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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

Abdominal Trauma / Fall in Pregnancy (321)

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

Abdominal trauma in pregnancy can range from mild (e.g. single fall from standing height) to major (e.g. high force blunt trauma). All women ≥ 23 weeks reporting direct abdominal trauma or a fall should be invited to attend Triage for assessment.

Assessment

  • Enquire about the severity of trauma and mechanism of the injury, using open questions
  • Enquire whether the woman was aware of direct trauma to her abdomen
  • Gestational age
  • Bleeding/ rupture of membranes
  • Fetal movements
  • Pain/tightenings
  • If history of assault must be seen in hospital setting
  • Refer as appropriate if other injuries (i.e. Minor injuries, Emergency Department, physiotherapy)

Examination

Maternal observation includes:

  • MEWs (Maternal Early warning score)
  • Abdomen – abdominal exam for tenderness/contractions/bruising
  • Fetal heart auscultation
  • Vaginal loss- SROM/APH

Investigations

  • CTG (if ≥ 26+0 weeks)
  • Kleihauer if trauma to abdomen ≥ 20 weeks gestation and Rh Negative

Treatment

  • Anti-D within 72 hours of event for Rh negative women with abdominal trauma in ≥ 12 weeks.

  • If minor trauma/assessment normal – reassure and send home with call back advice

  • If more significant trauma (especially road traffic accident (RTA/seatbelt injury), bleeding, tightenings, ROM, any concerns - Obstetric Middle Grade review/admit 24 hours.

  • If the woman’s condition is unstable or if there is any concern about the mother or baby – admit to LW/inform obstetric staff urgently.

  • If history of non – sexual assault, obtain careful history and full examination must be recorded with obstetric review.

  • If additional sexual assault described, inform police surgeon.

Editorial Information

Last reviewed: 28/08/2024

Next review date: 28/08/2027

Author(s): Mairi MacDermid.

Version: 3

Approved By: Maternity Governance Group

Document Id: 321