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  7. Fitting of Sigma® Diaphragm, Advice to Clients on Diaphragm and Cap use and Documentation
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

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

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

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.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Fitting of Sigma® Diaphragm, Advice to Clients on Diaphragm and Cap use and Documentation

Fitting of Sigma®

  • Diaphragms should initially be fitted by a competent health professional.
  • Diaphragms should be positioned so that the rim fits comfortably and not too
    loosely or tightly into the vaginal fornices. Ideally the anterior rim should sit in
    the grove behind the pubic bone.
  • Clients need to be competent at removing the diaphragm before they leave
    the clinic.
  • Clients should also be given the opportunity to insert the device themselves
    at the clinic.
  • The method cannot be relied upon for contraception until the client has
    returned and demonstrated confidence in its use

Advice to Clients on Diaphragm and Cap use

Clients need to read the manufacturer’s instructions that come with the device

Spermicide use
Singa: two strips of spermicide ~2cm long to upper side of the diaphragm. A little spermicide on the leading rim can make inserting easier.
Caya: 4 mls of spermicide (a teaspoonful) into the silicone membrane and some spread around the external rim, prior to inserting into the vagina
Femcap: ¼ teaspoon spermicide in the bowl, and ½ teaspoon in the groove, then spread all over the cap except where the thumb and finger will be holding it for insertion.

Apply more spermicide (as a pessary or as cream using an applicator) if sex is to take place > 3hrs ( caya – 2 hours) since device was inserted or if sex is repeated whilst method in place

Timing of insertion

Singa/Caya can be inserted at any time with spermicide before sex and must remain
in place for at least 6 hours after the last episode of sex.

Femcap should be placed at least 15 minutes before sexual arousal.

After insertion the client must always check that the cervix is covered and if not the diaphragm should be removed and an attempt made at reinsertion.

Timing of removal
A diaphragm/cap must be left in place for at least 6 hours after the last episode of sex but not left longer that the recommended time:
Singa & Caya 24 hours
Femcap: 48 hours

The CEU advise that a device can be kept in until at least six hours has passed even if this means it will be in place for more than 24 hour

Water can wash away spermicide so if bathing after insertion, opt for a shower rather than bath.

Care of diaphragms and caps

  • Wash the device after use in warm water with mild, unperfumed soap and dry
    with a soft clean clothStore device in its container in a cool dry place.
  • Advise regularly checking the diaphragm/cap for signs of damage or
    perishing.

Emergency Contraception may be indicated in the following situations
Diaphragm or cap is dislodged or removed within 6 hours of sex
Diaphragm has been left in for longer than 3 hours before sex and no
additional spermicide applied
Discuss the advance provision of oral emergency contraception

 

 

Documentation

The client’s record should be completed or updated on NaSH.

  • Name and size of the diaphragm provided
  • Written method information given to patient
  • Permission should be sought as to whether the client’s GP can be notified

Editorial Information

Last reviewed: 31/03/2022

Next review date: 30/09/2025

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group.

Version: 6.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health