Welcome to the Right Decision Service (RDS) newsletter for August 2024.
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.
The following toolkits are now live;
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.
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.
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
09/08/19 Update - addition of umbilical artery Doppler to any scan
| Please report any inaccuracies or issues with this guideline using our online form |
Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. Fetal movements have been defined as any discrete kick, flutter, swish or roll. A significant reduction or sudden alteration in fetal movement is a potentially important clinical sign. It has been suggested that reduced or absent fetal movements may be a warning sign of impending fetal death. Studies of fetal physiology using ultrasound have demonstrated an association between RFM and poor perinatal outcome.
Clinicians should be aware (and should advise women) that although fetal movements tend to plateau at 32 weeks gestation, there is no reduction in the frequency of movements in the late third trimester.
Women who have normal clinical assessment and investigations after first episode of RFM should be advised to contact the maternity unit if they have a further episode.
Women who have normal clinical assessment and investigations after second (or more) episode of RFM should undergo a scan (including umbilical artery Doppler) for fetal well being (unless they have had a normal scan within 3 weeks). At the third presentation, the woman should be referred to the consultant-led antenatal clinic for consideration of increased fetal surveillance.
Those women who are still not feeling fetal movements after having a normal scan and CTG should be offered either daily CTGs as an outpatient or admission and twice daily CTGs until movements return.
Women who present on two or more occasions with RFM are at increased risk of a poor perinatal outcome. There are no studies to determine whether intervention (e.g. delivery or further investigation) alters perinatal morbidity or mortality. The decision whether or not to induce labour at term in a woman who presents recurrently with RFM when the growth, liquor volume and CTG appear normal must be made after careful consultantled counselling of the pros and cons of induction on an individualized basis (RCOG Green Top Guideline No. 57)
If a woman presents with RFM between 24+0 and 27+6 weeks of gestation, the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device.
The fetal heartbeat should be confirmed to check fetal viability. History must include a comprehensive stillbirth risk evaluation, including a review of the presence of other risk factors associated with an increased risk of stillbirth. Clinicians should be aware that placental insufficiency may present at this gestation. A complete antenatal assessment including measurement of fundal height, BP and urine should be carried out. If there is clinical suspicion of FGR, or raised BP/proteinuria consideration should be given to the need for ultrasound assessment. There is no evidence on which to recommend the routine use of ultrasound assessment in this group.
If a woman presents with RFM before 24+0 weeks of gestation, the presence of a fetal heartbeat should be confirmed by auscultation with a Doppler handheld device.
A full antenatal check-up must also be completed including measurement of fundal height, BP and urine.
If fetal movements have never been felt before 24 weeks, a referral should be made to a medical sonographer to exclude any neuromuscular conditions.
Reduced fetal movements at ≥ 28+0 weeks assessment form (pdf)