"Treatment after a dog bite"

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.