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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

 

 

Maternity wound care (943)

Objectives

The purpose of this guideline is to ensure that all women within NHS Greater Glasgow and Clyde Acute Services Division who have a caesarean birth, episiotomy or perineal suturing have post-operative/perineal wound care that is clinically effective and evidence based combined with effective strategies in place to reduce the risk of postnatal/post-operative wound complications. 

The Guideline has been developed to standardise wound care postpartum, ensuring evidence based, cost effective practice is implemented and delivered throughout Greater Glasgow and Clyde

Scope

This guideline will be applied to all women who attend for caesarean birth, have an episiotomy or perineal suturing irrespective of their ethnicity, disability, religion and beliefs, sexual orientation or age.

This guideline will provide advice and guidance on effective clinical practice for all registered healthcare personnel when caring for postpartum wounds. It is not intended to address specific clinical issues that relate to individual women.

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

Roles and responsibilities

Registered Health Care Practitioners are responsible for: 

  • Informing women of the wound dressing protocol in the event of a caesarean birth and informing of appropriate wound care post caesarean birth/episiotomy/tear suturing.
  • Liaising with carers and the multidisciplinary team to promote compliance with dressing protocol, ensuring that each woman has an appropriate personalised care plan and that interventions are recorded and dated in line with the Board’s Record Keeping Policy.
  • Maintaining and updating their knowledge, skills and competence in line with their roles and responsibilities to care for women who undergo caesarean birth, episiotomy or tear suturing.
  • Seeking the advice of the Tissue Viability Service where appropriate, whilst maintaining ongoing responsibility for the woman’s episode of care.
  • Referring all non-progressing wounds after two weeks to the Tissue Viability Service. Ensure all caesarean wounds are documented on an adult wound assessment chart and the appropriate dressing regime is in place.

Datix reporting

A DATIX must be completed for every woman that is admitted to hospital for a wound related issue. 

Risk factors for wound complications

Many factors can potentially lead to a woman developing wound complications. These will be influenced by both intrinsic (from within the woman) and extrinsic (external) these factors must be considered when performing a holistic assessment and developing a plan of care.  

Intrinsic issues: 

  • High/low BMI
  • Reduced mobility / Immobility
  • Sensory impairment
  • Altered level of consciousness
  • Poor nutritional intake and dehydration
  • Prolonged surgery
  • Poor tissue perfusion/oxygenation
  • Incontinence
  • Excess moisture
  • Acute/Chronic/Terminal illness
  • Certain medications
  • Psychological factors
  • Previous tissue damage or wound healing complications
  • Colonisation with a resistant organism
  • Type 2 diabetes

Extrinsic issues:

  • Friction
  • Shearing
  • Increased Moisture

Underlying medical conditions will vary from woman to woman. It is also recognised that in some cases it is not always possible to prevent or manage some risk factors. Care planning should reflect this.

Postnatal wound inspection and wound assessment

  • Refer to Maternity Wound Algorithm (Appendix I)
  • PICO dressing should be used in women with a significant panniculus, who have required the use of Traxi retractor or those who have been admitted with wound complications after a previous caesarean birth.
  • When undertaking wound assessment all staff must follow NHS GGC standard infection control precautions.
  • Wound/dressing inspection should take place as per women centred plan of care (note: this can be carried out with dressing in place). If a woman declines wound inspection this should be documented and the risks fully explained to the woman.
  • If a woman shows signs of any wound complications, wound assessment and treatment plan documentation must be completed using the paper copy of the NHSGGC Adult Wound Assessment and Management chart. The NHSGGC Adult Wound Assessment and Management Chart will be scanned into Clinical Portal.

NHS GGC Wound assessment Chart

  • Tissue viability requests are now on TrakCare. Order under “new request”/others/Tissue Viability
  • Appropriate dressings and product selection should be based on the wound management objectives and specific woman’s needs. Refer to Maternity Core Wound Product List (Appendix II)
  • If a Caesarean birth Surgical Site Infection (SSI) is suspected the woman should be referred to the Named Obstetrician and the SSI details fully recorded on BadgerNet.

Discharge to primary care or other health care setting

  • Ensure a 7 day supply of wound products are given and record dressing regime in Clinical Portal.
  • Sanitary pads are not a wound dressing and should not be used as wound care products.
  • Once discharged from community midwife and the wound requires ongoing wound care, contact the patient's treatment room and make the first appointment for further consultation and review. If housebound contact District Nurse (DN) services, if required the DN or Treatment room (TR)  will refer to community Tissue Viability Nurse (TVN).
  • District Nurse phone numbers are: 0141 355 2180 Glasgow, 0141 207 7760 Renfrewshire
  • Other areas check with GP to access DN or TR services.

Review

This guideline will be reviewed every three years.

Appendix I: Maternity wound algorithm

Wound Infection

Check dressing daily and record in maternity record if any of the following are present as this may indicate signs of a wound infection:

  • Developing pyrexia
  • Increased pain or discomfort
  • Increasing swelling of peri-wound area
  • Offensive odour
  • Increased exudate
  • Exudate purulent
  • Increased redness/discoloration/heat of tissues surrounding wound. If any of the above signs are present:
  • Remove dressing
  • Complete NHS GGC wound assessment chart
  • Consider microbiology swabbing if systemic signs of infection present
  • Urgent medical review is required for sepsis if patient pyrexial/tachycardic/unwell.
  • Report as surgical site infection on Badger.       

Appendix II: Core wound product list

Maternity core wound product list.

Editorial Information

Last reviewed: 29/01/2025

Next review date: 28/02/2028

Author(s): Eilidh Henderson, Julie Astley.

Version: 2

Approved By: Maternity Clinical Governance Group

Document Id: 943

References

Calderdale and Huddersfield NHS Foundation Trust (2017) Prontosan New Mum Patient Information Leaflet

Cochrane Library Secondary suturing compared to non‐suturing for broken down perineal wounds following childbirth (2013) 

Dudley L, Kettle C, Waterfield J, Khaled M, Ismail K (2017) Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (preview): a nested qualitative study BMJ (2017) Vol 7 Issue 2

Health Protection Scotland National Caesarean Section SSI Surveillance programme: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2613/documents/10_ssiprotocol-edition-7.1-definition-of-ssi-surveillance-poster.pdf  

NHSGGC Wound Classification Product Selection Guide (2018)