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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

 

 

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.

 

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

  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

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

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

 

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