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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

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

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 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

 

 

Lower Uterine Caesarean Section (LUCS), Breech Delivery (342)

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

Applicable unit policies:

Breech presentation is a common indication for Caesarean.

The mother has consented on the basis that this is a less traumatic method of delivery for the baby.

It is sometimes difficult to deliver the after-coming head (ACH) at caesarean section and to explain why this was the case to the parents. This is more common with patients with oligohydramnios.

The following minimise the risk and/ or manages the problem.

  1. Read the notes and gain maximum information about type of Breech (i.e. extended, flexed), placenta site, etc.
  2. Remember that the baby may be big as well as breech!
  3. Make an appropriate skin incision: err on a larger incision than you might make for a Cephalic presentation. The shape of the Head may be unusual (doliocephalic, brachycephalic)
  4. Remember that there is no point in making a large skin incision and then a narrower sheath incision! Make as much room as you can. Lateral incision of the peritoneum may help.
  5. Establish where the fetal back lies.
  6. Once the uterotomy is made, as the baby is being drawn down, get your assistant to follow the head with their hand: this encourages neck flexion and reduces chance of head extension.
  7. Once the body is delivered deliver the ACH in the manner described for vaginal delivery.
  8. If there is entrapment DO NOT PANIC. You are still in the optimal environment.
  9. Do NOT simply pull harder!!!
  10. Consider Wrigley’s Forceps to ACH if there is enough room and deliver as per vaginal breech instructions.
  11. Identify where the entrapment is:
    • Skin: enlarge incision with care: a scalpel is best, pointing sharp edge away from baby.
    • Sheath: digital extension if possible, Scissors before scalpel.
    • Uterotomy: try digital extension. If not use scissors with aim to create a “J” to avoid damage to broad ligament vessels.
    • Remember Forceps to ACH may now work.
    • Consider GTN (see GTN link at top of guidelines)
    • If all else fails, a vertical uterotomy (inverted T) may be necessary: beware the anterior placenta!
  12. Paired cord pH samples
  13. Document carefully.
  14. Explain to couple what happened. This is of particular importance if a uterotomy is extended and VBAC no longer a future option.

Unusual manoeuvres.

Internal podalic version (IPV) This may be necessary to deliver:

  • a second twin at CS or at a vaginal birth
  • if there is an immediate need to deliver baby.
  • Tranverse lie caesarean section.

Documentation will inevitably be retrospective and must be clear.

Method of IPV

A fetal foot is identified by recognizing a heel through intact membranes. The foot is grasped and pulled gently and continuously lower into the birth canal (or through uterotomy at CS). The membranes are ruptured as late as possible. The baby is then delivered as an assisted breech or breech extraction with pelvi-femoral traction, Lovset’s manoeuvre to the shoulders if required and a controlled delivery of the head. This procedure is easiest when the transverse lie is with the back superior or posterior. If the back is inferior or if the limbs are not immediately palpable, do not panic, follow the curve of the back and down and round to find the leg. Confirm you have a foot before applying traction. This will minimise the risk of the unwelcome experience of bringing down a fetal hand and arm in the mistaken belief that it is a foot.

If ultrasound is immediately available to an experienced sonographer this may help identify where the limbs are.

A few seconds of calm consideration and accurate assessment will almost certainly result in an effective delivery manoeuvre.

Editorial Information

Last reviewed: 31/08/2018

Next review date: 31/12/2022

Author(s): Julie Murphy.

Version: 3

Approved By: Obstetrics Clinical Governance Group

Document Id: 342