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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

Postcoital Bleeding (893)

Warning

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

Post-coital Bleeding (PCB) is bleeding from the genital tract which occurs after intercourse. PCB after the menopause should be regarded as PMB and investigated as such. PCB can be associated with genital tract carcinoma but only a very few women presenting with this symptom have such serious pathology, the remainder having benign causes.

It’s worth noting that approximately 13% of women age 20-24 will experience PCB in any given year but in this age group only 0.002% of PCB is due to cervical cancer. 80% of such cancers are visible to the naked eye on speculum.

Causes

Cervical

  • Ectopy
  • Cervicitis
  • STI
  • Condyloma
  • Carcinoma (rarely)

Vaginal/Vulval

  • Trauma
  • Vaginitis
  • Tumours (rarely)
  • Vulval Dermatoses

Uterine

  • Endometrial polyp
  • Dysfunctional Uterine Bleeding (DUB)
  • Endometritis
  • Endometrial Hyperplasia/malignancy

Iatrogenic

  • IUCD/IUS
  • Following smear or treatment to the cervix
  • Hormonal contraception

History

The following aspects should be covered in the history:

  • nature and timing of bleeding
  • menstrual history
  • smear/colposcopy history
  • contraception history
  • sexual history for STI where appropriate
  • medical History e.g. bleeding diathesis, diabetes
  • medication e.g. anticoagulants, antibiotics with secondary candidiasis
  • dyspareunia

Examination and Investigation

  • Bimanual examination
  • Speculum examination
  • HVS
  • STI screen where appropriate (Chlamydia and gonococcus)
  • Cervical smear if due
  • Urgent colposcopy referral in the event of clinical suspicion of cervical malignancy
  • If no lower genital tract cause found, consider TVS in women over the age of 40

Referral guidance

  • Women with PCB should be referred to Colposcopy as ‘URGENT: Suspicious of cancer’ and seen within 10 working days if the appearance of the cervix on speculum examination is suspicious of or consistent with cervical cancer.
  • Women with PCB with abnormal cervical screening should be referred to Colposcopy as per usual colposcopy protocols. Those in whom screening is absent or overdue should have a cervical smear and be referred based on the smear result and clinical examination findings.
  • Women with persistent PCB aged less than 40yrs with a normal smear history and normal speculum examination should have a self-obtained vulvovaginal swab for chlamydia and gonorrhea NAAT testing and, where appropriate, treatment for genital tract infection.
    Consideration should be given to a change of hormonal contraceptive if relevant. A therapeutic trial of Relactagel (PV for one week after menses and repeated for 2 months) should also be considered. If these measures are ineffective, patients can be referred as ‘Routine’ for further assessment to gynaecology / colposcopy depending on local service provision.
  • Women over 40 should be referred as urgent and seen within secondary care services within 14 days (gynaecology / coloposcopy).
  • Patients are invited to participate in the national cervical screening programme from the age of 25. PCB is not an indication for a cervical smear in those aged less than 25.

Differences in age cut off and referral times in these recommendations compared to the RCOG / BSGE Abnormal Uterine Bleeding Covid Guideline should be noted. Differences are due to the current GGC service structure and Scottish Government treatment time targets which differ from the UK system.

Management (where cervical pathology has been excluded)

  • Treat infection
  • Remove endocervical polyps
  • Consider change of contraceptive formulation or method
  • Consider Relactagel®/Balance Activ® gel to acidify vagina. This should be used after menses,nightly for 1 week and repeated for 2 months. (NB contra-indicated if patient or partner has shellfish allergy).
  • Topical oestrogen preparations in the presence of atrophic vaginitis e.g oestradiol pessary (Vagirux® or Vagifem®) or Orthogynest® cream
  • Endometrial assessment in women over 40 in whom the above measures have failed.

Editorial Information

Last reviewed: 03/12/2020

Next review date: 31/12/2025

Author(s): Morton Hair.

Approved By: Gynaecology Clinical Governance Group

Document Id: 893