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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

Nonattendance for maternity care (620)

Objectives

This guideline aims to ensure that all women who have been referred to maternity services or are currently receiving maternity care and fail to attend an antenatal appointment are followed up, with any barriers to uptake of care addressed in order to provide women with optimal care. It aims to respect women’s choice to decline antenatal care.

Scope

This guideline is intended for the use of all maternity staff in both hospital and community settings.

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

This guideline replaces the DNA guideline.

Maternity services must be women centred and take into account social, emotional and physical factors that may affect their ability to access maternity care. If the reason why a woman has not attended an appointment is ascertained through sensitive enquiry, then alternate arrangements may be made to suit the circumstances of the individual. Consideration should be given to address the reason(s) for nonattendance including:

  • Miscarriage
  • Early pregnancy complications and admission (e.g. hyperemesis)
  • Change in booking hospital / relocation to another area
  • Misunderstanding of appointment (particularly where there are language problems or learning difficulties)
  • Alternative health beliefs leading to lack of engagement in antenatal care, including women who make an informed decision that they do not wish to accept any antenatal care.

 

Nonattendance at antenatal appointment

First non-attendance

The midwife should access TrakCare, clinical portal and badger net for

  • Recent information re non continuing pregnancy EPAS, Gynaecology, A&E, Sandyford
  • Recent information re inpatient care
  • Specialist reviews/changes to management plan
  • Care being received from another health board
  • Any difference/possible discrepancies in contact demographics
  • If TOP- Sandyford will now document on Portal/scanned documents
  1. If non-continuing pregnancy
    • Close badger net episode and outcome for no further appointment on TrakCare
    • Cancel future maternity appointments
  1. If continuing pregnancy and no evidence of care from another health board
    • Attempt to contact woman by telephone to discuss any difficulties being experienced which present a barrier for attendance
    • Utilize NHS GG&C interpreting services as per “Spoken Language, British Sign Language and Communication Support Interpreting Policy” where relevant
    • If woman/pregnant person not successfully contacted, reappoint and send letter with appointment time, date, location and send 1st class post. Consider hand delivering letter if short timescale for next appointment.
    • Letters requiring translation should be emailed to ross@ggc.scot.nhs.uk or nuzhat.mirza@ggc.scot.nhs.uk (equality and human rights team)
    • Outcome as “Did not attend – rebook” on TrakCare
    • Document nonattendance and actions taken in the “Did not attend” note on badger
    • If woman/pregnant person is successfully contacted, address childcare issues/work commitments etc., adjusting time/day/location of appointment where required
    • Transport can be arranged for women who are unable to attend if they have no access to a car available, or public transport is not a viable option; via the transport to assist women attending appointments for antenatal care. Requests should be emailed to Moreau@glasgowchildrenshospitalcharity.org
    • Discuss importance of antenatal care

Second non-attendance  

  • Midwife should repeat guidance for first non-attendance and in addition:
  • Consider contacting next of kin to confirm contact demographics
  • Liaise with additional professionals/agencies involved in the woman/pregnant person’s care, ask if they are aware of any difficulties which may be affecting the woman’s ability to attend
  • Complete and send letter A offering alternative arrangements

Third non-attendance

  • Midwife should repeat guidance for second non-attendance and in addition:
  • Inform Health visitor/GP (enquire about compliance with any previous children)
  • Check if woman known to Family nurse/SNIPS.
  • Discuss with woman actions that would be considered if no improvement in attendance/engagement with Maternity Services, e.g. request for assistance to social services.
  • Midwife should discuss necessary arrangements for maintaining engagement, e.g. further home visits or antenatal care at a suitable location. Consider if a referral is required to additional service, e.g. SNIPS,MNPI for additional support
  • A joint home visit should be considered, to assess the woman’s physical and emotional wellbeing and offer any assistance to the woman to attend the antenatal clinic, dependent on the individual situation and potential risk. Please refer to lone working policy for more information on safety around community visits. Notify the women in writing of date and time of proposed visit. – letter B
  • If home visit unsuccessful, complete and send letter C
  • Inform and discuss with team leader for further guidance and actions to be taken.

Fourth non-attendance

  • Midwife should also contact social services and determine if they have any pertinent family information.
  • Information from social work, in addition to observations from visits/discussions with woman, should inform ongoing risk and needs assessment, e.g. consider Request for Assistance or Notification of Concern where appropriate. Document in Badger social plan
  • Team Leader to escalate to Lead Midwife Community and outpatients

Women Declining Antenatal Care

  1. Community midwife to inform Team Leader and Lead Midwife Community & OPD
  2. Offer appointments / home visits for discussion of options for care
  3. Provide woman with copy of the NICE Antenatal Care guidelines (2008, updated 2019)
  4. If the woman is clear that she understands the benefits of receiving antenatal care and the risks of declining care but still choses to decline this, she has a right to do so.
  5. Seek support from appropriate Specialist Midwife team/Consultant Obstetrician.
  6. Involve appropriate support agencies – particularly where there maybe safeguarding concerns or mental capacity concerns
  7. Complete local safeguarding form for information only (unless specific welfare concerns)
  8. Ensure the woman is aware she can seek care at any point should she change her mind and has contact details to do so
  9. Document all discussions and plans made on badger

Appendix 1: Letter A

Letter A: Letter to patient who has not attended 2 Antenatal Clinic Appointments (pdf)

Appendix 2: Letter B

Letter B:Letter to patient who has not attended three Antenatal Clinic Appointments/notification of home visit (pdf)

 

Appendix 3: Letter C

Letter C:Letter to patient re notification of failed home visit (pdf)

Editorial Information

Last reviewed: 30/10/2023

Next review date: 31/10/2028

Author(s): Elaine Drennan.

Version: 2

Approved By: Maternity Clinical Governance Group

Document Id: 620