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Right Decision Service newsletter: October 2024

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

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

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

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 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.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   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

 

 

Blood Ordering Schedule, Obstetrics (355)

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

Key Points:

  1. 84% of blood cross matched for obstetric patients is currently returned unused to Blood Bank
  2. Fully cross matched blood can be available for collection from Blood Bank in 45 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  3. Group specific blood can be available for collection from Blood Bank in 20 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  4. There are 3 units of O Negative blood in the labour ward fridge
  5. The GGC Major Haemorrhage protocol will cross match up to 6 units of packed red cells if requested – please specify requirements depending on clinical case
  6. Indication must ALWAYS be specified on request to provide laboratory with accurate clinical detail
  7. Blood loss should be estimated by weighing swabs, drapes etc.
  8. Odd numbers as well as even numbers can be requested and given
  9. It is rare for obstetric patients to require more than 2 units of blood , even with PPH
  10. Dereserving cross matched blood promptly when clinically appropriate reduces waste

Recommendations: 
ALL WOMEN IN LABOUR SHOULD HAVE A ROUTINE GROUP AND SAVE

 

The following DO NOT require routine cross matching:

Asymptomatic Placenta Praevia on ward

G&S

Examination under anaesthetic

G&S

Multiple pregnancy in labour

G&S

Retained placenta 

G&S

Elective LUSCS

G&S

Emergency LUSCS 

G&S

Haemophilia carrier – normal FVIII/FIX

G&S

Von Willebrand Disease – normal FVIII/vWF

G&S

Therapeutic heparin in labour

G&S

Platelet count 50-80 x 109/L

G&S

Platelet count < 50 x 109/L in labour

Discuss with Consultant Obstetrician and Haematologist and ensure Anaesthetic team are aware. Follow specific antenatal plan for patient

Prolonged rupture of membranes in labour

G&S

Pre-eclampsia without haemolysis or haemorrhage 

G&S

Preterm delivery

G&S

Induction of labour

G&S
Fibroids – < 4cm in body of uterus

G&S

 

Organise cross matched blood if:

APH with ongoing bleeding

2 units

Major APH 

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS with abnormally invasive placental disease

Minimum of 4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

Minimum of 2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liase with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Please be mindful that some patients will have multiple risk factors which may influence clinical decision making around blood ordering. Each case is unique and there is a balance to be achieved between blood product wastage and patient safety. A degree of clinical independence is reasonable.

Appendix 1

Organise Cross Matched Blood if:

APH with ongoing bleeding

2 units

Major APH (e.g. heavy PV bleeding, IV fluids required) +/- additional risk factor, unstable

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS for suspected accreta

4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liaise with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Editorial Information

Last reviewed: 22/09/2022

Next review date: 30/09/2027

Author(s): Judith Roberts.

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 355