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Announcements and latest updates

Right Decision Service newsletter: September 2024

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

1.Business case for permanent provision of the Right Decision Service from April 2025 onwards

This business case has now been endorsed by the HIS Board and will shortly be submitted to Scottish Government.

2. Management of RDS support tickets

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

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

Key points to note are:

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

Critical/urgent issues are defined as:

  1. The Service as a whole is not operational for multiple users. OR
  2. Multiple core functions of the Service are not operational for multiple users.

Example – RDS website outage.

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

High priority issues are defined as:

  1. A single core function of the Service is not operational for multiple users. OR:
  2. Multiple non-core functions of the Service are not operational for multiple users.

Example – Build to app not working.

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

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

The majority of issues currently in support tickets fall into category 2 or 3 above, or both.

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

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

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

3. Next scheduled deployment.

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

We will update you on this in the next newsletter and in the planned webinar about support ticket processes.

4. Contingency arrangements for RDS

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

5. Transfer of CKP pathways to RDS

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

NHS Lothian musculoskeletal pathways

NHS Fife rehabilitation musculoskeletal pathways

NHS Tayside paediatric pathways

6. Other new RDS toolkits

Include:

Focus on frailty (from HIS Frailty improvement programme)

NHS GGC Money advice and support

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

To go live imminently:

  • Focus on dementia
  • NHS Lothian infectious diseases toolkit
  • Dumfries and Galloway Adult Support and Protection procedures
  • SIGN guideline – Prevention and remission of type 2 diabetes

 

7. Evaluation projects

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

  • Most respondents (64%) are frequent users of the toolkit, using it either daily or weekly. A further 25% use it once or twice per month.
  • 5% of respondents use the toolkit to deliver direct patient care and 82% use it for learning
  • Impact on practice and decision-making was rated as very high, with 80% of respondents rating these at a 4-5 on a 5 point scale.
  • Impact on time saving was also high, with 74% of respondents rating it from 3-5.
  • 74% also reported that the toolkit improved their knowledge and skills, rating these at 4-5 on the Likert scale

Key strengths identified included:

  • The information is useful, succinct, and easy to understand (31%).
  • Coverage is comprehensive (15%)
  • All information is readily accessible in one place and users value the offline access via mobile app (15%)
  • Information is reliable, evidence-based and up to date (13%)

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

8.RDS High risk prescribing (polypharmacy) decision support embedded in Vision and EMIS primary care E H R systems

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

9. Video tutorials for RDS editors

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

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

  • Wednesday 23rd October 4-5 pm
  • Tuesday 29th October 11 am -12 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.)

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

 

Domestic Abuse in Obstetric & Gynaecology settings (588)

Objectives

Other relevant policies:

Gender Based Violence Policy, Policy on Stalking, Health and Safety Policy, Forced Marriage Policy, Adult Support and Protection guidance and Procedures, Child Protection Procedures, Mental Health and wellbeing policy, Alcohol and Substance Misuse, Human Trafficking, Interpreting Policy.

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

NHS Greater Glasgow & Clyde (NHSGG&C) recognises gender-based violence (GBV) as both a cause and consequence of gender inequality and acknowledges the evidence that it is overwhelmingly perpetrated by men against women and children, with the latter more at risk from men they know. As part of its Equality Scheme, NHSGG&C has produced several gender based violence action plans which identify domestic abuse as part of a wider continuum of abuse, which also includes child sexual abuse, rape & sexual assault, sexual harassment, female genital mutilation, forced marriage and commercial sexual exploitation.

GBV cuts across all boundaries of class, ethnicity, religion and age. At the same time women in marginalised groups can suffer discrimination in relation to ethnicity, (dis)ability, sexual orientation, poverty, migrant or refugee status which can increase and intensify their vulnerability to abuse and limit access to services. Given the health consequences and links with child protection NHS staff have a pivotal role in responding to this issue.

The Scottish Government defines domestic abuse as;

“perpetrated by partners or ex partners (which) can include physical abuse (assault and physical attack involving a range of behaviour), sexual abuse (acts which degrade and humiliate women & are perpetrated against their will, including rape) and mental and emotional abuse (such as threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as isolation from family and friends)

The purpose of this guidance is to assist staff (W&CD) in identifying and responding sensitively to women accessing services during their reproductive years, who may have current or past experience of domestic abuse. This applies to areas where routine enquiry of domestic abuse has been implemented and for all other areas within Obstetrics & Gynaecology.

Routine enquiry

  • Be aware of the indicators of domestic abuse & its impact on health & (Appendix 1) & www.gbv.scot.nhs.uk
  • See all women alone for part of the consultation to ensure that any sensitive information can be discussed safely & in confidence.
  • Always set the context prior to asking about abuse. (Appendix 2)
  • Follow this up with a direct question that requires a direct answer (Appendix 2)
  • Always discuss confidentiality & its limits (child protection and vulnerable adults).    
  • Follow NHSGGC Spoken Language, British Sign Language and Communication Support Interpreting Policy (2012). It is not appropriate to use family or friends to communicate except in an emergency situation.

Have information on support services available in the department in places where they can be picked up easily

Asking about abuse at other times

Examples of what to ask:

  • “I notice you have cuts/bruises…has someone hurt you?
  • Some of our patients who have these symptoms are living with an abusive partner…is that something that affects you?

Asking about domestic abuse will not always result in disclosure. Some women may choose to disclose at a later date & others will never access support.

Responding to Disclosure

The safety of the woman and any children is paramount and therefore it is crucial that health workers assess any immediate risk/safety issues following disclosure and follow child protection and vulnerable adult procedures where there are any concerns.

Key aspects to explore when assessing risk: 

  • How frequent and severe is the abuse?
  • Is she afraid for herself or her children?
  • Is she isolated and without support?
  • Is she being harassed or stalked?
  • Is there sexual violence, pressure or jealousy?
  • Are there any other risk factors such as drug, alcohol or mental health issues?

For many women leaving is the most dangerous point in the relationship, & any fears raised by the woman for her safety should be taken seriously. Women seldom exaggerate the risk of harm & are more likely to minimise the abuse.

Safety Planning

Following disclosure the health worker should explore options with the woman to help her focus on her current and future safety.

  • Help her identify a safe place she can go with her children i.e. friends, family, refuge or temporary accommodation
  • Discuss packing a bag with essential documents, clothes, money, medication, important phone numbers in case she needs to leave in a hurry. Store the bag safely where the perpetrator won’t find it
  • Offer her the Scottish Domestic abuse & Forced Marriage Helpline Number 0800 027 1234 –and  the opportunity to phone the helpline from a private room
  • Does she want to report the incident to the police? Advise her to dial 999 in an emergency or 101 at other times
  • Follow child protection and vulnerable adult procedures where there are any concerns.
  • Ensure a follow-up appointment is arranged where appropriate.

Risk assessment is not a one off event and risk may change over time; therefore ongoing risk assessment is required.

 

Documentation of Abuse

This is important health information which should be documented in the woman’s hospital notes, never in ‘hand-held’ records.  .

Document any disclosure using the woman’s own words and include any action or referrals and plans for follow up.

Resources

Scottish Domestic Abuse & Forced Marriage 24 hour helpline
0800 027 1234 www.sdah.org.uk– men women and children

For support and information on domestic abuse: 
www.scottishwomensaid.org.uk

Help and information for anyone who has been raped or sexually abused: 
www.rapecrisisscotland.org.uk

Website for perpetrators of domestic abuse looking for help to address their behaviour:
www.respect.uk.net

Support for male victims of domestic abuse: 
www.mensadviceline.org.uk

Advice and information for lesbian, gay, bisexual and transgender people experiencing domestic abuse:
www.lgbtdomesticabuse.org.uk
www.brokenrainbow.org.uk/help/helpline

Police Scotland Information and support for victims of domestic abuse: 
http://www.scotland.police.uk/keep-safe/advice-for-victims-of-crime/domesticabuse/reporting-domestic-abuse/

For further information on GBV
www.equality.scot.nhs.uk

A series of guides to support health workers on gender based violence is available at:
www.gbv.scot.nhs.uk

Support for Staff

Support for Staff can be obtained via:

  • Your line manager or Supervisor of Midwives
  • Employee Policy on Domestic Abuse - Staffnet HR policies
  • Occupational Health and employee counselling service
  • The Pastoral Care Team can provide/access religious, spiritual and emotional support.

For professional or personal support regarding Gender Based Violence contact the GBV Resource Unit 0141 201 9777 or e-mail: gbvunit@ggc.scot.nhs.uk  or visit our website on Staffnet.

Appendix 1

Impact on Health 

Table listing some impacts on health of domestic abuse

Possible Indicators of Abuse

  • Missed appointments and non-compliance with treatment
  • Frequent presentations to health settings or delay in seeking medical treatment/advice
  • Overbearing or overly solicitous partner who is always present
  • Denial or minimising of abuse
  • Injuries at different stages of healing or that don’t fit with the explanation given
  • Appears evasive, socially withdrawn and is hesitant
  • Children on the child protection register or referred to other specialists for behavioural/emotional or developmental problems

These lists are not exhaustive & there may be other causes.

Some women experiencing abuse may show no signs or indicators.

Appendix 2

Routine Enquiry

Setting the Context:

 “Around 1:4 women experience emotional, sexual or physical abuse, because we know this affects your health (and pregnancy), we now routinely ask all women……”

Follow setting the context by giving a short explanation of each of the forms of abuse e.g. physical abuse can be a push, slap or kick, emotional abuse may be your partner putting you down or not letting you see family or friends and sexual abuse could be your partner forcing you to do something you don’t want to.

Examples of Direct Questions: 

  • Have you ever felt afraid of a partner/ex or family member?
  • Has your partner/ex, ever physically hurt or threatened you or your children?
  • Has your partner/ex ever destroyed things that you cared about?
  • Has your partner/ex ever forced you to have sex when you didn’t want to?
  • Does he/she force you to engage in sex that makes you feel uncomfortable?
  • Does your partner/ex ever get jealous? If so, how does he act?
  • Does your partner/ex try to control you in any way, for example preventing you from going out or limiting contact with your family or friends?

These questions are intended as prompts, it is not necessary to ask all of them and they should not be used as a checklist.

Editorial Information

Last reviewed: 01/06/2016

Next review date: 30/06/2021

Author(s): Elaine Drennan; Mairi McDermid.

Approved By: Obstetrics Clinical Governance Group

Document Id: 588