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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

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

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 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

 

 

Postnatal management of fetal arrhythmias (1081)

Objectives

To ensure a seamless transition from fetal to postnatal life of babies receiving a prenatal diagnosis of an arrhythmia.

Audience

This guideline is for neonatologists and paediatric cardiology teams, caring for babies with a prenatal diagnosis of a fetal arrhythmia.

Fetal arrhythmias are uncommon and the incidence of structural cardiac abnormalities in fetuses with irregular heart rhythms is low (<2%). Ectopic beats are estimated to be present in around 1% of unselected pregnancies and in the majority of cases will resolve before delivery.

Fetal tachycardia can result in significant morbidity and mortality if left untreated in utero. The ideal management is to treat the tachycardia prior to delivery so that the fetus is delivered in a non-hydropic state, at term, without evidence of tachycardia. Prenatal therapy is guided by the fetal cardiology and fetal medicine team jointly and in our institution 1st line maternal therapy is often flecainide. The addition of second line therapy is required in resistant cases. Therapy is carefully considered, implemented and monitored due to the potential adverse effects to the mother and fetus.

1. Fetal Irregular Heart Rhythm

a) If extrasystoles persist after birth

  • Remain on PNW for 48 hours before discharge home
  • 12 lead ECG
    • Mon-Fri 9-5pm arrange with cardiology department (84437), out of hours/weekend to be undertaken by the neonatal team
  • Auscultate HR for 1 minute
    • If ectopic every 10 beats - discuss with cardiology oncall (84440) whether a 24 hour ECG is required
    • If less frequent, no further investigations required but the baby should remain on PNW until 48 hrs old
  • Discuss 24 hour ECG with cardiology consultant and arrange f/u as required
  • If ventricular extra-systoles (VEs) on ECG, discuss with cardiology consultant or oncall cardiology registrar (84440)

b) If extra-systoles have resolved prior to birth

  • No postnatal follow-up or investigation is indicated.

2. Fetal Tachycardia

a) Failure to cardiovert medically during fetal life

  • Admit to NICU
  • Inform on call cardiology consultant or cardiology registrar (84440) immediately
  • Continuous ECG monitoring
  • Baseline echocardiogram and 12 lead ECG
  • Medical therapy/cardioversion as per on call cardiologist advice

b) Successful medical cardioversion during fetal life

  • Admit to NICU for 48 hours before transfer to PNW.
  • NEWS observations to be undertaken on PNW for 48 hours before discharge home.
  • Request cardiology consult (84440) within normal working hours if in sinus rhythm and cardiovascularly stable
  • Baseline echocardiogram and 12 lead ECG
  • Ensure parents are taught and competent at checking the heart rate by measuring the pulse/listening with stethoscope or ear.
  • Families will be provided with an information leaflet before discharge home, detailing monitoring and measuring heart rate – cardiac nurse specialists will provide leaflet.
  • Parents should assess the heart rate at least twice daily when baby settled.
  • Cardiac Nurse Specialists will discuss the additional benefits of an OwletTM monitor if parents wish to purchase for additional reassurance.
  • On discharge, parental advice to seek urgent medical attention if evidence of poor feeding, or tachycardia i.e. >180bpm when baby settled.
  • Provide contact details for the cardiac nurse specialists for non urgent support between outpatient clinics:
    CardiacSpecialist.NursesPaeds@ggc.scot.nhs.uk (0141 452 4925)
  • Arrange Cardiology OPC for 2 weeks post discharge.

  • If tachycardia recurs before discharge, therapy and f/u as per on call cardiologist advice

Editorial Information

Last reviewed: 03/05/2023

Next review date: 31/05/2025

Author(s): Dr Lindsey Hunter; Dr Karen McLeod; Lorraine Mulholland; Kathleen O’Reilly; Dr Andrew MacLaren.

Version: 1

Approved By: Paediatric Cardiology & Neonatology

Reviewer name(s): A Powls; M Worrall; G Bell.

Document Id: 1081

References
  1. FAST Trial – Fetal Atrial Flutter and Supraventricular Tachycardia Trial. Multicentre, international registry and RCT. Jeaggi et al, Toronto Sick Kids Hospital, Toronto, Canada.
  2. Jaeggi E, Ohman A. Fetal and Neonatal Arrhythmias. Clin Perinatol. 2016 Mar;43(1):99-112.
  3. Simpson J, Silverman N. Diagnosis of cardiac arrhythmias during fetal life. In: Gembruch U, editor. Fetal Cardiology. London: Martin Dunitz; 2003. p. 333-344.
  4. Vergani P, Mariani E, Ciriello E, Locatelli A, Strobelt N, Galli M, Ghidini A. Fetal arrhythmias: natural history and management. Ultrasound med Bio 2005 Jan;31(1):1-6
  5. Van Engelen AD, Weijtens O, Brenner JI, Kleinman CS, Copel JA, Stoutenbeek P, et al. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 1994;24(5):1371-5.
  6. Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998;79(6):576-81.
  7. Frohn-Mulder IM, Stewart PA, Witsenburg M, Den Hollander NS, Wladimiroff JW, Hess J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diagn 1995; 15(13):1297-302.
  8. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991;324(12):781-8.
  9. Fouron JC. Fetal arrhythmias: the Saint-Justine hospital experience. Prenat Diagn 2004;24(13):1068-80.