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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

 

 

 

Infectious Diseases Screening Tests in Late Bookers (357)

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

Late bookers are women who present for the first time on or after 24 weeks pregnancy. This is the stage at which the baby is potentially viable if early labour occurred.

The results of the infectious disease screening tests could affect the management at or after delivery, therefore all infectious diseases screening test results for a woman should be known prior to delivery and certainly before discharge.

If a woman presents to maternity services as a late booker i.e. on or after 24 weeks it is important to ensure that screening has been offered and results are received.

 

1) The woman presents to the antenatal clinic, and there is no immediate risk of delivery

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record.
  • Mark the  sample  as  URGENT  and  telephone  the  West of Scotland Specialist Virology Centre to let them know it is in the system. (0141 201 8722). Alternatively, email west.ssvc2@nhs.scot. State that the patient is a late booker, provide the lab with a contact phone number and state if you are want to receive the result on Clinical Portal or by phone.
  • Send the sample to the virus lab, via normal routine processes.
  • Ensure that the name and contact details of the person and a deputy who will be responsible for any positive results are clearly appended
  • Note that to view a result on portal a CHI number is essential

2) The woman presents to maternity assessment i.e. in pain, bleeding etc therefore the risk of delivery is high

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next                      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours(9.00 – 17.00 Monday to Friday), telephone the lab on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
    • Alternatively, in hours only, email west.ssvc2@nhs.scot, flag the email as urgent and state that the patient has a high risk of delivery. Provide the lab with a contact number. They will call you back within an hour.
  • Out of hours (including Saturday and Sunday).
    • Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above. Do not email the lab out of hours or at the weekend. 
  • If the timing of the local transport systems does not facilitate urgent transfer order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link])  
  • In normal hours the lab is able to process and produce results within 1-2 hours of receipt. Note that reactive samples will need to be confirmed on the next day.
  • Note that to view a result on Clinical Portal, a CHI number is essential.

3) The woman presents in labour

It is the responsibility of the labour ward staff to ensure that virology screening tests are offered and results received. Even intrapartum diagnosis can significantly, positively modify neonatal outcome therefore it is important to ensure women are offered screening tests no matter how late.

It is essential that you telephone the virology lab as soon as possible to discuss emergency testing of the woman.

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours (9.00 – 17.00 Monday to Friday), telephone the laboratory on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
  • Out of hours (including Saturday and Sunday) Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above.
  • Order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link]) 
  • As with ALL emergency blood tests ensure results are followed up immediately they are available. In normal hours the lab is able to process and produce results within 1-2 hours of receipt.  
  • Communication with paediatricians is essential as their management may be significantly altered by these results however the responsibility for taking and sending these investigations and obtaining these results remains with the midwifery / obstetric team.

Editorial Information

Last reviewed: 20/03/2021

Next review date: 30/04/2023

Author(s): Gillian Penrice.

Version: 4

Approved By: Maternity Clinical Governance Group

Document Id: 357