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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

Blood Ordering Schedule, Obstetrics (355)

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

Key Points:

  1. 84% of blood cross matched for obstetric patients is currently returned unused to Blood Bank
  2. Fully cross matched blood can be available for collection from Blood Bank in 45 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  3. Group specific blood can be available for collection from Blood Bank in 20 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  4. There are 3 units of O Negative blood in the labour ward fridge
  5. The GGC Major Haemorrhage protocol will cross match up to 6 units of packed red cells if requested – please specify requirements depending on clinical case
  6. Indication must ALWAYS be specified on request to provide laboratory with accurate clinical detail
  7. Blood loss should be estimated by weighing swabs, drapes etc.
  8. Odd numbers as well as even numbers can be requested and given
  9. It is rare for obstetric patients to require more than 2 units of blood , even with PPH
  10. Dereserving cross matched blood promptly when clinically appropriate reduces waste

Recommendations: 
ALL WOMEN IN LABOUR SHOULD HAVE A ROUTINE GROUP AND SAVE

 

The following DO NOT require routine cross matching:

Asymptomatic Placenta Praevia on ward

G&S

Examination under anaesthetic

G&S

Multiple pregnancy in labour

G&S

Retained placenta 

G&S

Elective LUSCS

G&S

Emergency LUSCS 

G&S

Haemophilia carrier – normal FVIII/FIX

G&S

Von Willebrand Disease – normal FVIII/vWF

G&S

Therapeutic heparin in labour

G&S

Platelet count 50-80 x 109/L

G&S

Platelet count < 50 x 109/L in labour

Discuss with Consultant Obstetrician and Haematologist and ensure Anaesthetic team are aware. Follow specific antenatal plan for patient

Prolonged rupture of membranes in labour

G&S

Pre-eclampsia without haemolysis or haemorrhage 

G&S

Preterm delivery

G&S

Induction of labour

G&S
Fibroids – < 4cm in body of uterus

G&S

 

Organise cross matched blood if:

APH with ongoing bleeding

2 units

Major APH 

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS with abnormally invasive placental disease

Minimum of 4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

Minimum of 2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liase with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Please be mindful that some patients will have multiple risk factors which may influence clinical decision making around blood ordering. Each case is unique and there is a balance to be achieved between blood product wastage and patient safety. A degree of clinical independence is reasonable.

Appendix 1

Organise Cross Matched Blood if:

APH with ongoing bleeding

2 units

Major APH (e.g. heavy PV bleeding, IV fluids required) +/- additional risk factor, unstable

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS for suspected accreta

4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units
CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

 

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liaise with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Editorial Information

Last reviewed: 22/09/2022

Next review date: 30/09/2027

Author(s): Judith Roberts.

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 355