NHS Pathways system update - clinical release note - release 48.2.2
Release 48.2.2 was made available to suppliers and providers on 30 June 2025.
NHS Pathways make changes to content based on new or emerging clinical evidence, change requests, and feedback from our providers or wider stakeholders.
NHS Pathways identifies areas of content that would benefit from enhancement. The aim of these enhancements is to provide clarity for users, and to benefit both users’ and patients’ experiences, thus ensuring that triage is as safe, effective, and efficient as possible.
The enhancements to Main Telephony made by NHS Pathways for Release 48.2.2 are highlighted below. Release 48.2.2 was made available to suppliers and providers on 30 June 2025.
What we've changed
Following recent guideline changes from the British Association of Perinatal Medicine (BAPM) a review of the resuscitation guidance for babies born pre-term was required
Pre-term resuscitation guideline changes
The BAPM guidelines advise that 'Where gestation is certain, attempted resuscitation of the baby before 22 completed weeks’ gestation is not appropriate and should not be undertaken.' (BAPM 2022).
- Babies born at under 22 weeks will no longer receive guidance on resuscitation but continue to receive supportive advice. Babies born over 22 weeks will be triaged with resuscitation advice. Those who are 'not sure' of gestation will follow the over 22 weeks assessment.
- An existing question 'Is she 22 weeks pregnant or more?' has replaced the previous question to assess gestation more accurately.
- Additional advice to ring 999 has also been added if bleeding becomes heavy.
Following stakeholder feedback, NHS Pathways were required to review the assessment for pregnant patients over 20 weeks gestation, with a focus on those who do not receive a Category 1 ambulance outcome for imminent birth or obstetric emergency
Ambulance Category Changes in Labour and Childbirth Pathways.
- A new question has been created 'Are any of the following happening?' to identify patients experiencing an urge to push or very frequent contractions, ensuring a Category 1 ambulance outcome where information provided suggests birth is imminent.
- If birth is not imminent, triage is based on gestation: Under 37 weeks: Category 2 ambulance outcome with follow-up call back advice. Over 37 weeks: Category 3 ambulance and new care advice.
- Patients reporting waters breaking or increasingly frequent contractions have their triage shortened and reach a 'Speak to Midwife or Labour Suite immediately' outcome for specialist advice.
- New care advice has been created to direct patients to call 999 if there is any bleeding or further signs of imminent birth.
NHS Pathways were required to make changes to the handling of repeat prescription requests to ensure patients are directed to the most appropriate service for their needs
Primary Care dispositions review within repeat prescription pathways.
- Repeat prescription requests are now clearly separated from medication enquiries and non-repeat prescription requests, supporting more accurate routing.
- Requests involving controlled medicines are now directed to a 'Speak to Primary Care' outcome, rather than to a pharmacy, to ensure the correct prescribing process is followed.
Continuing work completed in R47.2.0, NHS Pathways were required to make refinements to the triage process for the use of spare Adrenaline Auto-Injectors (AAIs) in schools
Amendments to the Adrenaline Auto-Injectors (AAI) school triage.
- Access to the school AAI triage has been focused to apply only when the reason for the call is a declared allergic reaction or anaphylaxis, ensuring the use of spare AAIs in school settings is aligned with appropriate clinical scenarios.
Following stakeholder feedback NHS Pathways were required to enhance clarity around the presentation of bulging membranes during labour
Question updates to include reference to bulging membranes/sac presentation during labour.
- Additional explanatory information has been added to the question asking if they can see the baby coming to ensure that callers with bulging membranes are guided to pick the 'seeing the baby' answer option. The updated guidance explains that this may appear as a 'sac' or 'balloon' at the entrance to the vagina and clarifies that this does not indicate the umbilical cord.
- Additionally, the care advice given when birth is imminent has been amended to ensure it is appropriate for occurrences of bulging membranes.
NHS Pathways have made several enhancements to the triage of patients with a tracheostomy or laryngectomy
Enhancement for management of ventilated patients.
- 1st party callers will no longer be asked a question about ventilator support.
- Additional care advice is now provided to manage ventilated patients.
- Triage and advice have been enhanced for 1st party callers who don't have an assistant with them. 1st/3rd party callers where there is no neck tube in place at the time of the call are now asked if they have been trained to use suction. If yes, they are provided with suction advice.
Following internal review, NHS Pathways have made changes to the existing triage for the identification of possible ischaemia and Deep Vein Thrombosis (DVT) in the limb pain or swelling pathways
Changes have been made to safely reduce Category 3 ambulance outcomes where appropriate.
- In the limb pain or swelling pathways, if the caller answers yes to the question 'Has a leg suddenly become cold, pale, blue or grey?' and the caller is not breathless, the 'Emergency Ambulance Response (Category 3)' outcome will now be replaced with 'Refer to Treatment Centre within 1 hour'.
- In the 'Arm Pain or Swelling' pathways, if the answer is yes to the question 'Has the whole arm suddenly become painful and swollen?' and the caller is not breathless, the 'Emergency Ambulance Response (Category 3)' outcome will now be replaced with 'Refer to Treatment Centre within 1 hour'.
Last edited: 27 June 2025 5:12 pm