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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

 

 

Misoprostol for cervical priming prior to surgical management of 1st trimester miscarriage up to and including 13+0 weeks gestation (1011)

Objectives

To provide guidance for the prescription and administration of misoprostol to women prior to surgical management of miscarriage

Audience

All healthcare professionals involved in the surgical management of 1st trimester miscarriage

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

Misoprostol is a synthetic prostaglandin E1 (PGE1) analogue.  It acts as a potent uterine stimulant.  Compared with no cervical priming, Misoprostol leads to reduction in failed surgical procedures and reduces the force required during cervical dilation.

Misoprostol should be administered prior to undertaking surgical evacuation of the uterus for women with a non-continuing pregnancy ≤13+0 gestation diagnosed according to NICE guidance for diagnostic criteria of miscarriage.

Misoprostol cervical preparation may not be required where patients have a diagnosis of an incomplete miscarriage, particularly where there is vaginal bleeding and the cervix has been examined as being open.

Prescribing and Administration

Misoprostol for cervical priming is a recognised use, but it is not licenced for this indication. 

Practitioners may consider sublingual or vaginal cervical preparation based on individual patient circumstance and wishes. 

Prior to administration, explain to the woman that cervical priming

  • Reduces the risk of incomplete procedure
  • Makes dilation easier
  • May cause bleeding and pain before the procedure

Sublingual administration

Misoprostol 400 micrograms (2 x 200 micrograms tablets) in a single dose should be placed in the buccal pouch and allowed to dissolve over a 15 minute period. If not dissolved within this timeframe it may be swallowed with small sip of water. 

It is suggested that this is given 2-3hours prior to the procedure to ensure sufficient cervical priming.  It can however be noted that where given by sub-lingual route, it can be effective for cervical priming if given at least 1 hour before the procedure. 

Sublingual misoprostol can cause more gastrointestinal side effects than vaginal misoprostol, and may be less acceptable for women. 

Vaginal administration

Misoprostol 400micrograms (2 x 200 micrograms tablets) in a single dose should be placed in the posterior fornix of the cervix and allowed to dissolve. Patient should therefore be advised to lie in semi recumbent position for 30 minutes post administration. 

It is suggested that vaginal misoprostol is given approximately 3 hours prior to procedure as it takes longer to achieve sufficient priming of the cervix for lower dilation force.  However, this is associated with more time with preoperative pain and bleeding than the sublingual route.

Side Effects

Possible short term side effects are usually apparent in the first few hours following administration. 

These include:

  • Nausea
  • Vomiting, this may affect the efficacy of the drug if it occurs within two hours of administration.
  • Diarrhoea
  • Weakness
  • Transient chills, shivering and fever
  • Dizziness
  • Abdominal and uterine cramps
  • Vaginal bleeding

Exclusion Criteria

  • Known hypersensitivity to misoprostol or any component of the product.

Caution

  • Caution advised in patients with a history cardiovascular disease where hypotension would be detrimental
  • If patient is breastfeeding, misoprostol acid in breast milk could cause undesirable effects such as diarrhoea in nursing infants.

Editorial Information

Last reviewed: 14/06/2023

Next review date: 31/05/2028

Author(s): Karen Dastey, Midwife, PRM.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 1011