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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

 

 

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

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

  • 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).

  • 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).

  • 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.

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

  • 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.

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

Postoperative Bladder Diary (Word doc)

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