Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
The following toolkits are now live;
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.
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.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
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
| Please report any inaccuracies or issues with this guideline using our online form |
Antenatal
There is currently no evidence to support screening all women for vasa praevia at the routine FAS.
However for those at higher risk of vasa praeva, (presence of a succenturiate lobe or low lying placenta), a combination of both TA and TV colour Doppler imaging ultrasonography provides the best diagnostic accuracy and performing this at the time of the routine fetal anomaly scan has a high diagnostic accuracy with low false positive rate. However, further research is required to determine the benefit of this.
All patients with suspected vasa praevia should have this confirmed by a further ultrasound in the third trimester
Intrapartum
Vasa praevia may be diagnosed during early labour during vaginal examination by;
Fetal mortality rate after rupture is at least 60% despite urgent Caesarean section.
If Vasa praevia is confirmed in the third trimester, deliver by elective Caesarean section between 34 -36 weeks.
Administer antenatal corticosteroids for fetal lung maturity from 32 weeks due to the increased risk of preterm delivery.
Tailor decisions for prophylactic hospitalisation from 30-32 weeks to individual patients, taking into account risk factors such as multiple pregnancy, antenatal bleeding and threatened preterm labour. Outpatient care has been associated with excellent outcomes in asymptomatic women.
Perform an emergency Caesarean section for patients with known Vasa Praevia at viable gestations with SROM and or labour without delay.
If ruptured Vasa Praevia is suspected do not delay delivery while trying to confirm the diagnosis.
Urgent Caesarean section and neonatal resuscitation, including the use of blood transfusion if required, is essential in the management of ruptured vasa praevia diagnosed during labour.
Send the placenta for pathological examination to confirm the diagnosis. This is particularly important where there has been a still birth or where there has been acute fetal compromise during delivery
Offer a post-natal debrief consultation
