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"Treatment after a dog bite"

About: Lanarkshire Community Services / GP Out of Hours service NHS 24 / NHS 24 (111 service)

(as a relative),

Late one Friday afternoon I needed to call NHS24 on behalf of my mum after she was bitten by her own dog on her hand which had broken the skin causing it to bleed. This had happened the night before. I managed to clean and dress the wound and contact her own GP practice to arrange for the nurse to see her in the treatment room to have this properly dressed along with a tetanus. This was all carried out in the community as she didn't require A/E or even minor injuries. 

The following day we required to contact NHS24 as it was now out of hours and heading into the weekend, the wound appeared inflamed and irritable and as per NICE guidance along with the local health board primary care antimicrobial guidance a 7-day course of Co-Amoxiclav should be issued. My call was answered after about 10-15 minutes which I think was really good given the ongoing pressures. I spoke to a lovely call handler who took my mum's details and a brief history of the presenting complaint. She then invited a clinical member of staff to join us. This is where our experience went downhill.

The majority of our family work in healthcare in acute care and emergency medicine and know the correct pathways to use and courses of treatment, however, obviously cannot prescribe for immediate family. I feel the triage by the member of clinical staff made things very difficult and they were asking my mother questions and wanted measurements of how red it was etc in terms of millimetres etc. Something that is really hard to describe over a phone. A video triage would have made this much easier. In my opinion, this is something that NHS24 should invest in as other primary and acute care services use to allow better and more effective triage. The clinical staff member was very insistent that my mother did not need antibiotics, which I disagreed with and believe goes against evidence-based practice and current guidance. They were willing after some further discussion to pass our call to the local hub for an OOH GP to call her.

After about 40 minutes Dr Dolan from OOH spoke to my mum and completely agreed with her that an antibiotic should be issued and was surprised that the clinitian stated it was not required. She was lovely to speak to and very professional. She immediately issued a script and faxed this to a local pharmacy of our choice. The script was then ready for collection in less than an hour which again was brilliant.

All in all the correct outcome was achieved in the end. However, we feel the clinitian at NHS24 issued the incorrect advice and I believe went against current guidance. This is something that could be looked at the ensure the animal and human bite algorithm has the NICE and primary care antibiotic guidance and when these should be issued. It would also be worth implementing enhanced video triage to ensure wounds etc can be looked at as this would ensure a better outcome for service users. My comment isn't a complaint but just one to use for future learning to enhance the service for other people.

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Responses

Response from Andrew Cassidy, Patient Experience Officer, Patient Experience, NHS 24 2 months ago
Andrew Cassidy
Patient Experience Officer, Patient Experience,
NHS 24

I manage Patient and Service User Feedback

Submitted on 21/09/2021 at 13:27
Published on Care Opinion at 13:27


picture of Andrew Cassidy

Dear Macca2021,

Thank you for sharing your story on Care Opinion. I was sorry to read of your mum's injury, and hope she is now recovering well. I am sorry that the service you received did not meet with your expectations.

I was pleased to read that the Call Handler was lovely, but I would be keen to carry out a review of your mum's care to establish if there is anything that we can learn from. To allow me to do this, I would be grateful if you would contact me directly with your mum's details; this will allow me to access her call record and request a review of the call. You can contact me at patient.experience@nhs24.scot.nhs.uk Please include your Care Opinion username in your email.

I was pleased to read that your mum received the medication she required from Dr Dolan from Out of Hours, and hope she is now recovering well after her injury.

I look forward to hearing from you.

Best wishes,

Andrew

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Response from Lesley Mallon, Patient Affairs Officer, NHS Lanarkshire Headquarters, NHS Lanarkshire 2 months ago
Lesley Mallon
Patient Affairs Officer, NHS Lanarkshire Headquarters,
NHS Lanarkshire
Submitted on 21/09/2021 at 16:54
Published on Care Opinion on 22/09/2021 at 11:36


picture of Lesley Mallon

Dear macca2021

Thank you very much for sharing your feedback in relation to your mum's recent contact with NHS24 and the Out of Hours Service, following an incident at home.

I see that my colleague from NHS24 has responded to your post and invited you to make contact with him. I hope that you feel able to do this in order that lessons can be learnt from your mum's experience.

Please be assured that I will share your lovely comments with Dr Dolan from the Out of Hours service and I hope that your mum is now feeling better.

Kind regards.

Lesley

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Response from Carmen Obre, Senior Nurse, Cambuslang/Rutherglen/ OOH, NHS Lanarkshire 2 months ago
Carmen Obre
Senior Nurse, Cambuslang/Rutherglen/ OOH,
NHS Lanarkshire
Submitted on 22/09/2021 at 12:29
Published on Care Opinion at 14:14


Dear macca2021,

Thank you so much for providing feedback on your mothers experience within our OOH service. I hope that she is recovering well from her injury. I will certainly pass on your comments to Dr Dolan within our OOH service.

regards

Carmen

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