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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

Infectious Diseases Screening Tests in Late Bookers (357)

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

Late bookers are women who present for the first time on or after 24 weeks pregnancy. This is the stage at which the baby is potentially viable if early labour occurred.

The results of the infectious disease screening tests could affect the management at or after delivery, therefore all infectious diseases screening test results for a woman should be known prior to delivery and certainly before discharge.

If a woman presents to maternity services as a late booker i.e. on or after 24 weeks it is important to ensure that screening has been offered and results are received.

 

1) The woman presents to the antenatal clinic, and there is no immediate risk of delivery

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record.
  • Mark the  sample  as  URGENT  and  telephone  the  West of Scotland Specialist Virology Centre to let them know it is in the system. (0141 201 8722). Alternatively, email west.ssvc2@nhs.scot. State that the patient is a late booker, provide the lab with a contact phone number and state if you are want to receive the result on Clinical Portal or by phone.
  • Send the sample to the virus lab, via normal routine processes.
  • Ensure that the name and contact details of the person and a deputy who will be responsible for any positive results are clearly appended
  • Note that to view a result on portal a CHI number is essential

2) The woman presents to maternity assessment i.e. in pain, bleeding etc therefore the risk of delivery is high

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next                      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours(9.00 – 17.00 Monday to Friday), telephone the lab on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
    • Alternatively, in hours only, email west.ssvc2@nhs.scot, flag the email as urgent and state that the patient has a high risk of delivery. Provide the lab with a contact number. They will call you back within an hour.
  • Out of hours (including Saturday and Sunday).
    • Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above. Do not email the lab out of hours or at the weekend. 
  • If the timing of the local transport systems does not facilitate urgent transfer order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link])  
  • In normal hours the lab is able to process and produce results within 1-2 hours of receipt. Note that reactive samples will need to be confirmed on the next day.
  • Note that to view a result on Clinical Portal, a CHI number is essential.

3) The woman presents in labour

It is the responsibility of the labour ward staff to ensure that virology screening tests are offered and results received. Even intrapartum diagnosis can significantly, positively modify neonatal outcome therefore it is important to ensure women are offered screening tests no matter how late.

It is essential that you telephone the virology lab as soon as possible to discuss emergency testing of the woman.

  • Seek informed consent for screening (HIV, Syphilis and hepatitis B)
  • Fill one 9ml purple topped EDTA bottle and complete a virology request form, clearly indicating which tests (HIV, Syphilis and hepatitis B) are to be carried out. Even if a woman does not consent to all three tests, please fill one 9ml purple topped EDTA bottle. Do not send two 5ml bottles, or other combinations to make up to 9 ml, the machines in the lab won’t accept them and the sample will not be processed.
  • Ensure tests are recorded on the maternity electronic record at next      
  • Mark the sample as ‘URGENT’ and telephone the West of Scotland Specialist Virology Centre before you send the sample.
  • In hours (9.00 – 17.00 Monday to Friday), telephone the laboratory on 0141 201 8722 and:-
    • Explain that an urgent sample is being sent;
    • Discuss the travel arrangements and
    • Arrange when and to whom the results will be communicated. You must provide the laboratory with adequate contact details to include the name and preferably two contact numbers of the main results recipient and a deputy.
  • Out of hours (including Saturday and Sunday) Please telephone the on-call virologist via the Switchboard 0141 211 4000 and discuss the above.
  • Order a taxi to ensure the sample reaches the laboratory. (see NHSGGC Amended Protocol Ordering and Use of Taxis and Couriers October 2011 [Staffnet link]) 
  • As with ALL emergency blood tests ensure results are followed up immediately they are available. In normal hours the lab is able to process and produce results within 1-2 hours of receipt.  
  • Communication with paediatricians is essential as their management may be significantly altered by these results however the responsibility for taking and sending these investigations and obtaining these results remains with the midwifery / obstetric team.

Editorial Information

Last reviewed: 20/03/2021

Next review date: 30/04/2023

Author(s): Gillian Penrice.

Version: 4

Approved By: Haematology Clinical Governance Group

Document Id: 357