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Scottish National Midwifery Formulary
Midwifery Formulary for Neonates

Announcements and latest updates

Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements are:

Optimising mobile app build process
Mobile app always to be downloadable.
Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
Automated daily emptying of the recycling bin (with a 30 day rolling grace period) in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
Supporting multiple passcodes (ticket 6079)
Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

Focus on dementia
Highland Council Getting it Right for Every Child
Dumfries and Galloway Adult Support and Protection procedures
National Waiting Well toolkit
Fertility Scotland National Network
NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest. The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

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

Friday 29th November 3-4 pm
Thursday 5 December 3.30 -4.30 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

The Right Decision Service: the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk Mobile app download: Apple Android

Midwifery Formulary for Neonates

Scottish National Midwifery Formulary

Central Nervous System

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Opioid antagonists
Naloxone -Neonate	ME	POM	V3	In Patient. 200microgram (0.5ml) by IM injection into the anterior thigh once only.

Vitamin K Group of Medicines

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction			V3
Phytomenadione (Vit K) IM 2mg in 0.2ml injection Neonate	ME	POM	V3	Scotland National Midwifery Formulary Monograph. See local guideline and PGD. Healthy infants ≥ 36+0 weeks and ≥ 2.5kg 1mg (0.1ml) IM single dose at birth. NB ampoule contains 2mg in 0.2ml.
Phytomenadione (Vit K) IM 2mg in 0.2ml injection NeonateGGC	ME	POM	V4 GGC	GGC Guideline – note variation from National Midwifery Formulary Monograph. See local guideline and PGD. Premature infants <36 + 0 weeks 0.5mg (0.05ml) IM single dose at birth. infants ≥ 36+0 weeks 1mg (0.1ml) IM single dose at birth. NB ampoule contains 2mg in 0.2ml.
Phytomenadione (Vit K) oral Neokay® Neonate	ME	POM	V3	Scotland National Midwifery Formulary Monograph. See local guideline and PGD. Oral prophylaxis in all healthy neonates including preterm babies who are not at particular risk of bleeding disorders and whose parents do not want IM vitamin K (Phytomenadione ). Give 1mg Neokay by mouth once. Continue once weekly for 12 weeks for exclusively breast-fed babies. Another dose should be given if the first dose is spat out or the baby is sick within 3 hours of the dose being given.
Phytomenadione (Vit K) oral Neokay® NeonateGGC	ME	POM	V4GGC	GGC Guideline – note variation from National Midwifery Formulary Monograph. See local guideline and PGD. Oral prophylaxis in all healthy neonates including preterm babies who are not at particular risk of bleeding disorders and whose parents do not want IM vitamin K (Phytomenadione). Give 1mg Neokay by mouth once weekly for 12 weeks. Another dose should be given if the first dose is spat out or the baby is sick within 3 hours of the dose being given.

Phytomenadione (Vit K) *oral Paediatric 2mg in* *0.2ml Konakion MM®* Neonate**	ME	POM	V3	Scotland National Midwifery Formulary Monograph. See local guideline and PGD. When Neokay capsules not available then Konakion Paediatric MM can be used as an oral solution if required. Oral prophylaxis in healthy neonates of 36 weeks gestation and older and whose parents do not want IM vitamin K (Phytomenadione). Give 2mg (0.2ml) Paediatric Konakion MM by mouth at birth and repeated between 4 and 7 days. Exclusively breast fed babies will require a further dose at 1 month. Maximum of 3 doses in accordance with local guideline. Doses must be administered by healthcare professionals.
Phytomenadione (Vit K) *oral Paediatric 2mg in* *0.2ml Konakion MM®* NeonateGGC**	ME	POM	V4GGC	GGC Guideline – note variation from National Midwifery Formulary Monograph. See local guideline and PGD. When Neokay capsules not available then Konakion Paediatric MM can be used as an oral solution if required. Oral prophylaxis in all healthy neonates including preterm babies who are not at particular risk of bleeding disorders and whose parents do not want IM vitamin K (Phytomenadione). Give 2mg (0.2ml) Paediatric Konakion MM by mouth at birth and repeat on day 7 and day 28 in accordance with local guideline. Doses must be administered by healthcare professionals.

Medicines used for Thrush Infections

Medicine as per BNF category		Arrangement for supply or administration	Legal status			Version of page	Greater Glasgow and Clyde Midwifery Formulary local arrangements
Miconazole 2% cream (neonate)		ME	POM			V1	In Patient or Out Patient. One pack of cream may be supplied on one occasion. Use in accordance with manufacturer’s instructions. Refer to a doctor if a repeat course may be required.
Nystatin oral suspension (neonate)		ME	POM			V2	In Patient or Out Patient. One original pack of oral suspension may be supplied on one occasion. Use in accordance with manufacturer’s instructions. Refer to a doctor if a repeat course may be required.

Immunological Products and Vaccines

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Greater Glasgow and Clyde Midwifery Formulary local arrangements
Introduction to monographs for medicines relating to Hepatitis B (neonate)			V3	Reader referred to table below introduction. Note included with table observing ‘NHS boards in Scotland may extend the criteria beyond those listed.’
Hepatitis B vaccine	ME	POM	V3	See local guideline. 0.5ml at birth IM in the anterolateral thigh. 1 dose by midwife, subsequent doses by Health Visitor or GP in accordance with Health Board Public Health agreed schedule of immunisations.
Hepatitis B immunoglobulin - human (HBIG)	ME	POM	V3	See local guideline. 200 international units as a single dose IM as soon after birth as possible. This is a high volume to give a neonate - ideally split the dose and site of administration. Administer at a separate site to hepatitis B vaccine. Potency varies by batch. The correct volume to give the stated potency is overprinted on the label.

Last reviewed: 27/01/2020

Next review date: 31/01/2022

Author(s): June Grant.

Version: 2020

Approved By: Heads of Midwifery