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  6. Emergency Contraception - Paediatric Emergency Medicine (117)
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

 

 

Emergency Contraception Guideline - Emergency Medicine, Paediatrics (117)

Warning

Objectives

Indications, exclusions and methods of emergency contraception available for adolescents. This includes information about the assessment of failure or potential failure of a contraceptive method. A proforma and algorithm are supplied to aid a healthcare professional.

Scope

Adolescents requiring emergency contraception advice.

Audience

Medical and nursing staff involved in the assessment, delivery of advice and management of young people requiring emergency contraception.

November 2023: This guidance is currently under review as it has gone beyond the standard review date. It reflects best practice at the time of authorship / last review and remains safe for use. If there are any concerns regarding the content then please consult with senior clinical staff to confirm.

Please read in conjunction with Managing sexually active young people - staff guidance

Indications

  • Unprotected sexual intercourse (UPSI)
  • Failure or potential failure of contraceptive method*
  • Wish to reduce likelihood of pregnancy

Not Indicated if:

  • Positive pregnancy test
  • More than one episode of UPSI this cycle, the first of which is greater than 120 hours ago

Methods

Copper IUD

  • IUD advice and Sandyford contact details should be offered to all females presenting for EC as this is the most effective method to prevent pregnancy
  • If used, ideally should be fitted at first presentation. POEC should be given in addition if a future appointment is made for IUD insertion 
  • Effective up to 120 hours (5 days) of UPSI in current cycle
  • If UPSI >120 hours an IUD can be fitted up to 5 days after earliest calculated day of ovulation
  • Estimated failure rate 0.1%
  • Prophylactic antibiotics to cover Chlamydia required at time of insertion if female thought to be at risk

Progestogen only EC (POEC) - Levonelle 1500

  • 1.5mg levonorgestrol one off dose taken as soon as possible within 72 hours UPSI
  • Prevents 86% of expected pregnancies
  • Efficacy may be affected the later treatment is given following UPSI
  • Side effects include- nausea, vomiting, dizziness, headache, lethargy, abdominal pain, breast tenderness and irregular periods
  • Offer domperidone if  nausea/ vomiting has been experienced with previous use
  • Repeat dose indicated if vomiting occurs within 2 hours 
  • Drug interactions with liver enzyme inducing drugs e.g. St John’s Wort, second dose should be given 12 hours later
  • No absolute medical contraindications  
  • Caution with wafarin
  • Abstinence/ consistent and correct barrier method required for the rest of the cycle
  • Does not protect against pregnancy for the rest of the cycle
  • Follow up if period does not start within three weeks or differs significantly from normal should be advised

Ulipristal- ellaOne

  • Progesterone receptor modulator
  • Single 30mg dose licensed for use up to 120 hours after UPSI, not licensed for use in under 18s but use in this age group is supported by the Faculty of Sexual and Reproductive Health
  • EllaOne should NOT be more than once in a cycle
  • Contraindicated in: pregnancy, uncontrolled  asthma or severe liver disease
  • Side effects include: abdominal pain and menstrual disturbances
  • Efficacy may be reduced in patients taking liver enzyme inducing drugs and drugs that increase gastric pH
  • Can reduce the effectiveness of combined-hormonal (COCP) and progesterone only (POP) contraceptive - additional precautions required for 14 days (or until next period)  

*What constitutes contraceptive failure?

Combined pill (COCP)

  • One pill missed at any time:
     - Take most recent missed pill as soon as remembered
     - Continue to take remaining pills at usual time
     - No additional contraception required
     - EC not required
  • Two or more pills missed at any time:
     - Take most recent pill as soon as remembered
     - Continue to take remaining pills at usual time
     - Additional contraception/ abstinence until pill taken correctly for 7 days

In addition:
 - If pills are missed day 1-7, consider EC if UPSI has occurred in the pill free interval or day 1-7 

 - If pills are missed day 15-21, pill free interval should be omitted (e.g. two packs run together with no break)

  • EC indicated if UPSI/ failed barrier method with 28 days following use of liver enzyme inducing drugs

Progestogen Only Pill (POP)

  • One or more pills missed or >3 hours late (12 hours for Cerazette) and UPSI has occurred in the 2 days following missed pill then EC is indicated
  • Additional contraception/ abstinence required until pill has been taken correctly for 2 days
  • EC indicated if UPSI/ failed barrier method with 28 days following use of liver enzyme inducing drugs

Barrier methods

  • Condom rupture/ slippage/ misuse or not used
  • Diaphragm/ cap incorrectly inserted/ dislodged/ torn

Copper IUD/Mirena Coil

  • Complete or partial expulsion is identified EC is required
  • If removal of normally sited device is required EC should be offered if UPSI had occurred in the last 7 days

Depo-Provera

  • EC indicated if contraceptive injection is late (i.e. more that 14 weeks from last injection) and UPSI has occurred  

Progestogen only implants

  • EC indicated if UPSI/ failed barrier method has occurred during or in the 28 days following liver enzyme inducing drugs

Proforma

Proforma Page 1Proforma Page 2

Algorithm

Algorithm flowchart

Discharge and Follow up: 

All cases should be provided with an EC leaflet: Click here for leaflet

All cases should be given contact details for the Sandyford ‘The Place’ clinic: Click here for website 

Advise to seek medical attention if:

  • They wish to discuss longer term contraception
  • Next period is more than 7 days late, lighter or shorter than normal
  • Develop acute, severe abdominal pain
  • Develop signs of STI

Editorial Information

Last reviewed: 20/09/2016

Next review date: 30/04/2024

Author(s): Marie Speirs.

Version: 2

Approved By: Paediatric Clinical Effectiveness & Risk Committee

Document Id: 117