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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

Membrane sweep for prolonged pregnancy (412)

Objectives

This guideline covers the reasoning behind why a membrane sweep may be performed at term and the process of this procedure. It aims to give women the option to have membrane sweeping to possibly prevent prolonged pregnancy and reduce the need for mechanical or pharmacological induction of labour.

Scope

This procedure can be carried out, with informed consent, by healthcare professionals i.e. Midwives and Obstetricians.

Audience

Healthcare professionals
Pregnant women, their families and carers

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

Who is suitable for a membrane sweep?

Pregnant women

  • After 39 weeks gestation who has given consent.
  • After previous caesarean birth if planning vaginal birth (VBAC). If a VBAC is the planned method of birth then a membrane sweep is not contraindicated.

Who is not suitable for a membrane sweep?

Pregnant woman who

  • Has been confirmed to have a placenta praevia.
  • Has had undiagnosed bleeding in third trimester.
  • Baby’s head high and not in pelvis.
  • Previous caesarean birth not planning vaginal birth
  • Woman for whom a vaginal birth is not suitable.

Advantages of a membrane sweep

  • Can prevent prolonged pregnancy.
  • May make it more likely the woman will labour spontaneously.
  • May reduce the need for mechanical or pharmacological induction of labour.
  • Can be repeated if spontaneous labour does not occur

Disadvantages of a membrane sweep

  •  Woman may experience some discomfort during the procedure.
  • May cause some light vaginal bleeding.
  • May not lead to spontaneous labour.

Procedure

A membrane sweep can be discussed with the woman in the latter stages of the third trimester and offered from 39 weeks gestation and performed at the both community midwife led and obstetric led antenatal clinics. The woman should be informed of the advantages and disadvantages of a membrane sweep to allow them to make an informed decision whether to have the procedure. The procedure should be discussed and verbal consent must be gained, from the pregnant person, before carrying out the membrane sweep.

Research suggest membrane sweeps performed twice weekly after 39 weeks are more effective than once weekly or no membrane sweep. Clinical judgement and women’s choice should be considered when arranging subsequent follow up.

  • Prior to the membrane sweep the woman should empty their bladder.
  • An abdominal palpation should be carried out to ascertain that presentation is cephalic and the vertex is in the pelvis. If not, then the procedure should not be performed.
  • The fetal heart should be auscultated prior to the procedure.
  • After gaining consent to start the procedure a vaginal examination should be performed.
  • To sweep the membranes, first locate the cervix.
  • A finger should then be passed through the cervix, if possible, and rotated against the wall of the uterus, to separate the membranes from the uterus.
  • If the cervix will not admit a finger, massaging around the cervix in the vaginal fornices may achieve a similar effect.
  • After the procedure the fetal heart should be auscultated again.
  • All findings should be discussed with the woman and documented on Badgernet.

The pregnant person should be informed that they may experience some light vaginal bleeding or ‘Show’. If any heavy bleeding, painful contractions or waters breaking (SROM) maternity assessment unit should be contacted. A discussion regarding whether the woman would like additional membrane sweeping should take place if spontaneous labour does not occur after the first sweep.

Editorial Information

Last reviewed: 14/12/2023

Next review date: 15/12/2028

Author(s): Elaine Drennan.

Version: 3

Co-Author(s): Kirsty Robertson, Laura Paterson.

Approved By: Maternity Clinical Governance Group

Document Id: 412

References

Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews. 2020(2)

NICE (2021). Inducing labour (NG 207) – Section 1.3: Methods for induction of labour.

Salau JO et al. Effectiveness and safety of membrane sweeping in the prevention of post-term pregnancy: a randomised controlled trial. J Obstet Gynaecol. 2022 Sep 30:1-7.