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March 2025 newsletter now available - see below.

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

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.