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Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 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.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

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

Acute Pelvic Pain, Initial Management (312)

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

Background
Pelvic pain is a common reason for women to present as an emergency to Gynaecology. Symptoms of pelvic or abdominal pain have significant overlap with symptoms of non-gynaecological conditions such as appendicitis. Liaison with other specialities may therefore be appropriate. Other specialities may not recognise atypical presentations of ectopic pregnancy and all women of reproductive age who present with abdominal or pelvic pain should have pregnancy testing performed.

Some women will require hospitalisation for assessment due to the severity of their symptoms. However where a patient is clinically stable it may be more appropriate to offer urgent out-patient assessment within Early Pregnancy Assessment Units or an Emergency Gynaecology Service.

Gynaecological causes of Acute Pelvic Pain

  • Ectopic Pregnancy
  • Miscarriage
  • Ovarian Cyst Accident (torsion, rupture,haemorrhage)
  • Mittelschmertz (Ovulation pain)
  • Pelvic Inflammatory Disease. See guideline – GG&C PID Guideline
  • Dysmenorrhoea
  • Exacerbation of Endometriosis

Assessment of the patient with acute pelvic pain

Clinical history

It is important to take an accurate history including –

  • Age and parity (particularly previous ectopic pregnancies)
  • LMP
  • Pain- onset, duration, site, radiation, nature, severity, exacerbating and relieving factors.
  • Associated symptoms- vaginal bleeding, vaginal discharge, bowel and urinary symptoms.
  • Menstrual and contraceptive history.
  • Previous gynaecological and obstetric history.

‘Red Flag’ Symptoms

  • Episodes of collapse.
  • Shoulder tip pain.
  • Significant exacerbation of pain with movement.
  • Fever and Rigors

Examination

  • Temperature, pulse, blood pressure, respiration rate and oxygen saturation
  • Abdominal examination.
  • Speculum and bimanual examination.

Investigations

Initial Investigations

  • Urinary pregnancy test
  • Urine dipstick.
  • Midstream specimen. Send for culture if dipstick positive for protein, nitrites or leucocytes.
  • Swabs for Chlamydia and Gonorrhoea if clinical suspicion of pelvic infection. See guideline – GG&C PID guideline
  • Full blood count and C-reactive protein.
  • Serum HCG if suspicion of ectopic pregnancy

Subsequent Investigations

  • Ultrasound- transvaginal where possible. Women who are not suitable for transvaginal scanning should be asked to attend with a full bladder.

Indications for Immediate Hospital Admission

  • Persistent tachycardia (pulse >100)
  • Hypotension
  • History of collapse
  • Severe pain
  • Signs of peritonism
  • Temperature over 38oC

If Severe Symptoms, consider

  • IV access and fluids
  • FBC and Group and retain
  • Sepsis 6 Protocol
  • Analgesia
  • Nil by mouth
  • Senior review

If stable / mild symptoms

Women who are stable/have mild symptoms can be discharged with an urgent outpatient review. They should be offered simple analgesia and given instructions to return if their symptoms deteriorate.

Editorial Information

Last reviewed: 05/06/2018

Next review date: 30/04/2023

Author(s): Catrina Bain.

Approved By: Gynaecology Clinical Governance Group

Document Id: 312

References

Management of Ovarian Cysts in Premenopausal Women RCOG Green Top Guideline Number 62. November 2011.

Diagnosis and Management of Ectopic pregnancy. RCOG Green Top Guideline 21 November 2016