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Right Decision Service newsletter: July 2024

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

1.Redesign and improvements to RDS

There has been a delay in implementing the final phase of the RDS redesign due to Tactuum having to prioritise the recent security and outage issues. Work has now resumed, and the intention now is that external user acceptance testing will start in September 2024.

As a reminder, the key improvements in this release include the following responses to user feedback:

  • Full redesign of search and browse to make it easier for users to go straight to the toolkits specific to their health board or to national toolkits. There is also a Favourites capability which enables users to access their most important toolkits directly without any search or browse requirements.
  • Comprehensive archiving and version control functionality.
  • Capability to customise and edit shared documents, save local version, and receive notification when the parent shared document is updated. The recipient of the shared document can then choose which edits to accept or ignore. This will significantly expand the opportunities for sharing guidance and collaboration across organisations and for localisation of national guidance.
  • Capability to provide a URL or QR code which will take the user direct to a specific downloadable mobile toolkit without requiring them to search and browse within the RDS mobile app. This should make for a simpler user journey. It should particularly help clinicians who want to signpost patients to download a specific mobile toolkit.

2. Migration of standalone apps to new RDS platform

Migration of the final two original standalone apps (NHS GGC paediatrics) was completed in July 2024. This means that the RDS is now truly the Once for Scotland platform for all web and mobile apps created using the RDS toolset. This has streamlined and simplified the processes around fixes, enhancements and release processes. The recent security issues are a case in point – previously these would have had to be addressed across 27 standalone apps as well as the RDS platform.

3. Evaluation - usage statistics

Figures 1 and 2 are derived from the usage statistics reports we generated in July 2024. They show how usage of the RDS has increased over the past 2.5 years. Figure 1 shows combined usage[1] across old standalone apps and the new Once for Scotland RDS platform. 2023 saw a 71% increase in usage over 2022 figures, and the usage in just 6 months of 2024 almost equals total use in 2022. Figure 2 shows use of the new RDS platform only. Usage in just 6 months of 2024 has increased by more than 100% compared with all 12 months of 2023.

             

       

 

As stated in a previous newsletter, there are caveats around comparison of use on the old and new platforms due to the different structures of each. Now that all the old standalone apps have been migrated to the new RDS platform we will focus primarily on usage of the new platform going forward.

 

4. Strategic highlights – supporting NHS Scotland priorities

Neurological Conditions Framework

The RDS will be supporting the SG Clinical Priorities team by delivering regional and national neurology guidance and  shared decision-making resources.

Waiting Well programme

The RDS team has been working with the NHS GGC Knowledge Services team to deliver a national toolkit for the Waiting Well programme. This will provide resources and tools for  services supporting patients to maintain wellbeing while on waiting lists.

Feasibility study for Value-Based Health and Care Action Plan

The RDS team has delivered an evidence review and report of stakeholder interviews to inform consideration by Scottish Government of the potential for a national approach to implementation of Patient Reported Outcome Measures (PROMs) across NHS Scotland. The final component of the feasibility study – a report on target architecture and realistic first steps towards delivery.

Gender Identity Standards

An RDS toolkit for the new Gender Identity Standards, including an interactive self-assessment questionnaire, is being developed in collaboration with the Standards and Indicators team in Healthcare Improvement Scotland. This toolkit should be published as part of a package of resources to be announced by Scottish Government in early October.

Please email ann.wales3@nhs.scot if you would like to know more about any of these developments.

5.National  IV fluid prescribing  calculator

We are now in the final stages of producing the UK CA marking documentation for this calculator and aim to publish it to live at the end of August 2024.

6. Training 

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

  • Wednesday 7 August 4-5 pm
  • Thursday 5 September 1-2 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. New toolkits

The NHS Grampian critical care toolkit is now live.

The following toolkits are due to go live imminently:

  • Care Inspectorate staffing method framework.
  • Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

8. Implementation projects

The RDS team has delivered a report for the SG Realistic Medicine Policy Unit on an implementation framework for digital tools to engage people in decisions about their care. The report was produced to support implementation of the Being a partner in my care: Realistic Medicine together app, but has wider applicability to shared decision-making apps more generally.  Please contact ann.wales3@nhs.scot if you would like to know more about the key findings and recommendations within this report.

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

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

[1] Unique users’ in Google analytics counts individual users to a website. Every time a user visits the website, their IP address assigns a unique identifier which is used to track the number of times they visit the site.

Early signs and symptoms of preterm labour (1037)

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

Definition

Preterm birth, defined as delivery at less than 37 completed weeks of gestation, is the single biggest cause of neonatal morbidity and mortality.

It is estimated that around 1 in 13 babies are born prematurely in the UK every year. This statistic has been largely unchanged over the last 10 years.

Three quarters of these births are due to spontaneous onset labour and not all of these women have risk factors for pre term labour.

What is the importance of early diagnosis of pre-term labour?

Early diagnosis of pre-term labour can allow time to potentially- Early diagnosis can allow time to implement antenatal optimisation bundle checklist. Do you use this at RAH? Its two simple infographics which could be utilised here?

  • Delay delivery in order to administer antepartum steroids and Magnesium sulphate to reduce morbidity by up to 30% (1).
  • Early diagnosis may also permit transfer of the fetus in-utero to a centre where neonatal intensive care unit facilities are available.

Can we recognise pre-term labour?

Women can experience a range of subtle and non-specific symptoms during the prodromal period leading up to pre-term labour. These symptoms can develop over days to weeks prior to established pre-term labour(3). 

Although with low predictive value, these symptoms cause women to present themselves to health care services providing the opportunity for early diagnosis.

Signs and symptoms may include (4) (Please refer to attached infograph)

  • Abdominal Cramps- with or without diarrhoea
  • Backache- low, dull constant
  • Contractions 
  • Vaginal Discharge (increase in the amount of discharge) or bleeding
  • un-Easiness- feeling “not right”
  • Fetal movements /urine Frequency– changed
  • Gush of fluid loss - preterm rupture of membranes
  • Heaviness or pelvic pressure—the feeling that the baby is pushing down

Subtle changes in uterine activity patterns have been detected a few days to several weeks before overt pre-term labour (5). Uterine activity may or may not be perceived by patients at all and are not necessarily painful. It has been observed that only about half of women can feel painful uterine activity in the days preceding pre-term labour. About a third of patients can report no uterine contractions (3). One in five patients admitted with suspected pre-term uterine activity go on to develop established pre-term labour.

What are the obstacles to diagnosis?

  • Delay in presentation as women can attribute their symptoms to stress or normal discomfort of pregnancy. Pre-term labour is often not recognised by the patient as a possible cause of their symptoms.
  • Not “piecing it together” a woman who has had recurrent presentations with non-specific symptoms- attention to pattern and progress of symptoms can help triage these patients appropriately.

What can we improve?

The first presentation to health care by the patient is dependent on them perceiving their symptoms to be concerning. It will be helpful to make patients aware of possible association of the non-specific symptoms with threated pre-term labour particularly if they are persistent or progressive.

It will be advisable to arrange an obstetric medical review (ST3+ or clinically experienced ST2)for women with symptoms so that a speculum examination can be done. There should be an awareness of red flags for pre-term labour.

Appendix: Infographic - The 'A-H' of Pre-term Labour

Editorial Information

Last reviewed: 31/12/2021

Next review date: 31/07/2025

Author(s): Julie Murphy.

Version: 1

Approved By: Obstetrics Clincal Governance Group

Document Id: 1037

References
  1. Antenatal Optimisation for Preterm Infants less than 34 weeks:A Quality Improvement Toolkit.
  2. Cooper, R. L., Goldenberg, R. L., Davis, R. O., Cutter, G. R., DuBard, M. B., Corliss, D. K., & Andrews, J. B. (1990). Warning symptoms, uterine contractions, and cervical examination findings in women at risk for preterm delivery. American Journal of Obstetrics and Gynecology, 162, 748-754.
  3. Weiss M, Saks N, Harris S.(2002).Resolving the uncertainty of preterm symptoms: women's experiences with the onset of preterm labor. J Obstet Gynecol Neonatal Nurs. Jan-Feb 2002;31(1):66-76.
  4. Maloni, J. A. (2000). Preventing preterm birth: Evidence-based interventions shift toward prevention. AWHONN Lifelines, 4(4), 26-33.
  5. Iams, J. D., Stilson, R., Johnson, F. F., Williams, R. A., & Rice, R. (1990). Symptoms that precede preterm labor and preterm premature rupture of the membranes. American Journal of Obstetrics and Gynecology, 162, 486-490.