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Announcements and latest updates

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

 

 

Domestic Abuse in Obstetric & Gynaecology settings (588)

Objectives

Other relevant policies:

Gender Based Violence Policy, Policy on Stalking, Health and Safety Policy, Forced Marriage Policy, Adult Support and Protection guidance and Procedures, Child Protection Procedures, Mental Health and wellbeing policy, Alcohol and Substance Misuse, Human Trafficking, Interpreting Policy.

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

NHS Greater Glasgow & Clyde (NHSGG&C) recognises gender-based violence (GBV) as both a cause and consequence of gender inequality and acknowledges the evidence that it is overwhelmingly perpetrated by men against women and children, with the latter more at risk from men they know. As part of its Equality Scheme, NHSGG&C has produced several gender based violence action plans which identify domestic abuse as part of a wider continuum of abuse, which also includes child sexual abuse, rape & sexual assault, sexual harassment, female genital mutilation, forced marriage and commercial sexual exploitation.

GBV cuts across all boundaries of class, ethnicity, religion and age. At the same time women in marginalised groups can suffer discrimination in relation to ethnicity, (dis)ability, sexual orientation, poverty, migrant or refugee status which can increase and intensify their vulnerability to abuse and limit access to services. Given the health consequences and links with child protection NHS staff have a pivotal role in responding to this issue.

The Scottish Government defines domestic abuse as;

“perpetrated by partners or ex partners (which) can include physical abuse (assault and physical attack involving a range of behaviour), sexual abuse (acts which degrade and humiliate women & are perpetrated against their will, including rape) and mental and emotional abuse (such as threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as isolation from family and friends)

The purpose of this guidance is to assist staff (W&CD) in identifying and responding sensitively to women accessing services during their reproductive years, who may have current or past experience of domestic abuse. This applies to areas where routine enquiry of domestic abuse has been implemented and for all other areas within Obstetrics & Gynaecology.

Routine enquiry

  • Be aware of the indicators of domestic abuse & its impact on health & (Appendix 1) & www.gbv.scot.nhs.uk
  • See all women alone for part of the consultation to ensure that any sensitive information can be discussed safely & in confidence.
  • Always set the context prior to asking about abuse. (Appendix 2)
  • Follow this up with a direct question that requires a direct answer (Appendix 2)
  • Always discuss confidentiality & its limits (child protection and vulnerable adults).    
  • Follow NHSGGC Spoken Language, British Sign Language and Communication Support Interpreting Policy (2012). It is not appropriate to use family or friends to communicate except in an emergency situation.

Have information on support services available in the department in places where they can be picked up easily

Asking about abuse at other times

Examples of what to ask:

  • “I notice you have cuts/bruises…has someone hurt you?
  • Some of our patients who have these symptoms are living with an abusive partner…is that something that affects you?

Asking about domestic abuse will not always result in disclosure. Some women may choose to disclose at a later date & others will never access support.

Responding to Disclosure

The safety of the woman and any children is paramount and therefore it is crucial that health workers assess any immediate risk/safety issues following disclosure and follow child protection and vulnerable adult procedures where there are any concerns.

Key aspects to explore when assessing risk: 

  • How frequent and severe is the abuse?
  • Is she afraid for herself or her children?
  • Is she isolated and without support?
  • Is she being harassed or stalked?
  • Is there sexual violence, pressure or jealousy?
  • Are there any other risk factors such as drug, alcohol or mental health issues?

For many women leaving is the most dangerous point in the relationship, & any fears raised by the woman for her safety should be taken seriously. Women seldom exaggerate the risk of harm & are more likely to minimise the abuse.

Safety Planning

Following disclosure the health worker should explore options with the woman to help her focus on her current and future safety.

  • Help her identify a safe place she can go with her children i.e. friends, family, refuge or temporary accommodation
  • Discuss packing a bag with essential documents, clothes, money, medication, important phone numbers in case she needs to leave in a hurry. Store the bag safely where the perpetrator won’t find it
  • Offer her the Scottish Domestic abuse & Forced Marriage Helpline Number 0800 027 1234 –and  the opportunity to phone the helpline from a private room
  • Does she want to report the incident to the police? Advise her to dial 999 in an emergency or 101 at other times
  • Follow child protection and vulnerable adult procedures where there are any concerns.
  • Ensure a follow-up appointment is arranged where appropriate.

Risk assessment is not a one off event and risk may change over time; therefore ongoing risk assessment is required.

 

Documentation of Abuse

This is important health information which should be documented in the woman’s hospital notes, never in ‘hand-held’ records.  .

Document any disclosure using the woman’s own words and include any action or referrals and plans for follow up.

Resources

Scottish Domestic Abuse & Forced Marriage 24 hour helpline
0800 027 1234 www.sdah.org.uk– men women and children

For support and information on domestic abuse: 
www.scottishwomensaid.org.uk

Help and information for anyone who has been raped or sexually abused: 
www.rapecrisisscotland.org.uk

Website for perpetrators of domestic abuse looking for help to address their behaviour:
www.respect.uk.net

Support for male victims of domestic abuse: 
www.mensadviceline.org.uk

Advice and information for lesbian, gay, bisexual and transgender people experiencing domestic abuse:
www.lgbtdomesticabuse.org.uk
www.brokenrainbow.org.uk/help/helpline

Police Scotland Information and support for victims of domestic abuse: 
http://www.scotland.police.uk/keep-safe/advice-for-victims-of-crime/domesticabuse/reporting-domestic-abuse/

For further information on GBV
www.equality.scot.nhs.uk

A series of guides to support health workers on gender based violence is available at:
www.gbv.scot.nhs.uk

Support for Staff

Support for Staff can be obtained via:

  • Your line manager or Supervisor of Midwives
  • Employee Policy on Domestic Abuse - Staffnet HR policies
  • Occupational Health and employee counselling service
  • The Pastoral Care Team can provide/access religious, spiritual and emotional support.

For professional or personal support regarding Gender Based Violence contact the GBV Resource Unit 0141 201 9777 or e-mail: gbvunit@ggc.scot.nhs.uk  or visit our website on Staffnet.

Appendix 1

Impact on Health 

Table listing some impacts on health of domestic abuse

Possible Indicators of Abuse

  • Missed appointments and non-compliance with treatment
  • Frequent presentations to health settings or delay in seeking medical treatment/advice
  • Overbearing or overly solicitous partner who is always present
  • Denial or minimising of abuse
  • Injuries at different stages of healing or that don’t fit with the explanation given
  • Appears evasive, socially withdrawn and is hesitant
  • Children on the child protection register or referred to other specialists for behavioural/emotional or developmental problems

These lists are not exhaustive & there may be other causes.

Some women experiencing abuse may show no signs or indicators.

Appendix 2

Routine Enquiry

Setting the Context:

 “Around 1:4 women experience emotional, sexual or physical abuse, because we know this affects your health (and pregnancy), we now routinely ask all women……”

Follow setting the context by giving a short explanation of each of the forms of abuse e.g. physical abuse can be a push, slap or kick, emotional abuse may be your partner putting you down or not letting you see family or friends and sexual abuse could be your partner forcing you to do something you don’t want to.

Examples of Direct Questions: 

  • Have you ever felt afraid of a partner/ex or family member?
  • Has your partner/ex, ever physically hurt or threatened you or your children?
  • Has your partner/ex ever destroyed things that you cared about?
  • Has your partner/ex ever forced you to have sex when you didn’t want to?
  • Does he/she force you to engage in sex that makes you feel uncomfortable?
  • Does your partner/ex ever get jealous? If so, how does he act?
  • Does your partner/ex try to control you in any way, for example preventing you from going out or limiting contact with your family or friends?

These questions are intended as prompts, it is not necessary to ask all of them and they should not be used as a checklist.

Editorial Information

Last reviewed: 01/06/2016

Next review date: 30/06/2021

Author(s): Elaine Drennan; Mairi McDermid.

Approved By: Obstetrics Clinical Governance Group

Document Id: 588