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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

Maternity wound care (943)

Objectives

The Guideline has been developed to standardise wound care postpartum, ensuring evidence based, cost effective practice is implemented and delivered throughout Greater Glasgow and Clyde.

Scope

This guideline will be applied to all women who attend for caesarean section, have an episiotomy or perineal suturing irrespective of their ethnicity, disability, religion and beliefs, sexual orientation or age.

This guideline will provide advice and guidance on effective clinical practice for all registered healthcare personnel when caring for postpartum wounds. It is not intended to address specific clinical issues that relate to individual women.

Note: This guideline should be read in conjunction with the Wound Classification Product Selection Guide (2018)

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

The purpose of this guideline is to ensure that all women within NHS Greater Glasgow and Clyde Acute Services Division who have a caesarean section , episiotomy or perineal suturing have post operative/perineal wound care that is clinically effective and evidence based combined with effective strategies in place to reduce the risk of postnatal/post operative wound complications.

Roles and responsibilities

Registered Health Care Practitioners are responsible for: 

  • Informing women of the wound dressing protocol in the event of a caesarean section and informing of appropriate wound care post caesarean section/episiotomy/tear suturing.
  • Liaising with carers and the interdisciplinary team to promote compliance of dressing protocol, ensuring that Interdisciplinary Women Focused Care Plans are in place and interventions are recorded and dated in line with the Board’s Record Keeping Policy.
  • Maintaining and updating their knowledge, skills and competence in line with their roles and responsibilities to care for women who undergo caesarean section, episiotomy or tear suturing.
  • Seeking the advice of the Tissue Viability Service where appropriate, whilst maintaining ongoing responsibility for the woman’s episode of care.
  • Referring all non-progressing wounds after two weeks to the Tissue Viability Service.

Datix reporting

A DATIX must be completed for every woman that is admitted to hospital for a wound related issue. 

Risk factors for wound complications

Many factors can potentially lead to a woman developing wound complications. These will be influenced by both intrinsic (from within the patient) and extrinsic (from out with the patient) these factors must be considered when performing a holistic assessment and developing a plan of care.

Intrinsic issues: 

  • High/low BMI
  • Reduced mobility / Immobility
  • Sensory impairment
  • Altered level of consciousness
  • Poor nutritional intake and dehydration
  • Prolonged surgery
  • Poor tissue perfusion/oxygenation
  • Incontinence
  • Excess moisture
  • Acute/Chronic/Terminal illness
  • Certain medications
  • Psychological factors
  • Previous tissue damage or wound healing complications
  • Colonisation with a resistant organism

Extrinsic issues:

  • Friction
  • Shearing
  • Increased Moisture

Underlying medical conditions will vary from woman to woman. It is also recognised that in some cases it is not always possible to prevent or manage some risk factors. Care planning should reflect this.

Postnatal wound inspection and wound assessment

  • Refer to Maternity Wound Algorithm (Appendix I)
  • When undertaking wound assessment all staff must follow NHS GGC standard infection control precautions.
  • Wound/dressing inspection should take place as per women centred plan of care (note: this can be carried out with dressing in place). Refusal to allow wound inspection should be documented and the risks fully explained to the woman.
  • If a woman shows signs of any wound complications, wound assessment and treatment plan documentation must be completed using the paper copy of the NHSGGC Wound Assessment and Management Plan. The NHSGGC Wound Assessment and Management Plan will be scanned into Clinical Portal.

NHS GGC Wound assessment Chart

  • Tissue viability requests are now on TrakCare. Order under “new request”/others/Tissue Viability
  • Appropriate dressings and product selection should be based on the wound management objectives and specific woman’s needs. Refer to Maternity Core Wound Product List (Appendix II)
  • If a Caesarean section Surgical Site Infection (SSI) is suspected the woman should be referred to the Named Obstetrician and the SSI details fully recorded on BadgerNet.

Discharge to primary care or other health care setting

Provide wound products for one weeks supply and record dressing regime in Clinical Portal.

Review

This guideline will be reviewed every three years.

Appendix I Maternity wound algorithm

Appendix II Core wound product list

Maternity core wound product list.

Editorial Information

Last reviewed: 30/06/2019

Next review date: 31/12/2022

Author(s): Rachel Hepburn.

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 943

References

Calderdale and Huddersfield NHS Foundation Trust (2017) Prontosan New Mum Patient Information Leaflet

Cochrane Library Secondary suturing compared to non‐suturing for broken down perineal wounds following childbirth (2013) 

Dudley L, Kettle C, Waterfield J, Khaled M, Ismail K (2017) Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (preview): a nested qualitative study BMJ (2017) Vol 7 Issue 2

Health Protection Scotland National Caesarean Section SSI Surveillance programme: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2613/documents/10_ssiprotocol-edition-7.1-definition-of-ssi-surveillance-poster.pdf  

NHSGGC Wound Classification Product Selection Guide (2018)