NHS issues - urgent advice appreciated please.

[OldQueen1969]

Hi there all,

Would appreciate some advice for a friend of mine who is currently in hospital and seems to be at some risk from some sort of system cock up.

I'll start by saying this is not about bashing the frontline staff who are obviously doing their best under pressure and with poor resources.

So my friend L who I saw yesterday evening had the beginnings of a tooth abcess and planned on sorting it with the dentist today - he's had them before and knows the drill so to speak, and would have done the usual routine except by this morning his face had swelled dangerously and his eye was closing, so he rang 111 and they advised A&E.

He and my other friend M for support went to one A&E (we have two on opposite sides of our town) at around 1.00pm. After three hours there it was concluded that no-one there was insured to go near teeth so they had to drive across to the other where they have been since. The swelling has got worse and L is actually crying with pain (chap in his early 30s and not a wuss by any means).

It was decided he should be admitted as he now has a fever and high temperature, but they didn't have any male beds available for a while so they had to wait in A&E. No meds could be administered until he was admitted.

He has now been given a bed, but apparently he can't be given any meds because his admission is nit showing on the system yet and until this happens they can't prescribe etc because they need to know where to "bill the meds to". It's nothing to do with cross referencing for allergies or anything. I have asked all the logical things and M is messaging me as time goes on. They are both really worried as he is now "ill" with this infected abcess and treatment is being withheld, and his pain is unbearable.

A nurse tried to get a canula in in preparation, but that went wrong as the vein was missed and has caused further distress. I guess that happens but it's not helped the situation.

My main question is whether this system failure is a common thing? And what should they do now? L has been seen by doctors etc but all say no system confirmation, no meds. Surely that can't be right as he is getting visibly worse - I've seen pictures and he looks terrible.

Any advice / opinions gratefully received.

**'And might I doubt a dedicated, specialist 'pain team' will be funded to be on duty at 20:30?

Please be aware, that does not mean 'no pain relief', it means no individualised, specialised pain relief on a per-patient basis, available into the night?'**

Of course there is. What a silly thing to say.

That's good he has AB started, hope he feels better soon and his surgery goes smoothly. Dental abscesses can be a big deal, the pain can be excuriating and he will find it difficult eating so lots a nice puddings.

Miljea, this isn't an issue regarding funding. If it was it would be relatively easy to solve. There are massive issues regarding software used within the NHS.

Then you go on to describe how it might be an issue of funding...

NHS connectivity, at the level it needs to function doesn't require incredibly highly intelligent and skilled individuals for a niche project.

I am a luddite. But I can see how having, because of budgetary restraints the need to utilise 5 different systems to bring 5 things together for a patient- isn't efficient.

You need accountants, financiers and politicians to bring that all together -not super-natural coders. They're all in Dominic Cumming's Whitehall, anyway .

IV paracetamol on its way too. Antibiotics are IV, so hopefully relief is round the corner.

Thanks again everyone for all the input. Very eye-opening indeed and also thanks to all in the NHS who do their best despite everything else that actively seems to scupper their hard work. You guys are legends.

I'm NHS and work next to an MIU, I often take my patients round there for emergency antibiotics if they have an infection that does not require hospitalisation and they just give them to my patient.
I can't imagine A&E would refuse drugs if someone is showing signs of sepsis surely to God.
If that is the case your friend needs to put in the mother of all complaints.

He will have been seen by maxfacs if he has been admitted.

Regardless there's no reason why he wasn't given antibiotics and pain relief in the first A&E.

Yes dental issues are not often dealt with in A&E, however if he has a swelling that's severe enough to be admitted plus a fever then it would only take a call to the maxfacs team (which the first A&E will be able to do) to confirm he needs antibiotics, any doctor can see he needs analgesia

It isn't facial cellulite. Its a dental abscess. He doesn't need a referral to the pain team, the maxfacs team should prescribe pain relief.

He will be going to surgery for drainage of the abscess and removal of the tooth. Don't worry OP this is perfectly 'normal' course for someone who is admitted with a facial swelling. It's not major surgery, it's nothing to be worried about

In my hospital, it's easy to give emergency antibiotics, for instance, because we're old fashioned and still prescribe on a piece of paper/card. In the super modern hospitals it all has to be done on an electronic prescribing system. Which is apparently great...when it works...

Lotte the OP can't jump Up and Down because they're not actually at the hospital. They're at home, feeding back what 'M' is telling them.

Mummy, I can assure you there isn't 'a pain team' on a bleep outside office hours at the place I work. Mid size DGH. Leafy Hampshire.The isn't. However 'silly' that seems.

@madcatladyforever

Love your username by the way :)

Once L is sorted and the stress has died down I will be sitting down with them both to see if a complaint is in order, or even just feedback that may be helpful. It could be a one off glitch but if it's not then it needs addressing for cases that are potentially high risk.

Just cross posted. Glad it has been sorted!

We have this issue with the software in our hospital, however if necessary I would prescribe on paper while we waited. It's not fair on patients. There should be ways round the online system, and no one should deny a patient who is at risk of sepsis antibiotics.

There have been a good few threads with dental issues on here, it seems a really grey area in the UK.

I hope he gets antibiotics soon.
Tell your friend to hold up a sign saying SEPSIS in huge letters.

Ask to have it written down that he is requesting antibiotics also.

I hope he gets sorted soon..poor guy

'NHS connectivity, at the level it needs to function doesn't require incredibly highly intelligent and skilled individuals for a niche project.'

Facepalm That's precisely why the NHS relies on software that doesn't work, because people who have no experience of programming think you can take a regular group of software engineers even from some of the most prestigious universities and they should be able to create a system that works. Wrong. Half of them can't code to save their bloody lives. It is so much more complicated than you could ever imagine. The architecture the entire system depends on requires the most highly skilled, intelligent programmers who also specialise in programming architecture. It is not something that just anyone can do. There is not a shortage of funding to sort it out either. The funding is unfortunately going to people who don't have the technical capability to fix it.

I'm glad that your friend is now getting antibiotics and pain relief - hopefully he will be feeling better soon

I have had a tooth abscess when I was 15 and the only thing that truly relieved the pain was emergency dental treatment - they drilled up through the tooth and up to the jaw to allow all of the pus to drain out.

I don't know what your friend's situation regarding pain relief is - but sometimes it can be very complicated and requires a consultant to sign off - I cannot tolerate anti-inflammatories or synthetic opiods such as oxycontin so Ihave to have a medication assessment before anyone will give me anything.

Some people have narrow blood vessels and it can be very difficult to put a needle in correctly - my personal record is 7 attempts from a surgical anesthetist in the recovery room. The nurses were still laughing about that 6 months later when I went for a follow up surgery.

Hope your friend feels better soon - if there is a lot of pain he should definitely ask for extra pain relief.

I really hope your friend soon feels better

MummyFriend

Good coders and NHS??

Now where do you wan to start eh;?.

I could bore you all with the way NHS IT systems almost saw me into an early grave:(

Glad to hear the poor bloke is being treated. Wonder how long it would take to treat a senior manager or board director member?.

Lets not start eh;?.

@mummyfriend. Maybe you're being ironic. No hospital I know has a 24 hour pain team, I've worked front line for 20 years.

It is facial cellulitis as a consequence of spreading dental abscess; huge swelling, closed eye and pyrexia.
A very large proportion of emergency dental OOH patients attend with a Dental abscess; a very tiny proportion of whom will occasionally have facial cellulitis also and will need admittance to the nearest hospital with a OMFS unit for IV antibiotics, GA extraction of the offending tooth plus incision and drainage.
The management of this has not changed in many decades.

Iv never known of this...

In my hospital, treatment is always started as soon as they have a diagnosis... And sometimes, "just incase, while they wait" for bloods to.come back....

I don't know anything about electronic prescribing but it seems very unsafe if patients are not given any treatment because they don't have an electronic prescription chart. What about emergency care, fluids, antibiotics, insulin, blood products, cardiac meds, anti epileptic meds. Do they have separate sheets for nurse administration prescriptions so at least you can have paracetomol.

Morning all - once again many thanks for the support last night; it was very much appreciated.

L has gone to theatre and M said he managed to get some sleep and was feeling a tiny bit better, so fingers crossed he's well on the road to recovery.

@HappyHammy

This is my query too. Obviously I can understand and respect clinical decisions for the most part, but it really seems that this was entirely driven by a "system". The staff seemed to have their hands tied by this entirely and were otherwise trying to do their very best for L. This is the point that needs further examination IMHO.

Overall though, hopefully all's well that ends well.

@LotteLupin it's not nice but he won't die from a dental abscess! It's not a dire medical emergency.

I had this. Not as bad but I had to beg in tears for antibiotics. Disgraceful really.

@toddlerteaplease

I just did a quick google and it seems general consensus when an abcess gets to the point of fever, swelling etc is that it can possibly lead to sepsis if left untreated. I'm sure that generally you are right, but in a situation where it progresses rapidly such as L experienced, a delay in starting treatment might be dangerous, especially if you have been at the hospital for five hours and surgery is then required.

Again, not knocking anyone, just trying to establish best practice and whether things could / should have been done differently.

You can technically die from a dental abscess.

You aren't going to die from a regular abscess, however if that starts spreading to a large facial swelling theres a risk.

If it's under your jaw the swelling can spread and block the airway. A swelling in the upper face can spread backwards and risk cavernous sinus thrombosis

There is obviously the risk of sepsis. I work in maxfacs and I have known of patients who have died from sepsis due to a dental abscess. It is very rare, but it happens

Now I don't think your friend is at risk OP, so don't panic. But I just wanted to dispel any misinformation

@dishranawaywiththespoon

Thank you for the additional clarification - I certainly don't want to come across as paranoid or scare-mongering, and appreciate that such an outcome is rare.

L has had surgery this morning and three teeth have been removed so hopefully this will mean he can follow up appropriately and that the situation won't arise again.

I have to say the difficulties around getting dental treatment can put people off seeking treatment - local NHS dentists are horribly over-subscribed and sometimes even NHS charges are beyond the struggling. And trying to get an emergency dental appointment can be a nightmare. My MIL, when she lived with us due to Alzheimers had a broken tooth which needed urgent attention - her dementia meant she was very distressed and it had to be sorted as fast as possible. The only emergency dentist that would take her was way out of town, public transport was not an option. It cost around a hundred pounds in a taxi to do the round trip and the appointment cost around 20.00. Our fault for not having our own transport I suppose, but it was very stressful - and believe me I tried every other option first. We live in a big University town on the South coast. I found it very odd that the only emergency dentist was so very far away - 20 miles in fact - the very irregular buses take over an hour and would have been impossible with stressed MIL. Someone without our resources - which were still tight - would be in a terrible situation, yet we can't be the only people in this circumstance.