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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

Preterm Prelabour Rupture of Membranes (PPROM) (348)

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

Rupture of Membranes prior to 37+0: no evidence of Labour.

Diagnosis

  • History and abdominal examination: remember association of PPROM and malpresentation.
  • Perform speculum examination and swabs, after the mother has adopted the left lateral position for 20 minutes. If pool of liquor seen send sample to bacteriology for culture. If there is any dubiety regarding whether liquor has been seen then a registrar shouldrepeat the examination.

Management if PPROM confirmed

  • Obtain HVS, LVS and MSSU.
  • Do not perform digital examination of cervix unless delivery is planned or imminent.
  • Check WCC and CRP.
  • If there is no evidence of chorioamnionitis, commence antibiotics. Erythromycin 250mg po qds for 10 days. [Antibiotic treatment following PPROM is effective at prolonging pregnancy and reducing maternal morbidity. There is however, nostatistically proven benefit that their use improves neonatal morbidity or mortality in the long term.]

Subsequent management depends on gestational age

1. <23+6 weeks

  • Arrange ultrasound to assess amniotic fluid volume and fetus
  • Consultant review
  • Discuss with neonatologists if > 22 weeks gestation

2. 23+6 – 37 weeks

  • Administer a course of steroids.
  • Arrange ultrasound to assess fetal wellbeing.
  • Ask neonatologists to see.
  • There is no evidence of benefit from the use of tocolytics following preterm premature rupture of membranes, therefore withhold.

If there is evidence of infection or fetal compromise seek senior obstetric opinion, with a view to delivery.

In cases of suspected chorioamnionitis: Sepsis 6 bundle. Commence intravenous antibiotics in accordance with Antibiotic Policy for Obstetric Patients.

If there is no evidence of infection or fetal compromise and the patient is subsequently discharged home, follow-up through Daycare should be arranged.

Timing of delivery is a consultant decision. In women with PPROM and no contraindication to continuing the pregnancy delivery should be planned at 37 weeks gestation.

See separate guideline for the Outpatient management of these patients.

Editorial Information

Last reviewed: 04/12/2018

Next review date: 01/12/2023

Author(s): Shrikant Bollapragada.

Version: 3

Approved By: Obstetrics Clinical Governance Group

Document Id: 348