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Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 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

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

Nonattendance for maternity care (620)

Objectives

This guideline aims to ensure that all women who have been referred to maternity services or are currently receiving maternity care and fail to attend an antenatal appointment are followed up, with any barriers to uptake of care addressed in order to provide women with optimal care. It aims to respect women’s choice to decline antenatal care.

Scope

This guideline is intended for the use of all maternity staff in both hospital and community settings.

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

This guideline replaces the DNA guideline.

Maternity services must be women centred and take into account social, emotional and physical factors that may affect their ability to access maternity care. If the reason why a woman has not attended an appointment is ascertained through sensitive enquiry, then alternate arrangements may be made to suit the circumstances of the individual. Consideration should be given to address the reason(s) for nonattendance including:

  • Miscarriage
  • Early pregnancy complications and admission (e.g. hyperemesis)
  • Change in booking hospital / relocation to another area
  • Misunderstanding of appointment (particularly where there are language problems or learning difficulties)
  • Alternative health beliefs leading to lack of engagement in antenatal care, including women who make an informed decision that they do not wish to accept any antenatal care.

 

Nonattendance at antenatal appointment

First non-attendance

The midwife should access TrakCare, clinical portal and badger net for

  • Recent information re non continuing pregnancy EPAS, Gynaecology, A&E, Sandyford
  • Recent information re inpatient care
  • Specialist reviews/changes to management plan
  • Care being received from another health board
  • Any difference/possible discrepancies in contact demographics
  • If TOP- Sandyford will now document on Portal/scanned documents
  1. If non-continuing pregnancy
    • Close badger net episode and outcome for no further appointment on TrakCare
    • Cancel future maternity appointments
  1. If continuing pregnancy and no evidence of care from another health board
    • Attempt to contact woman by telephone to discuss any difficulties being experienced which present a barrier for attendance
    • Utilize NHS GG&C interpreting services as per “Spoken Language, British Sign Language and Communication Support Interpreting Policy” where relevant
    • If woman/pregnant person not successfully contacted, reappoint and send letter with appointment time, date, location and send 1st class post. Consider hand delivering letter if short timescale for next appointment.
    • Letters requiring translation should be emailed to ross@ggc.scot.nhs.uk or nuzhat.mirza@ggc.scot.nhs.uk (equality and human rights team)
    • Outcome as “Did not attend – rebook” on TrakCare
    • Document nonattendance and actions taken in the “Did not attend” note on badger
    • If woman/pregnant person is successfully contacted, address childcare issues/work commitments etc., adjusting time/day/location of appointment where required
    • Transport can be arranged for women who are unable to attend if they have no access to a car available, or public transport is not a viable option; via the transport to assist women attending appointments for antenatal care. Requests should be emailed to Moreau@glasgowchildrenshospitalcharity.org
    • Discuss importance of antenatal care

Second non-attendance  

  • Midwife should repeat guidance for first non-attendance and in addition:
  • Consider contacting next of kin to confirm contact demographics
  • Liaise with additional professionals/agencies involved in the woman/pregnant person’s care, ask if they are aware of any difficulties which may be affecting the woman’s ability to attend
  • Complete and send letter A offering alternative arrangements

Third non-attendance

  • Midwife should repeat guidance for second non-attendance and in addition:
  • Inform Health visitor/GP (enquire about compliance with any previous children)
  • Check if woman known to Family nurse/SNIPS.
  • Discuss with woman actions that would be considered if no improvement in attendance/engagement with Maternity Services, e.g. request for assistance to social services.
  • Midwife should discuss necessary arrangements for maintaining engagement, e.g. further home visits or antenatal care at a suitable location. Consider if a referral is required to additional service, e.g. SNIPS,MNPI for additional support
  • A joint home visit should be considered, to assess the woman’s physical and emotional wellbeing and offer any assistance to the woman to attend the antenatal clinic, dependent on the individual situation and potential risk. Please refer to lone working policy for more information on safety around community visits. Notify the women in writing of date and time of proposed visit. – letter B
  • If home visit unsuccessful, complete and send letter C
  • Inform and discuss with team leader for further guidance and actions to be taken.

Fourth non-attendance

  • Midwife should also contact social services and determine if they have any pertinent family information.
  • Information from social work, in addition to observations from visits/discussions with woman, should inform ongoing risk and needs assessment, e.g. consider Request for Assistance or Notification of Concern where appropriate. Document in Badger social plan
  • Team Leader to escalate to Lead Midwife Community and outpatients

Women Declining Antenatal Care

  1. Community midwife to inform Team Leader and Lead Midwife Community & OPD
  2. Offer appointments / home visits for discussion of options for care
  3. Provide woman with copy of the NICE Antenatal Care guidelines (2008, updated 2019)
  4. If the woman is clear that she understands the benefits of receiving antenatal care and the risks of declining care but still choses to decline this, she has a right to do so.
  5. Seek support from appropriate Specialist Midwife team/Consultant Obstetrician.
  6. Involve appropriate support agencies – particularly where there maybe safeguarding concerns or mental capacity concerns
  7. Complete local safeguarding form for information only (unless specific welfare concerns)
  8. Ensure the woman is aware she can seek care at any point should she change her mind and has contact details to do so
  9. Document all discussions and plans made on badger

Appendix 1: Letter A

Letter A: Letter to patient who has not attended 2 Antenatal Clinic Appointments (pdf)

Appendix 2: Letter B

Letter B:Letter to patient who has not attended three Antenatal Clinic Appointments/notification of home visit (pdf)

 

Appendix 3: Letter C

Letter C:Letter to patient re notification of failed home visit (pdf)

Editorial Information

Last reviewed: 30/10/2023

Next review date: 31/10/2028

Author(s): Elaine Drennan.

Version: 2

Approved By: Maternity Clinical Governance Group

Document Id: 620