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Right Decision Service newsletter: April 2024

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

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Early Medical Termination of Pregnancy in the Home Setting (115)

Warning

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

Evidence from national research and local audit activity has demonstrated that early medical termination at home is a safe procedure which offers additional choice to women requesting termination of pregnancy.

Women meeting the inclusion criteria will be offered the option to attend the hospital for mifepristone administration, return 48 hours later for the administration of misoprostol and be given the opportunity to go home to abort.

Inclusion Criteria

  • Age 16 or above.
  • Gestation at the time of misoprostol < 63 days.
  • Singleton pregnancy.
  • Language – must be fluent in English and be able to read English.
  • Must stay within 30-45 minutes from a GG&C Gynaecology unit.
  • Must have transport available.
  • Must have immediate access to support at home if required.

Clinic Visit

  • Consultation as per normal referral at the clinic visit.
  • Patient will be risk assessed and MUST fit the inclusion criteria.
  • The consent form will be signed and stored in the casenotes.
  • Bloods will be taken for G+S and FBC.
  • Patient will be given the Early Discharge information leaflet (appendix 1).
  • The follow up pregnancy test information (appendix 1) will be given in conjunction with a pregnancy test.
  • If the pregnancy test result shows “risk of termination failure” then the patient should contact Sandyford.

Mifepristone Day

  • Ensure appropriate documentation is available.
  • Check consent form is signed.
  • Ensure intra-uterine pregnancy is confirmed by ultrasound scan.
  • Check paperwork in the ICP.
  • Check the patient is sure of their decision.
  • Mifepristone 200mg PO will be administered in the gynaecology day ward (except when the patient has been given this at the clinic).
  • Advise patient to return to the ward if she vomits within 1 hour.
  • Ensure advice is given to the patient regarding pain and/or bleeding they may experience over the following 24-48 hours.
  • Ensure the patient has the ward telephone number.
  • Relevant information should be documented in the ICP.

Misoprostol Day

48 hours following mifepristone.

  • Arrive patient under ward attenders on Trakcare.
  • Nurse enquires about pain/bleeding/passage of products of conception.
  • Check BP, pulse and temperature.
  • Explain the procedure to the patient including information about expected PV bleeding/ abdominal pain/ passage of tissue.
  • Patient is NOT routinely required to fast.
  • Misoprostol 800mcg is administered PV (this may be self administered.)
  • Metronidazole 1g is administered PR (this may be self administered.)
  • Diclofenac 100mg is administered PR as prophylactic analgesia unless contraindicated (this may be self administered.)
  • Anti-D prophylaxis MUST be given to ALL rhesus negative women.
  • Give prescribed contraception – COCP, POP, implant or Depo-provera prior to discharge. If the patient requires an IUCD or IUS they should attend Sandyford or their GP after their pregnancy test has established they are not pregnant.
  • Azithromycin 1g PO.
  • Discharge analgesia should be offered.
  • Ensure the patient has a pregnancy test to do in 2 weeks time.
  • Relevant information should be documented in the ICP.
  • Outcome patient under ward attenders on Trakcare.
  • Ensure the patient has contact phone numbers and advise them that they may telephone the ward today and then Sandyford with any queries/problems.

Follow Up Pregnancy Test at 2 Weeks Post Procedure

The patient will have been advised to do a pregnancy test 2 weeks after being administered misoprostol. They will be informed to contact Sandyford if the result states “there is a risk of termination failure” or if they have any concerns.

Appendix 1: patient information

Editorial Information

Next review date: 30/09/2022

Author(s): Elena Young.

Approved By: Gynaecology Clinical Governance Group

Document Id: 115

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