Title: MIU Meningococcal Disease and Bacterial Meningitis, management of. Services/Nurse Consultant Emergency Care

Transcription

1 Title: MIU Ref No: 1961 Version 2 Document Author: Ratified by: Senior Manager MIU Services/Nurse Consultant Emergency Care Care & Clinical Policies Group Meeting Clinical Director of Pharmacy Date 18 October 2017 Date: 18 October December 2017 Review date: 5 January 2021 Links to policies: 1. Purpose of this document - This clinical protocol provides a clear framework for nurses/paramedics employed by Torbay & South Devon NHS Foundation Trust when providing care to patients presenting at Minor injury Units with suspected meningococcal disease and bacterial meningitis. 2. Scope of the Policy: This protocol is for the use by Minor Injury Unit staff employed by Torbay and South Devon NHS Foundation Trust who has achieved the agreed Trust clinical competencies to work under this protocol Refer all patients with suspected meningococcal disease or bacterial meningitis via (9)999 ambulance immediately - do not delay transfer to carry out treatments etc. 3. Assessment 3.1. Presenting signs and symptoms; may include some of the following; NICE guidance: Bacterial meningitis and meningococcal septicaemia (2010 updated 2015 (Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management) Collated by Clinical Effectiveness Version 2 (January 2018) Page 1 of 6

2 Symptom/Sign Bacterial Meningitis (meningococcal meningitis and/or meningococcal septicaemia) Meningococcal disease (meningococcal meningitis and/or meningococcal septicaemia) Meningococcal septicaemia Common non- specific symptoms/signs Fever Vomiting/nausea Lethargy Irritable/unsettled Ill appearance Refusing food/drink Headache Muscle ache/joint pain Respiratory symptoms/signs or breathing difficulty Less common nonspecific symptoms/signs Chills/shivering Diarrhoea, abdominal pain/distension Sore throat/coryza or other ear, nose and throat signs/symptoms More specific Symptoms/signs Non- Blanching rash Last Review Date October 2017 Version 2 (January 2018) Page 2 of 6

3 Stiff neck Altered mental state Capillary Refill time more than 2 seconds Unusual skin colour Shock Hypotension Leg pain Cold hands/feet Back rigidity Bulging fontanelle Photophobia X Kernig s sign X Brudzinski s sign X Unconscious Toxic/moribund state Paresis X Focal neurological deficit including cranial nerve involvement and abnormal pupils X Seizures x Signs of shock * Capillary refill more than * Respiratory symptoms/ * Toxic/moribund state 2 seconds breathing difficulties * Altered mental state/decreased * Unusual skin colour * Leg Pain conscious level * Tachycardia and/or * Cold hands /feet * Poor urine output Hypotension symptoms/signs present x symptoms/signs not present Last Review Date October 2017 Version 2 (January 2018) Page 3 of 6

4 : not known if a symptom/sign is present (not reported in the evidence NB Microbiologists report that there have been several confirmed cases of meningococcal septicaemia where the rash has NOT been a typical non-blanching rash: ANY rash with other symptoms should be treated with suspicion 3.2 History: refer to protocol for History taking and Clinical Documentation Specific History; History of feeling generally unwell over the last few hours/days (flu like symptoms) May have a history of rapid onset of serious illness Headache, photophobia, vomiting Joint pain Pyrexia not controlled with antipyretics Recent Contact with case of meningococcal disease Past medical History, Medications & Allergies NB Be aware that children and young people with bacterial meningitis commonly present with non- specific symptoms and signs including fever, vomiting, irritability and upper respiratory tract symptoms. Some children with bacterial meningitis present with seizures. 4. Clinical Examination: 4.1. Look /palpate General appearance: pallor, malaise Cold extremities (particularly lower legs/feet in children) Non Blanching or blanching rash (NB visual check to include all areas of the body e.g. sacral area, soles of feet) Neck stiffness 4.2. Investigations Recording of Vital Signs Temperature, Pulse, Respiratory Rate, Oxygen Saturation level Blood pressure (NB pre- terminal in babies/young children) Glasgow Coma Score Capillary refill Blood glucose 5. Initial management & Referral 5.1 Suspected Meningococcal Disease (septicaemia & meningitis) and bacterial meningitis DIAL 999 ambulance for transfer to Emergency Department IMMEDIATELY all actions taken must not delay transfer For Suspected meningococcal disease (meningococcal meningitis or septicaemia with non- blanching rash) give intramuscular or Intravenous Benzyl penicillin as per Patient Group Direction (PGD) unless there is a known previous history of anaphylaxis from penicillin or cephalosporin s antibiotics. NB : a history of a rash following penicillin is not a contraindication. Last Review Date October 2017 Version 2 (January 2018) Page 4 of 6

5 For Suspected Bacterial meningitis without non- blanching rash give benzyl penicillin as per PGD if waiting/ delay in ambulance transfer. If Benzyl penicillin is contraindicated, emergency transfer to the Emergency department is of paramount importance. Without causing delay in treatment seek advice form the either from the emergency department consultant, on call paediatric consultant or microbiologist as to alternate antibiotic option. Administer high flow oxygen via reservoir bag Establish IV access if competent and time to do so. Continue to monitor patient closely until transfer. Contact Emergency Department to advise them of patient s imminent arrival. For children contact the paediatric team on call. 6. Documentation 6.1. Clinical records must be written in accordance with Torbay and South Devon NHS Foundation Trust History Taking and Clinical Documentation protocol and the Nursing & Midwifery Council standards and record keeping or relevant registering body e.g. Health & care professional Council (HCPC) record keeping guidance A summary letter of the MIU attendance and the care delivered must also be sent to the General practitioner and also the health visitor if less than 5yrs or school nurse if aged between 5yrs and 16yrs to ensure the central medical record of the patient is accurate For patients being transferred to the Emergency Department, ensure records are completed in a timely manner on shared symphony IT system. A summary letter will be sent to the General practitioner in the normal manner For patients seeing the General practitioner or specialist within the next 24 hours ensure the patient has a copy of the attendance record to take with them. A copy will be sent to the General practitioner in the normal manner. 7. Discharge information 7.1 Ensure those patients who have been referred for further acute intervention has appropriate transport to meet their needs, all relevant treatment has been prescribed and/or administered and correct information & documentation is given to the patient. 7.2 The patient /carer understand that if the condition deteriorates or they have any further concerns to seek medical advice. 7.3 The patient and /or carer demonstrate understanding of advice given during consultation. 7.4 The patient/carer has been provided with written advice leaflet to reinforce advice given during consultation. 7.5 The patient/carer demonstrates and understanding of how to manage. Last Review Date October 2017 Version 2 (January 2018) Page 5 of 6

6 8. Training and implementation: MIU Network meeting Cascade. All staff adhering to protocols must have agreed training and proven competence to work within protocol. Each protocol must be agreed and signed by line manager. 9. Monitoring tool _ Regular review of clinical practice to ensure individuals are adhering to clinical protocol. 10. References British National Formulary 2017 South & West Devon Formulary NICE CG102 Meningitis(bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management - updated Amendment History Issue Status Date Reason for Change Authorised 1 Created February 2013 Merger of Torbay Care Trust and NHS Devon Clinical protocol for meningitis 1.1 Reviewed August 2015 Protocol reviewed. no new clinical updates Documentation/discharge amended to reflect new Symphony IT system 2 Revised 5 January 2018 Trust name Nice Guidance update (CG102) signs and symptoms, administration of benzyl penicillin 2 12 February 2018 Review date extended from 2 years to 3 years Senior Manager MIU Services/Nurse Consultant Emergency Care Senior Manager MIU Services/Nurse Consultant Emergency Care Care and Clinical Policies Group Clinical Director of Pharmacy Last Review Date October 2017 Version 2 (January 2018) Page 6 of 6

7 The Mental Capacity Act 2005 The Mental Capacity Act provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they lack capacity in the future. It sets out who can take decisions, in which situations, and how they should go about this. It covers a wide range of decision making from health and welfare decisions to finance and property decisions Enshrined in the Mental Capacity Act is the principle that people must be assumed to have capacity unless it is established that they do not. This is an important aspect of law that all health and social care practitioners must implement when proposing to undertake any act in connection with care and treatment that requires consent. In circumstances where there is an element of doubt about a person s ability to make a decision due to an impairment of or disturbance in the functioning of the mind or brain the practitioner must implement the Mental Capacity Act. The legal framework provided by the Mental Capacity Act 2005 is supported by a Code of Practice, which provides guidance and information about how the Act works in practice. The Code of Practice has statutory force which means that health and social care practitioners have a legal duty to have regard to it when working with or caring for adults who may lack capacity to make decisions for themselves. The Act is intended to assist and support people who may lack capacity and to discourage anyone who is involved in caring for someone who lacks capacity from being overly restrictive or controlling. It aims to balance an individual s right to make decisions for themselves with their right to be protected from harm if they lack the capacity to make decisions to protect themselves. (3) All Trust workers can access the Code of Practice, Mental Capacity Act 2005 Policy, Mental Capacity Act 2005 Practice Guidance, information booklets and all assessment, checklists and Independent Mental Capacity Advocate referral forms on icare Infection Control All staff will have access to Infection Control Policies and comply with the standards within them in the work place. All staff will attend Infection Control Training annually as part of their mandatory training programme. Collated by Clinical Effectiveness Version 2 (January 2018) The Mental Capacity Act Page 1 of 1

8 Rapid (E)quality Impact Assessment (EqIA) (for use when writing policies) Policy Title (and number) Version and Date Policy Author An (e)quality impact assessment is a process designed to ensure that policies do not discriminate or disadvantage people whilst advancing equality. Consider the nature and extent of the impact, not the number of people affected. Who may be affected by this document? Patients/ Service Users Staff Other, please state Could the policy treat people from protected groups less favorably than the general population? PLEASE NOTE: Any Yes answers may trigger a full EIA and must be referred to the equality leads below Age Yes No Gender Reassignment Yes No Sexual Orientation Yes No Race Yes No Disability Yes No Religion/Belief (non) Yes No Gender Yes No Pregnancy/Maternity Yes No Marriage/ Civil Partnership Yes No Is it likely that the policy could affect particular Inclusion Health groups less favourably than Yes No the general population? (substance misuse; teenage mums; carers 1 ; travellers 2 ; homeless 3 ; convictions; social isolation 4 ; refugees) Please provide details for each protected group where you have indicated Yes. VISION AND VALUES: Policies must aim to remove unintentional barriers and promote inclusion Is inclusive language 5 used throughout? Yes No NA Are the services outlined in the policy fully accessible 6? Yes No NA Does the policy encourage individualised and person-centred care? Yes No NA Could there be an adverse impact on an individual s independence or autonomy 7? Yes No NA EXTERNAL FACTORS Is the policy a result of national legislation which cannot be modified in any way? Yes No What is the reason for writing this policy? (Is it a result in a change of legislation/ national research?) Who was consulted when drafting this policy? Patients/ Service Users Trade Unions Protected Groups (including Trust Equality Groups) Staff General Public Other, please state What were the recommendations/suggestions? Does this document require a service redesign or substantial amendments to an existing Yes No process? PLEASE NOTE: Yes may trigger a full EIA, please refer to the equality leads below ACTION PLAN: Please list all actions identified to address any impacts Action Person responsible Completion date AUTHORISATION: By signing below, I confirm that the named person responsible above is aware of the actions assigned to them Name of person completing the form Signature Validated by (line manager) Signature Please contact the Equalities team for guidance: For South Devon & Torbay CCG, please call or marisa.cockfield@nhs.net Collated by Clinical Effectiveness Version 2 (January 2018) Rapid (E)quality Impact Assessment Page 1 of 2

9 For Torbay and South Devon NHS Trusts, please call or This form should be published with the policy and a signed copy sent to your relevant organisation. 1 Consider any additional needs of carers/ parents/ advocates etc, in addition to the service user 2 Travelers may not be registered with a GP - consider how they may access/ be aware of services available to them 3 Consider any provisions for those with no fixed abode, particularly relating to impact on discharge 4 Consider how someone will be aware of (or access) a service if socially or geographically isolated 5 Language must be relevant and appropriate, for example referring to partners, not husbands or wives 6 Consider both physical access to services and how information/ communication in available in an accessible format 7 Example: a telephone-based service may discriminate against people who are d/deaf. Whilst someone may be able to act on their behalf, this does not promote independence or autonomy Collated by Clinical Effectiveness Version 2 (January 2018) Rapid (E)quality Impact Assessment Page 2 of 2

10 Clinical and Non-Clinical Policies New Data Protection Regulation (NDPR) Torbay and South Devon NHS Foundation Trust (TSDFT) has a commitment to ensure that all policies and procedures developed act in accordance with all relevant data protection regulations and guidance. This policy has been designed with the EU New Data Protection Regulation (NDPR) in mind and therefore provides the reader with assurance of effective information governance practice. NDPR intends to strengthen and unify data protection for all persons; consequently, the rights of individuals have changed. It is assured that these rights have been considered throughout the development of this policy. Furthermore, NDPR requires that the Trust is open and transparent with its personal identifiable processing activities and this has a considerable effect on the way TSDFT holds, uses, and shares personal identifiable data. The most effective way of being open is through data mapping. Data mapping for NDPR was initially undertaken in November 2017 and must be completed on a triannual (every 3 years) basis to maintain compliance. This policy supports the data mapping requirement of the NDPR. For more information: Contact the Data Access and Disclosure Office on dataprotection.tsdft@nhs.net, See TSDFT s Data Protection & Access Policy, Visit our GDPR page on ICON. Collated by Clinical Effectiveness Version 2 (January 2018) New Data Protection Regulation (NDRP) Page 1 of 1