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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

 

 

Early Pregnancy Assessment Service Ultrasound Protocol (502)

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

Applicable Unit Policy Documents 

  • EPAS Ultrasound Management Plan
  • EPAS Ultrasound Report on Badger net

Patient privacy and dignity must be maintained at all times. 

On arrival in the department, the patient should be scanned trans-abdominally in the first instance, to exclude major pelvic pathology, or advanced pregnancy. 

A full bladder is essential. 

If more information is required then the patient should be prepared for a trans-vaginal scan. 

An explanation should be given and latex allergy excluded (all departments should be using latex free gloves and probe covers).

Should a TV scan be declined, this must be documented on the ultrasound report on Badger net.

Measurements should be taken of the CRL if there is a fetal pole, or measurements of the mean sac diameter of the gestation sac +/- yolk sac if no fetus is found. 

The pouch of Douglas and adnexal regions must be examined. 

Any tenderness should be recorded. 

The recommendations of the Royal College of Obstetricians and Gynaecologists/ Royal College of Radiologists (RCOG/RCR) as detailed in the GGC protocol for diagnosis of non-continuing pregnancy must be adhered to, with follow up appointment arranged if indicated. (Attached as Appendix I and II)

If any doubt exists then a medical opinion must be sought. 

If an ectopic pregnancy is suspected, a medical opinion must be sought immediately and the patient told to await review. 

On completion of the scan, the findings should be communicated to the patient in a compassionate manner and she should be referred to the midwifery staff for continuity of care. 

All reports must be recorded on Badger net with the authorisation box completed as your electronic signature.

Appendix I: The Management of Early Pregnancy Loss

Addendum to GTG No 25 (Oct 2006): The Management of Early Pregnancy Loss

Recent research suggests that given inter-observer variability in ultrasound measurements and the greater variation in early embryonic growth than has hitherto been assumed, a more conservative approach to the diagnosis of early pregnancy loss is warranted. 

The studies from Imperial College London, Queen Mary, University of London and the Katholieke Universiteit Leuven, Belgium published in the November 2011 issue of Ultrasound in Obstetrics and Gynaecology concluded that current definitions used to diagnose miscarriage could lead to an incorrect diagnosis and they call for clearer evidence-based guidance on detecting miscarriage through ultrasound scans. 

Having carefully considered these papers, we recommend adoption of the following interim guidance with immediate effect:

  1. Ultrasound diagnosis of miscarriage should only be considered with a mean gestation sac diameter >/= 25mm (with no obvious yolk sac), or with a fetal pole with crown rump length >/=7mm (the latter without evidence of fetal heart activity)
  2. Transvaginal ultrasound scan should be performed in all cases where there is uncertainty.
  3. Where there is any doubt about the diagnosis and/or a woman requests a repeat scan, this should be performed at an interval of at least one week from the initial scan before medical or surgical measures are undertaken for uterine evacuation. No growth in gestation sac size or CRL is strongly suggestive of a non-viable pregnancy in the absence of embryonic structures.

These revised values for 'mean gestation sac diameter' and 'crown rump length' do not imply that previously used values were wrong, nor that diagnosis of miscarriage in the past has been unsafe, This interim guidance suggests a more cautious approach is warranted, pending more definitive data becoming available. It extends the criteria included in the RCOG Green Top Guideline No 25, which recommended a conservative approach with mean gestation sac diameter <20mm or fetal CRL <6mm. 

Authors:

  • Christoph Lees MRCOG on behalf of the RCOG Ultrasound Advisory Group
  • Kim Hinshaw FRCOG Lead author, Green Top Guideline No. 25  Philip Owen FRCOG Chair, RCOG Guidelines Committee
  • David Richmond FRCOG RCOG Vice President (Standards)

19th October 2011

RCOG clinical guideline The Management of Early Pregnancy Loss

Appendix II: GGC Diagnosis of Non- Continuing Pregnancy

Ultrasound diagnosis of miscarriage should only be considered when:

  • Mean Gestation Sac Diameter >/= 25mm (with no obvious yolk sac) on Transvaginal scan
  • A fetal pole with Crown Rump Length (CRL) >/= 7mm on Transvaginal scan (without evidence of fetal heart activity)
  • A fetal pole with Crown Rump Length (CRL) >/= 32mm on Transabdominal scan (without evidence of fetal heart activity)

A second Sonographer (with at least one years post competency experience) MUST physically rescan the woman to confirm the diagnosis. If this is not possible the same day then another scan should be performed by a DIFFERENT Sonographer at a time that suits patient/department or at an interval of at least one week from the initial scan if the scan is performed by the SAME Sonographer.

Sonographers MUST ensure the name and authorisation boxes are completed on Badger net.

In all cases, where there is any doubt about the diagnosis and/or a woman requests a repeat scan, this should be performed at an interval of at least one week from the initial scan before medical or surgical measures are undertaken for uterine evacuation.

Editorial Information

Last reviewed: 03/05/2024

Next review date: 16/11/2028

Author(s): Donna Bean.

Version: 2

Approved By: Maternity Governance Group

Document Id: 502