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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.

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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

 

 

Manual Vacuum Aspiration (MVA) for treatment of miscarriage and retained pregnancy tissue (1078)

Objectives

To provide guidance to clinical teams undertaking MVA in the management of early pregnancy loss.

Audience

All healthcare workers in GGC involved in the care of women experiencing early pregnancy loss including doctors, nurses, midwives, EPAS staff, A&E staff

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

Manual Vacuum Aspiration (MVA) is an option for women for the management of early pregnancy loss or retained tissue.

NICE suggest surgical or medical management can be offered when expectant treatment is not acceptable to the woman or has failed.  The Miscarriage Association and the Association of Early Pregnancy Units support discussing with women all options that are clinically appropriate and locally available.

MVA has been shown to be a safe and effective procedure and compared with Electric Vacuum aspiration management under general anaesthetic.  Advantages include quicker recovery, shorter hospital stay, lower cost, reduced waiting time and avoids the risks associated with general anaesthesia.

Complication rates (infection, retained tissue, bleeding, perforation and intrauterine adhesions) are similar to those of electric vacuum aspiration. 

MVA can also be used in an emergency situation as it can be performed quickly in a clinical room, providing there is access to an ultrasound machine, MVA supplies, resuscitation equipment and a trained nurse is present.  

Inclusion Criteria

Ultrasound features (see NICE guidance for diagnostic criteria of miscarriage, below indicates suitability for MVA procedure)

  •  Ultrasound diagnosis of early embryonic miscarriage where Crown Rump Length (CRL) does not exceed 25mm on TVUSS
  • Ultrasound diagnosis of anembryonic pregnancy ≤ 10 weeks gestation where there is no CRL and Mean Gestation Sac (MGS) does not exceed 40mm on TVUSS
  • Ultrasound diagnosis of an incomplete miscarriage with RPOC measuring less than 5cm mean diameter on TVUSS
  • Ultrasound diagnosis as above with failed medical management of miscarriage

Patient characteristics

  • Motivated and well counselled woman who can tolerate a speculum examination, bearing in mind that the procedure will be performed under local anaesthetic with the patient still awake.
  • No clinical signs of infection - fever/offensive discharge/ generalized lower abdominal pain.
  • An emergency procedure can be carried out in the event of heavy vaginal bleeding where an ultrasound scan has previously confirmed a non-continuing pregnancy of less than 10 weeks gestation.

Contraindications

  • pregnancy >10 week period of gestation by Ultrasound measurements
  • Bleeding disorders/ Current Anti-coagulant treatment
  • Signs of active Infection
  • Allergy to local anaesthetic
  • Mobility issues affecting positioning on couch with footrests
  • Hb <10
  • Women with Uterine anomalies or suspected molar pregnancy should be discussed with consultant prior to procedure

Note - Previous caesarean section is not a contra-indication to MVA, providing ultrasound excludes scar implantation

Complications

MVA is safe but like all procedures there is a small risk of complications. The risk of complications with an MVA are similar to surgical uterine evacuation under general anaesthesia but without the complications caused by general anaesthetic.

Complications related to the procedure are uncommon or rare—they include:

  • Heavy bleeding (haemorrhage) (3%)
  • Infection (3%)
  • The need for a repeat operation if not all the pregnancy tissue is removed (3%)
  • Perforation (tear) of the womb that may need repair (less than 1 in 1000)
  • Adhesions or scar tissue within the womb.

Organisation of MVA procedure

  • Elective MVA procedures are currently performed on sites in the North and South or the City and within Clyde. The procedure will be organised by contacting EPAS or via the gynaecology emergency team at each of the units.
  • Provide Patient information leaflet outlining Elective MVA with contact numbers for EPAS, local gynaecology ward, and ward or clinic area for planned procedure.  Include details of admission procedure (day, date, time)
  • Discuss and complete Procedure Consent form
  • Discuss and complete Form 2 (Sensitive Disposal of pregnancy tissue) with original to be sent to pathology on day of procedure, with a copy for patient notes and an additional copy for the patient.
  • Obtain FBC and Group and Save (valid for 72 hours)
  • Prescribe Misoprostol 400 mcg Sublingual to be taken 2 – 3 hours prior to procedure
  • Prescribe analgesia to be taken 1 hour before procedure, suggested regime is  Paracetamol 1g oral or Cocodamol 8/500 x 2 tablets oral and Ibuprofen 800mg oral
  • Advise patient to have breakfast or light lunch as normal the day of the procedure

Pre-procedure Assessment on day of procedure

  • Review with nursing and medical staff involved with procedure
  • Confirm paperwork complete and medication has been taken as directed
  • Confirm blood results and request Anti-D if required
  • Baseline observations to be recorded in notes (Temperature, Pulse and Blood Pressure)

Post-procedure Assessment

  • Women should be observed in a recovery area after the procedure for at least 1 hour
  • Observations should be obtained and recorded (Temperature, Pulse and Blood Pressure)
  • Vaginal blood loss to be monitored
  • Patients can eat and drink and should be offered refreshments
  • Check Rhesus status and administer Anti-D if required

Prior to discharge

  • Patient may be discharged home an hour after procedure if well and vaginal loss is not excessive
  • Discuss performing a home pregnancy test in 4 weeks and where to contact if it remains positive
  • Discuss return of periods and future fertility
  • Discuss and provide contraception if required
  • Ensure patient has phone numbers for EPAS and local gynaecology ward
  • Offer support and give contacts from The Miscarriage Association if needed
  • Ensure discharge letter for GP is complete

Editorial Information

Last reviewed: 23/03/2023

Next review date: 31/03/2028

Author(s): Sarah Woldman.

Version: 1

Approved By: Gynaecology Clinical Governance Group

Document Id: 1078

References

BPAS – Mannual Vaccum Aspiration Clinical Guideline – March 2008 Manual Vacuum Aspiration (durbinglobal.com)

Manual Vacuum Aspiration: an outpatient alternative for surgical management of miscarriage.  The Obstetrican and Gynaecologist (TOG) 2015;17:157–61

Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group A.M. Kolte1,*, L.A. Bernardi2, O.B. Christiansen1,3, S. Quenby4,

R.G. Farquharson5, M. Goddijn6, and M.D. Stephenson7 on behalf of the ESHRE Special Interest Group, Early Pregnancy, Human Reproduction, Vol.30, No.3 pp. 495–498, 2015

110   Ectopic pregnancy and miscarriage: diagnosis and initial management.  NICE guideline [NG126] Published 17 April 2019, updated 24 November 2021

Mean sac diameter | Radiology Reference Article | Radiopaedia.org

Abortion care, Cervical priming before surgical abortion NICE guideline NG140 Evidence reviews September 2019 Abortion care review M: Cervical priming before surgical abortion (nice.org.uk)