Welcome to the March 2025 update from the RDS team
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:
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:
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.
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.
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.
Introductory webinars for RDS editors will take place on:
Special webinar for RDS editors – 1 May 3-4 pm
This webinar will cover:
Running usage statistics reports using Google analytics
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.
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)
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.
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
Jaundice persisting beyond day 14 of infant’s life is common occurring in 2-15% of all neonates and 15-40% of those who are breastfed. In most occasions it is normal but it is important to exclude serious conditions such as Biliary Atresia and G6DP that can benefit from prompt diagnosis and management.
The initial referral will be made to medical / ANNP holding bleep 6123
community.childrensnursingteam@borders.scot.nhs.uk
OPCL (outpatient clinic letter) \pjaun Instructions on how to complete this attached.
Printed copies are sent to child health secretary, who will upload them to EMIS, task the HV and send a copy to parents. paediatric.secretaries@borders.scot.nhs.uk
Term babies who remain visibly jaundiced beyond 14 days and preterm babies beyond 21 days require further assessment.
The baby is referred to bleep 6123 by the community team.
At the time of referral, the baby is admitted to a slot in the ACU Prolonged Jaundice Clinic to allow generation of a letter and printing of labels.
The referral information becomes the start of the outpatient clinic letter (OPCL) and this is done by the person taking the call. The letter is prewritten (\pjaun) but does involve options and deleting the parts not relevant.
CCNs abbreviated referral form is completed and emailed to CCN team, the ANNP mailbox and the consultant of the week.
CCN team should see term babies by D21 and preterm by D28
History and information from the referral should be clarified and clinical assessment, including weight (if not done recently), carried out. The information is added to the OPCL by the CCN.
In the absence of any other concerns, investigations are limited to:
Total and conjugated bilirubin
The blood should be taken from a capillary sample, using the baby’s heel and be collected into lithium heparin (orange or small green) tube, labelled and returned to the BGH lab.
Guidance on good technique for capillary blood sampling is attached to this guideline
Sucrose can be used for pain
The ANNP / Dr carrying 6123 should be made aware of this to allow them to chase results and complete OPCL.
Parents should be informed they will be phoned if the results are abnormal and given the information leaflet within this document.
NB Breast milk jaundice can take up to 12 weeks to resolve, it is not a reason to stop breast feeding
Total bilirubin significant if > 300
Conjugated bilirubin significant if > 30 or 20% of total bilirubin
Information to clarify on referral:
Age of infant in days
Breast or formula fed
Urine and stool colour and frequency
Regained birth weight by D14
Gestation < or > 37 weeks
Are they unwell (e.g. large vomits, poor feeding, lethargy, breathlessness)
Is the mother Rh –ve or known to have antibodies
Was the newborn blood spot screening done?
Risk of G6PD
Referral Letter for Prolonged Jaundice
Please click on the link above to download a copy of referral letter
A capillary sample is a blood sample collected by puncturing the skin and collecting the blood from the tiny blood vessels which are near the skin surface.
It can be used when small volume samples are required, and can help preserve peripheral veins.
Both Serum Bilirubin and Full blood counts can be taken this way.
Good technique is important to avoid sample problems and the requirement of a repeat specimen.
Consideration for the baby:
To help with the pain EBM / formula can be given prior to the procedure or it can be carried out while the baby is feeding or use of pacifier to encourage sucking.
Non sterile gloves
Cotton wool
Blood tubes: orange lithium heparin, red EDTA
Blood lancet for puncturing skin (Tender foot)
Clean disposable tray for equipment
Sharps box
A good flowing specimen will aid processing of sample, any haemolysis will impact on the result and the laboratory may not be able to process it at all.
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| Toxins / injury |
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Biliary atresia: a guide - Children's Liver Disease Foundation
Jaundice is described as a yellowing of the skin, and sometimes of the whites of the eyes. It occurs in 90% of newborn infants. Prolonged jaundice is the term for jaundice which is still present after 2 weeks in term babies (>37 wks) and 3 weeks in preterm babies
Jaundice is caused by a buildup of bilirubin, a dark yellow substance. This is a natural waste product of the normal breakdown of red blood cells. Before birth, the mother’s liver removes the product, but after birth the baby’s liver must get rid of it on its own.
However, the liver is still immature in newborns, so it is less efficient at clearing waste products. These can build up in the skin and appear as jaundice.
Jaundice usually appears after 2-3 days and gradually disappears on its own by 14 days. However, jaundice can often last longer, especially in the breastfed or preterm baby.
Prolonged jaundice is usually related to breast milk feeding and is harmless. In this case, jaundice will disappear in the coming weeks, and you should continue breastfeeding your baby.
Very rarely prolonged jaundice can be a sign of liver, thyroid, metabolic or blood problem. This is very uncommon but must be investigated so that treatment can be given if required.
If your baby develops dark urine, pale stools or is not thriving seek advice from health visitor or GP
Term babies who remain jaundice at 15 days and preterm babies who remain jaundice at 22 days will be referred to the children’s dept at the BGH to be reviewed by a member of the neonatal team within the following week.
If prior to this appointment there are any clinical concerns an urgent referral for review should be made via HV/GP/NHS 24.
NHS Borders clinical guidelines