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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

Retained Products of Conception (RPOC) (677)

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

The term retained products of conception (RPOC) refers to placental and/or fetal tissue that remains in the uterus after a spontaneous pregnancy loss (miscarriage), planned pregnancy termination or preterm/term delivery. The presence of RPOC after a spontaneous pregnancy loss distinguishes a complete from an incomplete miscarriage.

Signs of RPOC

The characteristic clinical manifestations of RPOC may include heavy or prolonged uterine bleeding and pelvic pain. Signs of infected RPOC can commonly include pyrexia, offensive discharge or uterine tenderness.

Diagnosis

RPOC are diagnosed by ultrasound. Patients should have a transvaginal scan to assess RPOC unless the patient declines. On scan, the presence of hyperechoic material within the endometrium is suggestive of evidence of RPOC. A thickened endometrium alone is not a predictor of RPOC.

Management

Any patient haemodynamically unstable or clinically unwell requires urgent medical review.

Perform speculum examination to assess bleeding and look for RPOC where there is moderate or heavy bleeding.

NICE Guidelines recommend that if bleeding is not heavy and women are clinically stable, all women wait 7 days and rescan undertaken before undergoing active treatment, if previous scan has identified an intrauterine pregnancy.

Patient to call EPAS if:

  • Bleeding fails to settle after 3 complete weeks from being diagnosed, even if pregnancy test negative. (Requires rescan)
  • If pregnancy test remains positive after 3 weeks. (Requires rescan + HCG)
  • If signs of infection present e.g. raised temperature, foul smelling discharge, generally feeling unwell. (Requires rescan and infection screening)

Antibiotics should not routinely be prescribed unless there are signs of infection (offensive vaginal discharge / pyrexia / raised WCC/CRP).

It is also important to use the flow-chart as a guide Other factors such as amount of bleeding, time-frame, etc. must also be taken into account with individualised care plans be made for some patients.

Editorial Information

Last reviewed: 01/08/2019

Next review date: 31/03/2024

Author(s): Emily Smith.

Approved By: Gynaecology Clinical Governance Group

Document Id: 677