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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.

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

 

 

Postoperative bladder care (688)

Objectives

  • To standardise the practice for management of bladder care after uncomplicated gynaecological procedures
  • To diagnose and manage postoperative voiding problems
  • This guideline applies to those patients admitted to Day surgery, 23 hour beds and inpatient beds

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

Background

One in 10 women in the immediate postoperative period following gynaecological surgery will have urinary retention. Indwelling catheters are associated with increased risks of urinary tract infection (UTI) and the longer they are in situ, the higher the risk of UTI.

Postoperative bladder voiding issues may be due to:

  • Pre-existing voiding problems
  • Bruising /swelling around bladder/urethra e.g. after anterior colporrhaphy
  • Over-distension of the bladder by delayed trial of voiding (TOV) can cause bladder atony
  • Physical obstruction - stress urinary incontinence procedures eg mid-urethral sling, colposuspension, autologous fascial sling (AFS)
  • Clot retention e.g. bladder injury during surgery

Removal of Catheter After Surgery

  • The planned date for catheter removal should be clearly documented in the postoperative care plan
  • All urethral catheters should be removed at 06.00 the next morning as per ERAS unless otherwise stated in the operation notes or there are clinical concerns
  • Patients who have had colposuspension (open/laparoscopic) or AFS usually have indwelling catheter for at least 48 hours
  • Women who do not have an indwelling catheter (this includes midurethral sling and bladder neck injection) should have a trial of void 4 hours after surgery
  • For the trial of void, women should be encouraged to drink normally and aim to pass urine at around 4 hrs.
  • All urogynaecological procedures, ie those for incontinence and prolapse repair, should have a bladder scan after the first two voids. The residuals should be recorded in the ‘bladder diary’ (see Appendix 1).

Trial without catheter (TWOC)

  • Measure the urine volume after each void, no later than 6 hours from catheter removal
  • Residual volume should be measured immediately after the patient passes urine
  • If uncomfortable and unable to pass urine 4 hours after catheter removal, check bladder residual by scan and follow protocol as below (Table 1).

Women undergoing AFS

  • These women are very likely to have initial short term voiding dysfunction (approximately 67% based on local data) and are taught Clean Intermittent Self Catheterisation (CISC) pre-operatively. They should be encouraged and supported to do CISC if required post-operatively. Patients who are unable to perform CISC should be discharged with an indwelling catheter. They must also be referred to Urogynaecology nurses at the Victoria ACH for ongoing care.  This is done via the following referral form: Clean Intermittent Catheterisation referral form.

Assessment and Management of Post-void Residual

Table 1: Assessment and Management of Post-void Residual 

Volume voided

Diagnosis

Action

2 voids each >200 ml

USS residual <50% of voided volume

Normal

Nil required

Small volume (<200mL) voided

Frequency of micturition (1-2 hourly)

Likely incomplete bladder emptying

Bladder scan residual after second void. 

If voided volumes increase (>50% of residuals) and residual volume decrease, continue trial of void.

If voided volumes are not increasing and residuals ≥ voided volume see below

Unable to pass urine or residuals 

> 50% of voided volumes 4– 6 hours post operatively

Urinary retention

Inform medical staff

Perform vaginal examination to assess for haematoma/bruising

Insert indwelling catheter – short Female size 12

  • If the patient is discharged with an indwelling catheter following a midurethral sling procedure, inform the surgeon who performed the operation as early division of the tape may be required
  • Patients with voiding concerns following bladder neck injection should have CISC performed by nursing staff. If voiding fails to improve over 48 hours, offer to teach patient CISC and refer to urogynaecology nurses. Discuss with the urogynaecology team if patient is unable to perform CISC and continues to have voiding difficulties. Do not insert an indwelling catheter as this may compromise the outcome of the procedure.
  • Women who have a successful TWOC but remain as an inpatient should continue to have their bladder/voiding assessed by monitoring input/output. Ensure patient is voiding 3-4 times/day and has no sensation of incomplete bladder emptying

Guidelines for women sent home with an indwelling catheter

  • Ensure woman understands catheter care and a follow-up appointment for TWOC in the gynaecology ward is in place. She should have an emergency contact number for the ward.
  • Prophylactic antibiotics are not routinely required unless symptomatic of infection.
  • A Foley catheter size 12 with a flip-flo valve and leg bag should be used. The valve should be released every 4 hours during the day and the leg bag should be left on free drainage overnight.

First TWOC after an episode of retention

Table 2: First TWOC after an episode of retention

2 voids, each >200mL

USS residual <50% of voided volume

No further intervention

2 voids where residual volumes are >50% of voiding volume despite trying double void technique

Teach CISC

Contact the Urogynaecology specialist nurse team for follow up 
  • If TWOC unsuccessful after 1 week, please inform the responsible clinician

Appendix 1: POSTOPERATIVE BLADDER DIARY

Postoperative Bladder Diary (Word doc)

Contacts for further assistance

QEUH
Karen Nicolson        
Senior Charge Nurse, Urogynaecology
Karen.Nicolson@ggc.scot.nhs.uk
01412012264

PRM
Julie Graham        
Senior Charge Nurse, Gynaecology
Ward 56 
Julie.Graham@ggc.scot.nhs.uk
01412114433

RAH
Ward 32
01418879111

Editorial Information

Last reviewed: 14/08/2024

Next review date: 14/08/2029

Author(s): Veenu Tyagi.

Version: 2

Approved By: Gynaecology Clinical Governance Group

Document Id: 688

References
  1. Bodker B, Lose G. Postoperative urinary retention in gynaecological patients. Int Urogynecol J (2003) 14: 94–97
  2. Hakvoort R, Thijs S, Bouwmeester F, Broekman A, Ruhe I, Vernooij M, Burger M, Emanuel M, Roovers J. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal Prolapse surgery: a multicentre randomised trial. BJOG 2011; 118:1055–1060