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Important: please update your RDS app to version 4.7.3

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

 

 

Minimising urinary tract injury at gynaecological surgery for benign disease (1038)

Objectives

To provide guidance for those undertaking benign gynaecological procedures where there is a risk of urinary tract injury.

Scope

All healthcare professionals undertaking gynaecological procedures where there is a risk of urinary tract injury

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

Injury to the urinary tract at benign gynaecological surgery is uncommon as defined by the RCOG (1).

A systematic analysis found the rate of urinary tract injury in laparoscopic surgery for benign  gynaecological operations to be 3.3/1000.

Urinary tract injury is however more common at hysterectomy. RCOG consent advice (3) recommends quoting a rate of urinary tract injury of 7/1000 for abdominal hysterectomy procedures.

A retrospective study of almost 1000 hysterectomies for benign conditions in NHSGGC found the following rates of urinary tract injury (presented at ESGE 2018)

Rate of injury to bladderRate of injury to uterer
Laparoscopic hysterectomy1.3%1.9%
LAVH1%3%
Open hysterectomy0.8%0.6%

A retrospective analysis performed by the BSGE found a ureteric injury rate of 0.5% in excision of deep infiltrating endometriosis at endometriosis centres in the UK with 9.2% of procedures requiring stent insertion. (4)

Bladder injury is typically by incision of the bladder and is usually recognised at operation. Ureteric injury can occur by angulation, crushing, resection, division or damage by heat or devascularisation and may be less likely to be unrecognised (5). Ureteric injury may present late with urinary leakage being delayed after thermal or vascular damage with no apparent injury at the time of operation.

Alternatives to surgery should be discussed with each patient who is considering surgery.

The consent process should note any factors that may increase the rate of urological tract injury and this should be explicit in the consent process, such as but not exclusively:

Patient factors: BMI, previous pelvic surgery, previous caesarean section.

Pathology factors: pelvic abscess or endometriosis, malignancy, known hydronephrosis.

Pre-operative imaging to exclude hydronephrosis or hydroureter should be performed if there is disease suspected in the lateral pararectal fossa or a large pelvic mass. If hydronephrosis is confirmed on imaging then renography with MAG3 scanning should be performed to assess renal function. Pre-operative stent insertion should be considered and referral to urological colleagues made if hydronephrosis is confirmed or if disease processes involve the ureter.

Pre-operative request for urological opinion should be sought in these patients:

  1. Previous ureterolysis when operating in the lateral pararectal fossa is anticipated.
  2. Known hydronephrosis
  3. Known disease involving the ureter. Specialist urological radiology reporting may be needed in complex pathology.

The urinary bladder should be emptied to reduce the risk of urinary tract injury.

There is a difference in approach between gynaecologists and urologists when operating in proximity to the ureter. Gynaecologists do not use ureteric stents routinely when operating within the lateral pararectal space. It is recognised common gynaecological practice to visually identify the ureter prior to clamping and ligating pedicles (or using instruments for vessel sealing) or applying surgical heat at operation. Ureterolysis is performed by gynaecologists for up to 10cm of ureteric length without stent insertion. Surgeons should be familiar with the thermal effects of any energy device employed during surgery (6)

Ureteric stenting may reduce ureteric injury in two ways. Firstly it may help to identify the ureter if there is difficulty in visual identification. Secondly stenting may reduce ureteric injury leading to leakage when there has potentially been thermal or vascular damage to the ureter. Stenting may reduce the risk of hydronephrosis due to angulation injury. However stenting may alter the anatomy of the lateral pararectal fossa by straightening the ureter to a more medial position.

Urological colleagues are always happy to assist with stent insertion. Requests for an intraoperative urological opinion should be sought in these patients:

  1. If the ureter cannot be identified. Insertion of a temporary ureteric catheter may help a gynaecologist who is competent with their use to identify the ureter but may not protect against later ureteric leakage if there has been damage to the vascular supply to the ureter or thermal injury to it.
  2. If there is a bladder injury and the gynaecological surgeon does not have expertise to close the bladder.
  3. Any bladder injury where injury to the trigone is suspected.
  4. Any suspected ureteric injury.

In patients who experience a urological complication of gynaecological surgery their operating gynaecology consultant should be the point of contact for urological colleagues.

A follow up appointment should be requested with the operating gynaecology surgeon via their secretary on patient discharge.

Editorial Information

Last reviewed: 14/07/2022

Next review date: 14/07/2027

Author(s): Chris Hardwick.

Version: 1

Approved By: Gynaecology Clinical Governance Group

Document Id: 1038

References

1. RCOG Clinical Governance Advice No. 7
2. Wong, Jacqueline M. K. MD; Bortoletto, Pietro MD; Tolentino, Jocelyn MD, MPH; Jung, Michael J. MD, MBA; Milad, Magdy P. MD, MS Obstetrics & Gynecology. 131(1):100-108, January 2018
3. Abdominal Hysterectomy for Benign Conditions (Consent Advice No. 4) (rcog.org.uk)
4. e018924.full.pdf (bmj.com)
5. Minas V, Gul N, Aust T, Doyle M, Rowlands D. Urinary tract injuries in laparoscopic gynaecological surgery; prevention, recognition and management. The Obstetrician & Gynaecologist 2014;16:19–28.
6. Bentham GL, Preshaw J. Review of advanced energy devices for the minimal access gynaecologist. The Obstetrician & Gynaecologist 2021;23:301–9. https://doi.org/10.1111/tog.12774