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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

 

 

Domestic Abuse in Obstetric & Gynaecology settings (588)

Warning Warning: This guideline is 1378 day(s) past its review date.

Objectives

Other relevant policies:

Gender Based Violence Policy, Policy on Stalking, Health and Safety Policy, Forced Marriage Policy, Adult Support and Protection guidance and Procedures, Child Protection Procedures, Mental Health and wellbeing policy, Alcohol and Substance Misuse, Human Trafficking, Interpreting Policy.

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

NHS Greater Glasgow & Clyde (NHSGG&C) recognises gender-based violence (GBV) as both a cause and consequence of gender inequality and acknowledges the evidence that it is overwhelmingly perpetrated by men against women and children, with the latter more at risk from men they know. As part of its Equality Scheme, NHSGG&C has produced several gender based violence action plans which identify domestic abuse as part of a wider continuum of abuse, which also includes child sexual abuse, rape & sexual assault, sexual harassment, female genital mutilation, forced marriage and commercial sexual exploitation.

GBV cuts across all boundaries of class, ethnicity, religion and age. At the same time women in marginalised groups can suffer discrimination in relation to ethnicity, (dis)ability, sexual orientation, poverty, migrant or refugee status which can increase and intensify their vulnerability to abuse and limit access to services. Given the health consequences and links with child protection NHS staff have a pivotal role in responding to this issue.

The Scottish Government defines domestic abuse as;

“perpetrated by partners or ex partners (which) can include physical abuse (assault and physical attack involving a range of behaviour), sexual abuse (acts which degrade and humiliate women & are perpetrated against their will, including rape) and mental and emotional abuse (such as threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as isolation from family and friends)

The purpose of this guidance is to assist staff (W&CD) in identifying and responding sensitively to women accessing services during their reproductive years, who may have current or past experience of domestic abuse. This applies to areas where routine enquiry of domestic abuse has been implemented and for all other areas within Obstetrics & Gynaecology.

  • Be aware of the indicators of domestic abuse & its impact on health & (Appendix 1) & www.gbv.scot.nhs.uk
  • See all women alone for part of the consultation to ensure that any sensitive information can be discussed safely & in confidence.
  • Always set the context prior to asking about abuse. (Appendix 2)
  • Follow this up with a direct question that requires a direct answer (Appendix 2)
  • Always discuss confidentiality & its limits (child protection and vulnerable adults).    
  • Follow NHSGGC Spoken Language, British Sign Language and Communication Support Interpreting Policy (2012). It is not appropriate to use family or friends to communicate except in an emergency situation.

Have information on support services available in the department in places where they can be picked up easily

Examples of what to ask:

  • “I notice you have cuts/bruises…has someone hurt you?
  • Some of our patients who have these symptoms are living with an abusive partner…is that something that affects you?

Asking about domestic abuse will not always result in disclosure. Some women may choose to disclose at a later date & others will never access support.

The safety of the woman and any children is paramount and therefore it is crucial that health workers assess any immediate risk/safety issues following disclosure and follow child protection and vulnerable adult procedures where there are any concerns.

Key aspects to explore when assessing risk: 

  • How frequent and severe is the abuse?
  • Is she afraid for herself or her children?
  • Is she isolated and without support?
  • Is she being harassed or stalked?
  • Is there sexual violence, pressure or jealousy?
  • Are there any other risk factors such as drug, alcohol or mental health issues?

For many women leaving is the most dangerous point in the relationship, & any fears raised by the woman for her safety should be taken seriously. Women seldom exaggerate the risk of harm & are more likely to minimise the abuse.

Safety Planning

Following disclosure the health worker should explore options with the woman to help her focus on her current and future safety.

  • Help her identify a safe place she can go with her children i.e. friends, family, refuge or temporary accommodation
  • Discuss packing a bag with essential documents, clothes, money, medication, important phone numbers in case she needs to leave in a hurry. Store the bag safely where the perpetrator won’t find it
  • Offer her the Scottish Domestic abuse & Forced Marriage Helpline Number 0800 027 1234 –and  the opportunity to phone the helpline from a private room
  • Does she want to report the incident to the police? Advise her to dial 999 in an emergency or 101 at other times
  • Follow child protection and vulnerable adult procedures where there are any concerns.
  • Ensure a follow-up appointment is arranged where appropriate.

Risk assessment is not a one off event and risk may change over time; therefore ongoing risk assessment is required.

 

This is important health information which should be documented in the woman’s hospital notes, never in ‘hand-held’ records.  .

Document any disclosure using the woman’s own words and include any action or referrals and plans for follow up.

Scottish Domestic Abuse & Forced Marriage 24 hour helpline
0800 027 1234 www.sdah.org.uk– men women and children

For support and information on domestic abuse: 
www.scottishwomensaid.org.uk

Help and information for anyone who has been raped or sexually abused: 
www.rapecrisisscotland.org.uk

Website for perpetrators of domestic abuse looking for help to address their behaviour:
www.respect.uk.net

Support for male victims of domestic abuse: 
www.mensadviceline.org.uk

Advice and information for lesbian, gay, bisexual and transgender people experiencing domestic abuse:
www.lgbtdomesticabuse.org.uk
www.brokenrainbow.org.uk/help/helpline

Police Scotland Information and support for victims of domestic abuse: 
http://www.scotland.police.uk/keep-safe/advice-for-victims-of-crime/domesticabuse/reporting-domestic-abuse/

For further information on GBV
www.equality.scot.nhs.uk

A series of guides to support health workers on gender based violence is available at:
www.gbv.scot.nhs.uk

Support for Staff can be obtained via:

  • Your line manager or Supervisor of Midwives
  • Employee Policy on Domestic Abuse - Staffnet HR policies
  • Occupational Health and employee counselling service
  • The Pastoral Care Team can provide/access religious, spiritual and emotional support.

For professional or personal support regarding Gender Based Violence contact the GBV Resource Unit 0141 201 9777 or e-mail: gbvunit@ggc.scot.nhs.uk  or visit our website on Staffnet.

Impact on Health 

Table listing some impacts on health of domestic abuse

Possible Indicators of Abuse

  • Missed appointments and non-compliance with treatment
  • Frequent presentations to health settings or delay in seeking medical treatment/advice
  • Overbearing or overly solicitous partner who is always present
  • Denial or minimising of abuse
  • Injuries at different stages of healing or that don’t fit with the explanation given
  • Appears evasive, socially withdrawn and is hesitant
  • Children on the child protection register or referred to other specialists for behavioural/emotional or developmental problems

These lists are not exhaustive & there may be other causes.

Some women experiencing abuse may show no signs or indicators.

Routine Enquiry

Setting the Context:

 “Around 1:4 women experience emotional, sexual or physical abuse, because we know this affects your health (and pregnancy), we now routinely ask all women……”

Follow setting the context by giving a short explanation of each of the forms of abuse e.g. physical abuse can be a push, slap or kick, emotional abuse may be your partner putting you down or not letting you see family or friends and sexual abuse could be your partner forcing you to do something you don’t want to.

Examples of Direct Questions: 

  • Have you ever felt afraid of a partner/ex or family member?
  • Has your partner/ex, ever physically hurt or threatened you or your children?
  • Has your partner/ex ever destroyed things that you cared about?
  • Has your partner/ex ever forced you to have sex when you didn’t want to?
  • Does he/she force you to engage in sex that makes you feel uncomfortable?
  • Does your partner/ex ever get jealous? If so, how does he act?
  • Does your partner/ex try to control you in any way, for example preventing you from going out or limiting contact with your family or friends?

These questions are intended as prompts, it is not necessary to ask all of them and they should not be used as a checklist.

Editorial Information

Last reviewed: 01/06/2016

Next review date: 30/06/2021

Author(s): Elaine Drennan; Mairi McDermid.

Approved By: Obstetrics Clinical Governance Group

Document Id: 588