Welcome to the Right Decision Service (RDS) newsletter for April 2024.
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.
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.
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.
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.
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
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
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
Some of the toolkits the RDS team is currently working on:
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.
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.
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
A range of online resources are available to support women and families and professionals to develop a care plan, such as through the voluntary sector.
Provide all women/birthing parents with information about the importance of enquiring about, and attending to, any mental health problems that might arise across the perinatal period.
If a woman/birthing parent agrees, provide information to and involve their significant other(s) in discussions about her/their emotional wellbeing and care throughout the perinatal period.
Pre-conceptual advice and information should be considered for all women of childbearing age with a mental health diagnosis, where relevant. Lifestyle advice can improve outcomes.
Specialist pre-conceptual review by mental health services is required for women/potential birthing parents with a history of complex mental illness, particularly where there is a history of postpartum psychosis or bipolar affective disorder.
See the full guideline for further information about what to include and resources available.
Provide advice about the risk of relapse during pregnancy and especially in the first few postpartum months to women/birthing parents who have a new, existing or past mental health condition and are planning a pregnancy.
Women and birthing parents need to be given information about the safety of medication use during breastfeeding. Information for practitioners is available from the UK Breastfeeding Medicines Advice Service (UK Drugs in Lactation Advisory Service (UKDILAS). Further resources are available in the pharmacological therapies section.
Discuss treatment (medication and psychological) options that would enable a woman/birthing parent to breastfeed if they wish to and support those who choose not to breastfeed.
Care planning with the extended multidisciplinary team (eg maternity staff, eating disorder service, perinatal mental health services, general practitioner, health visitor, family nurse partnership or other agencies if relevant such as children’s services) should be considered for pregnant women/birthing parent with a current or past history of an eating disorder relevant to their presenting needs.
Co-ordinated care planning involving maternity services, primary care, mental health services, health visiting and other agencies where appropriate, is required for women/birthing parents with complex mental illness.
It may also be relevant to consider use of an advanced statement (a personal statement witnessed by a relevant professional stating future preferences relating to care and treatment) (Mental Health Welfare Commission).
See full guideline for more information about what to include and resources available.
For women/birthing parents with schizophrenia, bipolar disorder or borderline personality disorder, a multidisciplinary team approach to care in the perinatal period is essential, with clear communication, a documented care plan and continuity of care across different clinical settings.
Wherever possible, assessment, care and treatment of the mother/birthing parent should include the infant.
Where possible, health professionals providing care in the perinatal period should access training to improve their understanding of care for women/birthing parents with schizophrenia, bipolar disorder and borderline personality disorder.
In planning postnatal care for mothers/birthing parents with schizophrenia, bipolar disorder, severe depression or borderline personality disorder, take a co-ordinated team approach to parent and infant mental health care and relevant interventions.
When caring for mothers/birthing parents with severe mental illness, including borderline personality disorder, it is important to ensure that child protection risks are understood and addressed, if necessary.
Support families to access relevant statutory and third sector services, which could help to reduce any stress or adversity and/or provide practical and social support.
Infant mental health and the potential impact of maternal mental illness needs to be considered when treating both a mother/birthing parent and their baby.
From 32 weeks’ gestation until the end of the first postnatal year women/ birthing parents and their infant (s) should be offered specialist Mother and Baby Unit (MBU) admission in Scotland. These are specially designed units to treat acute mental illness as well as supporting the mother-infant relationship and preventing avoidable separation, with benefits for both parent and baby.
MBU admission is appropriate for women/ birthing parents who are the primary carer of their baby and where risks are manageable within the MBU ward environment.
The MBU Families fund can cover out-of-pocket travel and accommodation expenses required to support admission.
In exceptional circumstances where a mother or birthing parent is admitted to a general adult ward, they should be supported to maintain contact with their baby, supported with infant feeding and access to family-friendly spaces for visiting and therapeutic interventions. Mother and baby unit admission should continue to be offered if appropriate.
See the full guideline for more information.
Where possible, if a mother/birthing parent with a severe postnatal episode requires hospital admission, avoid separation from her/their infant with co-admission to a specialist mother-baby unit where facilities are available and appropriate.28
When prescribing for a women/birth parent in the perinatal period the potential for harm to the fetus and the breastfed infant must be carefully balanced with the potential harm to the mother/birthing parent and fetus or infant if the mother/birthing parent remains untreated.
Involve the women/birthing parent, and their family (where appropriate), in all decisions about treatment, including an individualised assessment of benefit versus risk.
Ensure that information is provided in plain language.
Take into consideration factors that may support relapse prevention or potential barriers to care, including stigma, and plan accordingly.
Provide information on:
Ensure there is a clear rationale for drug treatment, in keeping with relevant guidance and considering the differing risks of relapse with different illnesses.
Up-to-date safety alerts are available from the Medicines and Healthcare products Regulatory Agency - GOV.UK (www.gov.uk), and the UK Drugs in Lactation Advisory Service (UKDILAS).
See the full guideline for more information.
Discuss the potential risks and benefits of pharmacological treatment in each individual case with the woman/birthing parent and, where possible, their significant other(s), if consent is given to do so. Document the discussion.
Ideally, treatment with psychoactive medications during pregnancy involves close liaison between a treating psychiatrist or where appropriate the woman/birthing parent’s GP, and their maternity care provider(s). In more complex cases, it is advisable to seek a second opinion from a perinatal psychiatrist and other relevant members of the multidisciplinary team if needed, such as a pharmacist, neonatologist, or non-medical prescribers.
Ensure that women/birthing parents are aware of the risks of relapse associated with stopping or changing medication and that, if a medication is ceased, this needs to be done gradually and with advice from the treating clinician.
Plan for pharmacological review in the early postpartum period for women/birthing parents who cease psychotropic medications during pregnancy.
Discuss treatment (medication and psychological) options that would enable a woman/birthing parent to breastfeed if they wish to and support those who choose not to breastfeed.
When exposure to psychoactive medications has occurred in the first trimester (especially with anticonvulsant exposures) pay particular attention to the 11–14 week or 18–20 week ultrasound because of the increased risk of major malformation.
Consider that infants exposed to medication in pregnancy may be at risk of neonatal adaptation syndrome and may require additional monitoring after birth. Monitoring should be individualised and considered as part of multidisciplinary birth planning taking into consideration the medication dose, polypharmacy, infant feeding and infant vulnerability such as risk of preterm delivery, low birth weight and any obstetric complications.
Advise women/birthing parents against sleeping in bed with their infant, particularly if taking sedative drugs. Parents should be encouraged to follow safe sleep advice published by the Scottish Government,109 .
Mental health in pregnancy and after birth (SIGN)