infectious Diseases Team (In-patient) (Guidelines)
• COVID-19: Aerosol Generating Procedures (Guidelines) 
• Sleep onset difficulties (Paediatric Guidelines)
• CKD: Screening and diagnosis & CKD: Management. These have been combined into the one CKD guideline. 
• TAM515: Lymphoedema, Assessing vascular status (Guidelines) Guideline not developed as awaiting national guidance. 

January 2024

Updated Guidance

• Psychotic disorders
• Liver
• Raigmore Rib fracture management in trauma 
• Aerosol generating procedures 

February 2024

Updated guidance

• Ocular trauma 
• Lipid lowering therapy in the prevention/treatment of atherosclerosis
• Urology referral guideline 
• Frank Haematuria 
• Occult or non visible haematuria 

Removed guidance

• Introduction to treatment of low electrolytes as the information is within the guidance

March 2024

New guidance

• Haematology Full guideline suite reviewed with updates to guidelines and new guidelines added: 
  • Thrombocytopenia
  • Neutropenia
  • Neutrophilia
  • Lymphocytosis
  • Eosinophilia
  • Basophilia
  • Monocytosis
  • Splenomegaly
  • Lymphadenopathy
  • Elevated plasma viscosity
  • Iron deficiency
  • Hyperferritinaemia
  • Abnormal coagulation screen and bruising
  • VTE and travel
  • Blood parasite investigation
• ADHD Guidelines

Updated guidance

• Haematology Full guideline suite reviewed with updates to guidelines and new guidelines added:
  • Anaemia
  • Macrocytosis
  • Microcytosis
  • Lymphopenia
  • Vitamin B12 or Folate deficiency
  • Thrombophilia testing
• Vaccines and antisera (Formulary)
  • UK immunisation schedule
  • Vaccines and antisera for at risk groups
  • Vaccines and medicines for travel
• Bariatric surgery
• Psychotic disorders
• Tuberculosis
• Chronic kidney disease management

Removed guidance

• ADHD Pilot Pathway 
• Post partum haemorrhage 
• Physical monitoring with mental health

April 2024

New Guidance

• Raynaud's Phenomenon 
• Anaemia in chronic kidney disease (CKD): NHS Highland renal service (Guidelines)
• Pre-operative fluid fasting (Guidelines) | Right Decisions (scot.nhs.uk)
• Pre-operative indications for echocardiography | Right Decisions (scot.nhs.uk)
• Radiation proctitis | Right Decisions (scot.nhs.uk)
• Acute urinary tract infection
• Penicillin allergy poster

Updated Guidance (with changes)

• Menopause and HRT (Guidelines) | Right Decisions (scot.nhs.uk)
• Orthopaedics musculoskeletal pathways
• Unplanned alcohol withdrawal (Guidelines) | Right Decisions (scot.nhs.uk)
• Warfarin and DOACs in adults undergoing surgery or invasive procedures (Guidelines) | Right Decisions (scot.nhs.uk)
• Antimicrobial Guidelines for Adult In-Patients poster
• Critical care - empiric second line antibiotic guidelines for level 2 and 3
• Hospital acquired pneumonia
• Lyme disease
• Skin and soft tissue landing page
• Cellulitis/wound infections
• Acute lower urinary tract infection in adults (no fever or flank pain)
• Acute upper urinary tract infection
• Intra-abdominal sepsis
• Long covid (Guidelines) | Right Decisions (scot.nhs.uk)

Updated Guidance (no changes)

• AMT131 Gentamicin Prescribing Tips in Sepsis
• AMT118 Pre-op oral antibiotics prior to elective colorectal surgery
• AMT164 Cold sores
• AMT165 Fungal nail and skin infections
• AMT172 Varicella zoster/chicken pox - Herpes zoster/shingles
• AMT117 Gastroenteritis
• AMT120 Threadworm
• AMT122 Pancreatitis
• TAM414 PSA (Prostate-specific antigen) follow-up monitoring

Removed Guidance 

• COVID115 Management of surgical patients who decline a COVID19 test
• AMT136 Prophylaxis following tick bite
• AMT137 Erythema migrans (EM) and/or non-focal symptoms (eg 'flu-like' symptoms)
• AMT138 Lyme disease affecting the cranial nerves or peripheral nervous system
• AMT139 Lyme disease affecting the central nervous system
• AMT140 Lyme disease arthritis, Acrodermatitis chronic atrophicans
• AMT141 Lyme carditis: haemodynamically stable
• AMT142 Lyme carditis: haemodynamically unstable

May 2024

New Guidance:

• Clozapine initiation and re-titration: Specialist Mental Health (Guidelines) | Right Decisions (scot.nhs.uk)
• Perinatal and Infant Mental Health Team | Right Decisions (scot.nhs.uk)
• Unscheduled bleeding on HRT (Guidelines) | Right Decisions (scot.nhs.uk)

Updated Guidance: 

• Embolism prophylaxis for patients with non-valvular, persistent or permanent atrial fibrillation (Guidelines) | Right Decisions (scot.nhs.uk)
• Ocular trauma (Guidelines) | Right Decisions (scot.nhs.uk)
• Ophthalmology referral guidelines, including Out of Hours (Guidelines) | Right Decisions (scot.nhs.uk)
• Oral anticoagulants (Formulary) | Right Decisions (scot.nhs.uk)
• Prazosin for PTSD-related nightmares (Guidelines) | Right Decisions (scot.nhs.uk)

Removed Guidance:

• Anticoagulant recommendations. This is replaced with: Warfarin.

June 2024

New guidance:

• Orthopaedic on-call (Guidelines) | Right Decisions (scot.nhs.uk)

Updated guidance: 

• Pilondial disease (Guidelines) | Right Decisions (scot.nhs.uk)
• Prescribing medicines in renal impairment | Right Decisions (scot.nhs.uk)
• Pre-Diabetes and type 2 diabetes referrals (Guidelines)
• Anticoagulant switching | Right Decisions (scot.nhs.uk)
• Healthy weight Adult (Guidelines) | Right Decisions (scot.nhs.uk)
• Warfarin (Guidelines) | Right Decisions (scot.nhs.uk)
• Unplanned alcohol withdrawal (Guidelines) | Right Decisions (scot.nhs.uk)
• Intra-uterine contraceptive devices (IUCD) (Formulary) | Right Decisions (scot.nhs.uk)
• Vancomycin in haemodiafiltration (HDF) (Guidelines) | Right Decisions (scot.nhs.uk)
• Perinatal and Infant Mental Health Team | Right Decisions (scot.nhs.uk)
• Nephrostomy (Guidelines) | Right Decisions (scot.nhs.uk)
• AMT157 Bronchiectasis
• AMT158 Community Acquired Pneumonia (CAP)
• AMT162 Bites
• AMT163 Cellulitis/Wound Infections
• AMT168 Impetigo
• AMT169 Leg Ulcer
• AMT171 Scabies

Guidance reviewed with no changes: 

• AMT116 Eradication of Helicobacter pylori
• AMT146 Bone and Joint Infections
• AMT170 Necrotising Fasciitis

Removed guidance: 

• Referral to clinical Psychology (Guidelines)
• Orlistat Frequently Asked Questions (Patient information)
• Bariatric Surgery Frequently Asked Questions (Patient information)
• Non-steroidal anti-inflammatory drugs (NSAIDS) (Guidelines)
• Self Help Service - patient information leaflet (Guidelines)

July 2024

New guidance: 

• Myasthenia gravis (Guidelines) | Right Decisions (scot.nhs.uk)
• Orthopaedic on-call (Guidelines) | Right Decisions (scot.nhs.uk)
• Complex bronchiectasis referral pathway (Guidelines) | Right Decisions (scot.nhs.uk)
• Bronchiectasis (Guidelines) | Right Decisions (scot.nhs.uk)
• Pulmonary embolism (Guidelines) | Right Decisions (scot.nhs.uk)
• Food allergy referral (Paediatrics guidelines) | Right Decisions (scot.nhs.uk)
• Egg allergy (Paediatric guidelines) | Right Decisions (scot.nhs.uk)
• Intracerebral Haemorrhage (ICH) (Guidelines) | Right Decisions (scot.nhs.uk)
• Blood delivery (Guidelines) | Right Decisions (scot.nhs.uk)
• Transfusion special requirements | Right Decisions (scot.nhs.uk)
• Drug Management of Adult Hospital In-patients with COVID-19 Infection following LFT/PCR positive | Right Decisions (scot.nhs.uk)
• Risk factors for progression to severe COVID-19 infection | Right Decisions (scot.nhs.uk)
• Hospital prescription forms and prescribing chart example for oral antivirals | Right Decisions (scot.nhs.uk)
• Delayed / precocious puberty (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Short stature (Paediatric guidelines) | Right Decisions (scot.nhs.uk)

Updated Guidance: 

To view the changes to guidance, see the 'What's new' section of each guideline. 

• Monoclonal gammopathy of uncertain significance (MGUS) (Guidelines) | Right Decisions (scot.nhs.uk)
• Mastitis and breast abscess (Guidelines) | Right Decisions (scot.nhs.uk)
• Children and young people: deliberate self-harm with suicidal intent (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Ultrasound follow-up of gall bladder polyp (Guidelines) | Right Decisions (scot.nhs.uk)
• Non-hospitalised patients with symptomatic COVID-19 infection (Guidelines) (1) | Right Decisions (scot.nhs.uk)
• Adrenarche (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Referral to community diabetes specialist nurses (guidelines) | Right Decisions (scot.nhs.uk)
• Baricitinib for adults and children aged 2 years and older admitted to hospital with confirmed SARS-CoV-2 infection (Guidelines) | Right Decisions (scot.nhs.uk)
• Antivirals and neutralising Monoclonal Antibodies (nMABs) for COVID-19 | Right Decisions (scot.nhs.uk)
• Endocrine (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Pulmonary embolism (Guidelines) | Right Decisions (scot.nhs.uk)
• Sayana press (Guidelines) | Right Decisions (scot.nhs.uk)
• Warfarin, DOACs and antiplatelets in adults undergoing surgery or invasive procedures (Guidelines) | Right Decisions (scot.nhs.uk)
• Bell's Palsy (Guidelines) | Right Decisions (scot.nhs.uk)
• HIV Post-exposure prophylaxis (PEP/PEPSE) supporting guidelines (Guidelines) | Right Decisions (scot.nhs.uk)
• Human immunodeficiency virus (HIV) (Guidelines) | Right Decisions (scot.nhs.uk)

Removed guidance: 

• Hospital in-patients admitted with symptomatic COVID-19 infection (Guidelines)
• Hospital in-patient with hospital-acquired/hospital onset COVID-19 infection (Guidelines)
• Highest Risk List: COVID-19 (Guidelines):
  Replaced by: Risk factors for progression to severe COVID-19 infection | Right Decisions (scot.nhs.uk)
• Community Pharmacy (Resources):
  Archived as information now available on CP website. 
• Allergy (Paediatric guidelines):
  Replaced by Food allergy referral and Egg allergy guidelines. 
• Epidural (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)

August 2024

New Guidance:

• Asthma in children aged 2 to 5 years (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)

Updated Guidance:

To view the changes to the guidance, see the 'What's new' section of each guideline. 

• Weight and health (Guidelines) | Right Decisions (scot.nhs.uk)
• Malignant spinal cord compression (Guidelines) | Right Decisions (scot.nhs.uk)
• Palliative Care resources (Guidelines) | Right Decisions (scot.nhs.uk)
• Inpatient diabetes guidelines (Guidelines) | Right Decisions (scot.nhs.uk)
• Acute treatment and secondary prevention of transient ischaemic attacks (TIA) and ischaemic stroke (Guidelines) | Right Decisions (scot.nhs.uk)
• Personality disorder integrated care pathway (Guidelines) | Right Decisions (scot.nhs.uk)
• Hyponatraemia (Guidelines) | Right Decisions (scot.nhs.uk)
• Ultrasound follow-up of gall bladder polyp (Guidelines) | Right Decisions (scot.nhs.uk)

Guidance reviewed with no changes:

• Analgesia (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Naloxone and managing complications of opioids (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Subcutaneous opioid (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Local anaesthetic infusion (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)

September 2024

New guidance: 

• Outpatient Antibiotic Therapy (OPAT) | Right Decisions (scot.nhs.uk)
• Suspected blood transfusion reaction (Guidelines) | Right Decisions (scot.nhs.uk)
• Neuropsychology referral (Guidelines) | Right Decisions (scot.nhs.uk)
• Endometriosis (Guidelines) | Right Decisions (scot.nhs.uk)
• Post-fall medication review (Guidelines) | Right Decisions (scot.nhs.uk)
• Time critical medicines (Guidelines) | Right Decisions (scot.nhs.uk)

Updated guidance:

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Computerised cognitive behavioural therapy (cCBT) (Guidelines) | Right Decisions (scot.nhs.uk)
• DMARD monitoring in Primary Care (Guidelines) | Right Decisions (scot.nhs.uk)
• Lipid lowering therapy in the prevention / treatment of atherosclerosis (Guidelines) | Right Decisions (scot.nhs.uk)
• Inpatient diabetes guidelines (Guidelines) | Right Decisions (scot.nhs.uk)
• CHILDREN - Empirical antibiotic therapy (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Non-hospitalised patients with symptomatic COVID-19 infection (Guidelines) | Right Decisions (scot.nhs.uk)
• Nausea and vomiting (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Risk factors for progression to severe COVID-19 infection | Right Decisions (scot.nhs.uk)
• Antibiotic prophylaxis for infective endocarditis (Dental Guidelines) | Right Decisions (scot.nhs.uk)
• Mucosal Ulceration and Inflammation (Simple Gingivitis) (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Acute Necrotising Ulcerative Gingivitis and Pericoronitis (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Dental Abscess (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Eczema (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Acute Sore Throat (Antimicrobial) | Right Decisions (scot.nhs.uk)

Archived guidance: 

• Antibiotics in children (Paediatric-guidelines). 
  The information is duplicated in: CHILDREN - Empirical antibiotic therapy (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Gynacology (COVID-19): Removed as out of date
• Pericoronitis (Antimicrobial): replaced by: Acute Necrotising Ulcerative Gingivitis and Pericoronitis

October 2024

Updated guidance:

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Highland Sexual Health referral process (Guidelines) | Right Decisions (scot.nhs.uk)
• Beta Blocker (IV) for Hypertension (Critical Care Formulary)
• LIVER (Guidelines) | Right Decisions (scot.nhs.uk)
• Investigating for diabetes in children (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)

Guidance updated with no amendments:

• Croup (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)

Guidance removed and archived:

• Polyarthritis / Polyarthropathy

November 2024

New Guidance:

• Milk allergy (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Finerenone in diabetic kidney disease (Guideline) | Right Decisions (scot.nhs.uk)
• Management of medical chest drains (Guidelines) | Right Decisions (scot.nhs.uk)
• Major haemorrhage protocol (ARGYLL and BUTE) (Guidelines) | Right Decisions (scot.nhs.uk)
• Buprenorphine injection (Buvidal®) for opioid dependence | Right Decisions (scot.nhs.uk)

Updated Guidance:

To view the changes to the guidance, see the 'What's new' section of each guideline.

• Food allergy referral (Paediatrics Guidelines) | Right Decisions (scot.nhs.uk)
• Egg allergy (Paediatric Guidelines) | Right Decisions (scot.nhs.uk)
• Aspiration Pneumonia (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Acute lower urinary tract infection in adults (no fever or flank pain) (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Acute upper urinary tract infection (pyelonephritis/urosepsis) (Antimicrobial) | Right Decisions (scot.nhs.uk)
• Hyperkalaemia (Guidelines) | Right Decisions (scot.nhs.uk)
• Heart Failure: Diagnosis (Guidelines) | Right Decisions (scot.nhs.uk)
• Pharmacy First (Formularies) | Right Decisions (scot.nhs.uk)
• Gender identity guidance (Guidelines) | Right Decisions (scot.nhs.uk) (AWAITING APPROVAL)
• COVID-19: Drug management following positive LFT / PCR test (Guidelines) | Right Decisions (scot.nhs.uk)
• SOCIAL PRESCRIBING | Right Decisions (scot.nhs.uk)
• Scarlet Fever (Antimicrobial) | Right Decisions (scot.nhs.uk)

December 2024

Included in Feb 2025 updates. 

January 2023:

New guidance

• TAM535 ADHD pilot pathway

Amended guidance 

• TAM528 Delirium management
• TAM281 Parkinsons disease
• TAM148 Achieving control in type 2 diabetes
• TAM481 Giant cell arthritis (GCA)
• TAM331 Non-IgE Cows Milk Protein Allergy Guidance 
• TAM135 Acute coronary care syndrome
• AMT101 Amikacin
• AMT152 Influenza treatment
• Urinary tract (UTI)
• TAM508 Pre-Diabetes and type 2 referrals

Removed guidance 

• COVID078 Emergency management of tracheostomy patient on LTV 
• COVID019 Rheumatology COVID-19
• COVID102 Anticoagulant COVID-19
• COVID004 Cancer COVID-19
• COVID052 End of life Acute COVID-19
• COVID006 Diabetes COVID-19 
• TAM302 Management following colposcopy 
• TAM299 Cervical smear recall 
• TAM387 Incontinence dermatitis
• FCR110 Inner Moray Firth Investigation and Treatment Room Service 
• COVID021 SKIN COVID-19
• COVID020 Sexual Health
• COVID013 Mental Health COVID-19

February 2023:

NB this section is being updated on a daily basis throughout the month.

New guidance

• Refugee and asylum seeker support
• Protocol for the administration of intravenous mannitol to reduce raised intra-ocular pressure

Amended guidance 

• TAM310 GP Out of Hours HSCP
• COVID111 Non hospitalised patients with symptomatic COVID-19 infection 
• COVID039 Aeroso generating procedures
• TAM185 Ophthalmology diagnosis/flowcharts 
• TAM148 Achieving control in type 2 diabetes 
• TAM UTI guidance 

March 2023:

New guidance

• ADHD pilot pathway

Updated guidance

• Stress and distress in dementia

Removed guidance

• Incontinence dermatitis
• Skin COVID-19
• Sexual Health COVID-19

April 2023:

New guidance

• Protocol for the administration of intravenous mannitol to reduce raised intra-ocular pressure
• VTEP guidance: New Craigs

Updated guidance

• Aerosol generating procedures COVID-19
• Eyes
• Genital tract
• Highest Risk List: COVID-19
• HIV pre-exposure prophylaxis PrEP
• Infective endocarditis
• Influenza treatment
• Microbiology susceptibility reporting
• Non-hospitalised patients with symptomatic COVID-19 infection
• Smoking cessation
• Ultrasound referral guidelines
  
  • Neck lump added

Removed guidance

• Long term ventilation: Primary Care: COVID-19

May 2023:

New guidance

• ECG monitoring of patient on drugs known to prolong the QT interval
• Gender identity guidance
• Palpable cervical lymph nodes (paediatrics)
• Ultrasound follow-up of gall bladder polyp
• Vancomycin in haemodiafiltration

Updated guidance

• Chronic and persistent pain

June 2023:

Updated guidance

• Hyperkalaemia
• FAQ for GP CT Referral for Cancer
• Imaging pathway for Primary Care direct access to CT chest/abdomen/pelvis for suspected malignancy
• Ophthalmology referral guidelines, including Out of Hours
• Ophthalmology emergency admission protocol: Raigmore and NTC
• Orbital cellulitis
• Lower limb lymphoedema
• Upper Limb lymphoedema
• Age-related macular degeneration (nhsh.scot)
• Patient information - Stroke (nhsh.scot)
• Imaging pathway for Primary Care direct access to CT chest/abdomen/pelvis for suspected malignancy (nhsh.scot)
• FAQ for GP CT Referral for Cancer Pathway (nhsh.scot)
• Referral to Community Diabetes Specialist Nurses (nhsh.scot)

July 2023:

Updated guidance

• Sayana Press
• Armed forces and veterans 

August 2023:

New Guidelines

• Major haemorrhage protocol 

Updated Guidelines 

• Computerised cognitive behaviour (cCBT) 
• Referral to community diabetes
• FAQ for GP CT Referral for cancer pathway 
• Imaging pathway for Primary Care direct access
• Age related macular degeneration 
• Patient information stroke 
• Hyperkalaemia
• Colorectal investigation and referral
• Incorrect use of combined hormonal contraception 
• Acute treatment and secondary prevention of transient ischaemic attacks (TIA) and ischaemic stroke 
• Adrenarche
• Sleep onset difficulties 

September 2023:

New guidance:

• Oral buprenorphine in opioid dependence (Guidelines) 
• Medication assisted treatment (MAT) (Guidelines)
• Serotonin syndrome (Guidelines)

Updated Guidance:

• Malignant spinal cord compression
• Uncomplicated chlamydia in Primary Care
• Patient information stroke 
• Acute treatment and secondary prevention of transient ischaemic attacks (TIA) and ischaemic stroke
• Management of children under 16yrs under the influence of drugs/alcohol 
• Improving the Safety of Patients with a Tracheostomy
• Ultrasound scan (USS) referral guidelines 

October 2023:

New guidance

• Personality disorder integrated care pathway

Updated guidance

• Prolonged seizure / status epilepticus in adults (Primary Care)
• Osteoporosis
• Computerised cognitive behavioural therapy (cCBT) 
• Glucose monitoring
• Red eye
• Gender identity guidance 
• Corticosteroids (dexamethasone, prednisolone and hydrocortisone for patients confirmed SARS-CoV-2 infection
• Acute otitis media 
• Acute otitis externa
• Tuberculosis
• Acute Coronary Syndrome
• Emergency contraception 
• Heart Failure assessment and investigations
• Heat Failure diagnosis 
• Heart Failure Medical management
• Heart Failure Management of decompensation 
• Non-hospitalised patients with symptomatic COVID-19 infection
• Hospital in-patient with hospital-acquired/hospital onset COVID-19 infection
• Lymphopenia assessment
• ED Stroke Thrombolysis 
• Ophthalmology referral guidelines, including Out of Hours 
• Treatment COVID19
• Antivirals and neutralising monoclonal antibodies COVID19
• Hospital in-patient Tocilixumab and Sarilumab
• Generalised anxiety disorder
• Depression

November2023: 

Updated Guidance

• Gender identity guidance (Guidelines) | Right Decisions (scot.nhs.uk)
• Acute coronary syndrome
• Highland Eating Disorder Service (HEDS) & Medical Emergency Eating Disorder (MEED)
• Hospital in-patient with hospital-acquired/hospital onset COVID-19 infection 
• Non-hospitalised patients with symptomatic COVID-19 infection
• Chronic Kidney Disease 
• Acute Kidney Injury
• Polycythaemia erythrocytosis
• Psychotic Disorders
• Thrombocytosis
• Post-menopausal bleeding

December 2023: 

Updated Guidance

• Feeling of lump in throat
• Vascular
• Treatment COVD19
• Female urinary incontinence

September 2022:

New guidance:

• Short synacthen test
• Resuscitation
• Hypercalcaemia
• Plasma metanephrines measurement
• Delirium management
• Child healthy weight
• Faecal incontinence
• Investigation of primary hyperaldosteronism

Updated guidance:

• SGLT2 inhibitors type 2 diabetes

Guidance removed:

• Toddler and young children; food, mood and health guidance

October 2022:

New guidance:

• Colorectal secondary guidance

Updated guidance:

• Testosterone replacement in menopause TAM492 
• Gestational diabetes
• Computerised cognitive behaviour (cCbt)
• Folate testing and management
• B12 deficiency testing and management
• Children empirical antibiotic therapy
• Intermittent claudication/critical ischaemia
• Baricitinib for adults and children aged 2 years and older
• Clostridium dificile
• NTproBNP
• Pre diabetes and type 2 diabetes referrals

Guidance removed:

• Toddler and young children food mood and health guidance 

November 2022:

New guidance:

• Bronchiolitis 
• Emergency admission of adults with acute constipation
• Groin hernia pathway 
• Gallstone disease 
• Anti reflux surgery

Updated guidance:

• Amputation pain Raigmore
• Ketamine
• Teicoplanin
• Gentamicin dosing in infective endocarditis in adults 
• Naloxone and managing opioid
• Post operative nausea and vomiting
• Patient controlled analgesia PCA 
• Subcutaneous opioid
• Epidural analgesia
• Local anaesthetic infusion
• Wet legs lymphorrehoea

Guidance removed: 

• None 

December 2022:

New Guidance: 

• Silver Diamine fluoride
• Bronchiolitis 
• Raigmore emergency ophthalmology admission protocol

Updated Guidance: 

• Pre diabetes and type 2 diabetes referrals
• Testosterone replacement in menopause
• Gentamicin
• Subcutaneous Methotrexate
• Highland eating disorder (HEDS) and MEED 
• Subcutaneous opioids
• Acute pain management in adults with renal impairment
• Epidural analgesia 
• Assessing vascular status
• Wet legs lymphorrhoea
• Ketamine infusion
• Amputation
• Pain assessment
• Pain controlled analgesia
• Post operative nausea and vomiting 
• Naloxone and managing opioid
• Local anaesthetic infusion 

Removed guidance: 

• Information for patients, carers and families 
• Treatment of medically unwell patients with anorexia nervosa 
• MARSIPAN checklist 
• Summary of a dieticians role 
• Increased levels of care 

New Guidance:

• Items will be added when published. 

Major updates: 

See the 'What's new' section of each guideline.

• Items will be added when published. 

Minor updates: 

See the 'What's new' section of each guideline.
These items will be ratified at the next TAMSG. 

• Items will be added when published. 

Reviewed with no changes: 

• Items will be added when published. 

Removed Guidance:

• Items will be added when removed.