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Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 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.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

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

Blood Ordering Schedule, Obstetrics (355)

Please report any inaccuracies or issues with this guideline using our online form

Key Points:

  1. 84% of blood cross matched for obstetric patients is currently returned unused to Blood Bank
  2. Fully cross matched blood can be available for collection from Blood Bank in 45 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  3. Group specific blood can be available for collection from Blood Bank in 20 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  4. There are 3 units of O Negative blood in the labour ward fridge
  5. The GGC Major Haemorrhage protocol will cross match up to 6 units of packed red cells if requested – please specify requirements depending on clinical case
  6. Indication must ALWAYS be specified on request to provide laboratory with accurate clinical detail
  7. Blood loss should be estimated by weighing swabs, drapes etc.
  8. Odd numbers as well as even numbers can be requested and given
  9. It is rare for obstetric patients to require more than 2 units of blood , even with PPH
  10. Dereserving cross matched blood promptly when clinically appropriate reduces waste

Recommendations: 
ALL WOMEN IN LABOUR SHOULD HAVE A ROUTINE GROUP AND SAVE

 

The following DO NOT require routine cross matching:

Asymptomatic Placenta Praevia on ward

G&S

Examination under anaesthetic

G&S

Multiple pregnancy in labour

G&S

Retained placenta 

G&S

Elective LUSCS

G&S

Emergency LUSCS 

G&S

Haemophilia carrier – normal FVIII/FIX

G&S

Von Willebrand Disease – normal FVIII/vWF

G&S

Therapeutic heparin in labour

G&S

Platelet count 50-80 x 109/L

G&S

Platelet count < 50 x 109/L in labour

Discuss with Consultant Obstetrician and Haematologist and ensure Anaesthetic team are aware. Follow specific antenatal plan for patient

Prolonged rupture of membranes in labour

G&S

Pre-eclampsia without haemolysis or haemorrhage 

G&S

Preterm delivery

G&S

Induction of labour

G&S
Fibroids – < 4cm in body of uterus

G&S

 

Organise cross matched blood if:

APH with ongoing bleeding

2 units

Major APH 

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS with abnormally invasive placental disease

Minimum of 4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

Minimum of 2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liase with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Please be mindful that some patients will have multiple risk factors which may influence clinical decision making around blood ordering. Each case is unique and there is a balance to be achieved between blood product wastage and patient safety. A degree of clinical independence is reasonable.

Appendix 1

Organise Cross Matched Blood if:

APH with ongoing bleeding

2 units

Major APH (e.g. heavy PV bleeding, IV fluids required) +/- additional risk factor, unstable

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS for suspected accreta

4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liaise with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Editorial Information

Last reviewed: 22/09/2022

Next review date: 30/09/2027

Author(s): Judith Roberts.

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 355