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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

Congenital uterine anomalies (951)

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

Congenital uterine anomalies (CUA) are malformations of the uterus which occur during development in-utero. These malformations are therefore present from birth and many women have no symptoms-some may experience heavy periods. The implications of CUA, depending on the type and severity, can range from an increased risk of 1st/2nd Trimester miscarriage(s), intra-uterine growth restriction (IUGR), fetal malpresentation, pre-eclampsia and pre-term birth (PTB). There can be an association with anomalies of the genital tract, bladder and kidneys. Consideration should therefore be given to ultrasound imaging of the renal tract if indicated.

Types

  • Bicornuate uterus (heart-shaped womb)
  • Unicornuate uterus
  • Didelphic (double womb)
  • Septate/sub-septate uterus
  • Arcuate womb

Women who have had resection of a uterine septum remain at risk of PTB

Implications

Women with bicornuate and unicornuate uteri have an increased risk of first trimester miscarriage (OR 3.4; 95% CI 1.18–9.76 and OR 2.15; 95% CI 1.03–4.47 respectively), preterm birth (OR 2.55; 95% CI 1.57–4.17 and OR 3.47; 95% CI 1.94–6.22 respectively) and fetal malpresentation (OR 5.38; 95% CI 3.15–9.19 and OR 2.74; 95% CI 1.3–5.77 respectively), while women with uterus didelphys appear to have an increased risk of preterm labour (OR 3.58; 95% CI 2.0–6.4) and fetal malpresentation (OR 3.7; 95% CI 2.04–6.7).

The presence of variations in uterine size and shape in expectant mothers is associated with a two to five-fold increase in the risk of spontaneous preterm birth compared to those with normal uterine anatomy.

Management

The UK Preterm Birth Clinical Network Guidance advises women with CUA are referred to consultant antenatal clinics to form a plan of care for the remainder of pregnancy. 

Within GG&C we suggest that women found to have a CUA on an EPAS or dating ultrasound should have a Critical Alert-Womangenerated on Badger by the sonographer and an appointment arranged with the patient’s named consultant at 16 weeks gestation in order to discuss this further.

Critical Alert-Woman

To enter a Critical Alert-Woman please search under the ‘Enter new note tab’ (See Picture 1) Complete the boxes (See Picture 2) detailing the details of the alert e.g. Bicornate uterus at EPAS scan. 

Picture 1

Picture 2

Suggested management includes 3rd trimester growth scans to monitor for IUGR and to confirm fetal presentation by 36 weeks gestation. Women with CUA are advised with signs and symptoms of PTB to contact MAU 24/7 for further assessment. If PTB at <30 weeks gestation is confirmed the PreTerm Labour guideline should be followed remembering to include; corticosteroids, Magnesium Sulphate and anti-biotic cover.

Editorial Information

Last reviewed: 30/11/2021

Next review date: 30/11/2026

Author(s): Lynne Thomson.

Version: 1

Approved By: Gynaecology Clinical Governance Group

Document Id: 951

References

Reproductive Implications and Management of Congenital Uterine Anomalies MA Akhtar, SH Saravelos, TC Li, K Jayaprakasan, on behalf of the Royal College of Obstetricians and Gynaecologists

UK Preterm Clinical Network. Reducing preterm birth. Guidelines for commissioners and providers. 2019 [www.tommys.org/our-orga nisation/our-research/premature-birth-research/reducingpretermbirth-rates]

https://www.tommys.org/pregnancy-information/pregnancy-complications/uterine-abnormalityproblems-womb

Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online2014; 29(6): 665 – 8

Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 2011; 205(6): 558 e1 –5