Useless, useless useless NHS direct and OOH

[Flighttattendant]

I'm so cross and can't believe it.

Ds2 was a bit warm when he fell asleep at about 9pm. He woke just before 10 and was coughing and distressed - his temp was about 37.5. I gave him nurofen to help, couldn't find the calpol, and he just kept coughing. Temp went up to 38.3 so I rang the OOH at about 10.30.

The nurse rang back and asked the usual questions, by which time ds was finally back to sleep so she said ring back if he gets worse.
I didn't sleep but at 12.45 I took his temp again and it was 39.4. So I rang again and the doctor rang me. He said was he in a ventilated room - well it's a big room and not hot but the windows are painted shut. So the best we can do. He's only wearing a nappy.
Do we have a fan? No. So he said try fanning him with some newspaper or a bit of cardboard
and ring back in 40 minutes if no improvement.

I went and rang NHS direct instead. I got a very slow woman and she started off by telling me to stop using a flannel on him (it was hottish water, not cold - I was desperate) and not to bath him, not to do anything, not to take him outside.
Then we had the really long series of questions and at the end of it she said she had to speak to someone so can I hold. Five minutes later she comes back and says to wait till 2am for him to have some more nurofen.

I said that's not good enough, he'll have a convulsion if he gets any hotter. She said 'does he have convulsions?' I said 'Not yet no!'

That was that. Zero advice.
I took him out the front for a minute and he woke a little, and talked a bit, so we came in here and are now watching transformers.

He has had some calpol now (my having located it) and I am hoping he will be Ok.

But honestly I was just shocked at how useless their advice was.

Is there basically nothing you can do for a feverish child but give them some proprietary painkiller?

em.

you're expectations are unreasonable. 'that's not good enough' when told to wait to give him more nurofen is a ridiculous response.

he is feverish so keep him comfortably cool and give him calpol and nurofen (can combine the two and they work best if you stagger them).

unless he becomes more unwell, that's the only advice you should expect.

any fitting/jerky movements or a temp 40+, get prompt medical attention for him.

How old is he? I took my DS to the walk in with a temp of 39 and all they did was give him paracetamol and ibuprofen and fan him til the temp came down. My youngest gets a fever with every little bug and shoots up to 39/40, but they've never done anything, or advised anything, beyond that.

just noticed it's you, FA.

i work for NHS24 so get annoyed when people get frustrated with the system that we have to use for patient safety (ie the questions at the beginning- they are asked for good reason, even though you may find them frustrating).

i do think though that in the absence of other symptoms (vomiting/breathlessness/headache/rash etc) paracetemol, ibuprofen, plenty fluids and monitoring him is the best course of action.

a wet cloth to the forehead and/or back of neck works better than fanning by the way.

I don't think there's anything you can do except give him calpol r nurofen plus the wet cloth on forehead. If he's not presenting other symptoms...hope he's feeling better now.

With no other symptoms he should be fine (sorry forgot to add that). It's scary but they bounce back.

I don't think the expectations are unreasonable, tbh.

Her dc was hot, yet was told not to cool & him down & wait for next round of painkillers.

Crap advice! From Doctors & nurses! It isn't good enough when mums are worried about their babies/children.

Thankyou, guys. Blinks, I'm sorry, i was venting. I didn't actually say 'that's not good enough!' but I was thinking it. i was very polite and thanked her, then hung up and went and sat almost in tears.

It wasn't the questions she had to ask - I understand those are necessary. It was the fact she went through them all very slowly, asking me to repeat stuff, then came up with no advice at all.

You've just said that the flannel is a useable idea so why did she keep telling me to 'take the flannel off him now!'? I don't understand.

It was also mainly the doctor who said to use a bit of cardboard, that inspired me to think 'how useless' though. It would have saved time for him to say ;right, your child has a high fever, there is actually nothing you can do about it, I'm so sorry, hope he is better soon'.

and I suppose partly I was afraid, that because I couldn't find the calpol, I'd be stuck here, the late night pharmacy already closed, and a child about to explode because his temp was still going up.

I understand it isn't their fault, any of it, but surely there are some suggestions they could have offered - a few months ago I was told to bathe the child in warm water and now even that isn't allowed.

It made me feel totally helpless. That's all

He's still hot btw but seems a bit less so...thanks for asking.

I've had really bad advice on the two occasions that I rang NHS Direct. They were very nice and pleasant but the advice was terrible.
First time I rang them was when DS was 5 months old. He'd stopped breathing and it took me 1&1/2 mins to 'bring him back'. After I'd got him breathing again I shouted screamed for DH (I was downstairs with DS and DH was upstairs asleep as it was 5.30am). When DH came downstairs I passed DS to him as I was shaking that much and nearly hysterical. DH sat on the sofa with DS on his knee and DS seemed ok (was by this time sat on daddy's knee giggling!). As first time parents we didn't know what to do as his breathing was normal. I rang NHS Direct and was told if he's ok now not to do anything but monitor for next 30 mins! We had a hospital appt later that day at hospital (DS had been having seizures - which I had told NHS Direct about). The consultant said we should have called 999 regardless of how he was afterwards as babies must ALWAYS be assessed at that age!

Second time we called was when DS was 11 months old. He was really hot to touch but his temp was 35.2. I only called to ask if I took a layer off as he was hot to touch and sweating or if I put another layer on as temp was low. I made it very clear that I was not worried as, other than a mild cold, he was ok. After a 5-10 min hold wondering if she'd hung up I was told they were sending an ambulance!! I said I didn't think it warranted that but if necessary would take him to OOHs GP. At this point I was turned into a seriously worried mummy after being told he must get immediate attention as his temp was dangerously low and if he didn't get heat blankets applied within 15-20 mins he would, not may go into hyperthermic shock and a life-threatening coma!!! I was scared half to death. When we got to A&E we were told his temp was ok at 35.2 and he was in no danger (dr looked at us as if we were mad for taking him to hospital at all!).
After these horrendous experiences I would NEVER use or recommend using NHS Direct. If I needed advice I would prob come on here and ask other mums.

Sorry for very long post! Hope your DS is better soon - please keep us updated x

Your child won't have a convulsion just because he has a high temperature. You know that, don't you? It's just that your post makes it look like you think your child will automatically have a convulsion if the temp rises above a certain level. Or do you have some history of it with other children?

There's not much you can do with a temp except what they said and what everyone else has said.

Personally I wouldn't do anything except watch unless there was a lot of pain. Let the temp run its course unless it goes over 102, 103.

Back - yes, yes I do know that but because it appeared to be rising regardless of the nurofen I was not sure whether this would actually stop. And anything around 39 and a half really does worry me.

I was mainly trying to emphasise the point about it not seeming to be under control, and wanting her to reassure but she just ignored that point.

Bev - thankyou for sharing your stories, it sounds like you did have some pretty useless advice. I've also been told by one of the nurses in the past that I dfeinitely did NOT have so and so (which I suspected) and not to bother doing anything about it...that night was pretty awful and the next day I was diagnosed with something potentially life threatening that took about 5 months to get rid of...I did actually complain but they wriggled out of it and I was too stressed and ill to take it further at the time.

Basically trust your own instincts I think - the service they provide is necessarily limited and I think it is possibly something that started off as a great idea but is just not appropriate in some instances.

Again Blinks I hope not to have offended. As we both know sometimes their service is excellent.

Hi Flighty
I work for NHSdirect (previously 9 years A&E) and Im sure we don't get it right every time but I'm also sure from our feedback and from comments to me from callers that most times we do.
Regarding the temp not responding, it is terrifying for parents, its something I'm never happy with myself. Hopefully the situation has eased, but if I were you I'd get the windows sorted, a portable fan and a huge stock of brufen and calpol
We dont advise tepid bathing anymore because it brings the temp down very quick and then it rises quicky again. It is this rapid rise that causes febrile convulsions! A cool flannel on the forehead is cooling and comforting though.

Bev. I agree that was crap advice. In the first instance I would have called an ambulance for you. In the second (I recently had a similar call) I'd have said if he is responding normally, body feels warm, and no other worrying symptoms such as rash - it was probably that he had sweated a lot (had he had calpol/brufen?) in which case if he was lightly dressed the sweat would have cooled the skin superficially and temp read low. A low temp is not important unless there is genuine hypothermia or septic to the point of coma - something no one is going to miss

NHS Direct saved my life. I wasn't in a fit state to talk to them but my stepson did and despite protests from me between them they called an ambulance. I needed it - by the time it arrived I'd stopped breathing.

So have to say I'm impressed and have been the other times I've used them, when they helped me confirm that I didn't need to go to drs etc, just to home remedy, or that I did need to go.

I think I saved someones life yesterday. Her friend rang on her behalf from another address. I got her number, rang her, and she could barely speak - she managed to get out ' my lips are blue' . I called an ambulance immediately then spoke to her (she was alone) till the ambulance arrived (about 4 minutes so well done them!) as I could hear she was petrified. Couldnt believe she didn't call 999. She had asthma which is so nasty.
I spoke to an elderly man once (diabetic) whos toe was going black (over the course of a week) I assessed him and told him to go to gp next day. He said 'I just thought I'd check with you while im waiting for the ambulance to arrive!!!
There's nowt so queer as folk

I guess I just had really bad advice on those two occasions. You're right beammeupscottie after all you're only human and not being able to see the patient must make it so hard sometimes, hence the lengthy questioning (which I don't have a problem with). My DS had a vest and babygrow on when he had the low temp but hot to touch and sweaty. What you said makes sense about sweat cooling his temp. Like I said I wasn't at all concerned pre call as he was fine but I genuinely didn't know whether to go by temp or touch/sight and wanted advice as to whether to take layer of clothing off or another on. I wish I'd spoken to you that night as I would've been very happy with what you've said above. He had no rash etc (although wasn't asked on the night).
I know what you mean about asthma. I have acute brittle asthma which means I can go from ok to respiratory arrest in just 10 mins. Whenever I've been bad I never realised how bad it was each time and kept feeling annoyed at everyone for panicking! When an ambulance took me to hospital with blues & twos and when taken to A&E resus room or ITU I remember thinking what a waste of time but obviously needed it!
Have to say massive well done beammeupscotty sounds like you saved that person's life. It's people like you that make the NHS a wonderful service. Sure, NHS sometimes get it drastically wrong but more times than not they get it so right. I think the drs and nurses in NHS do such a fantastic job in such difficult conditions (under staffed, under paid, sometimes poor resources and very heavily criticised in the media). If it wasn't for people like beammeupscotty I wouldn't be here today, so on behalf of the British public; Thank you to all the great medical staff in the NHS - keep up the good work.

I hope my first post didn't come across like I was putting the whole NHS Direct down. Like I said I had two very bad experiences so wouldn't have ever used them again. However, after hearing from beammeupscotty I feel a little reassured and think I may well try them again if I needed OOHs advice. Hopefully 3rd time lucky!
Hope I didn't offend you or your colleagues beammeupscotty and thanks for clarifying what you would've said if you'd taken my call that night.

it's amazing some of the calls we get. in one week i personally have had people calling because (not including the usual high temperatures, vomiting and diarrhoea, flu etc) they've been-

bitten by a dog, found a lump, having a panic attack, suicidal, taken an overdose, choking, having a heart attack, needing information about medication, loneliness (an oh so common call), hearing voices, vomiting blood, reporting a death, in labour, having a miscarriage, having a mental breakdown, reporting a sexual assault, having a stroke, fallen and can't get up, sustained a serious head injury.

Bev
Thank you so much for your comments and compliments, we deal with around 30 calls a day and under our new system we have no script to follow if we are experienced (me -18 months)!. Luckily all my years of A&E experience stand me in good stead plus a big dollop of common sense! Because of cuts they are going to employ less experienced nurses as well, and non qualified staff will be giving scripted advice. We nurses are not happy about it, but its budget cuts, and time will tell

I'm with blinks, our calls are so varied, and I personally am scared stiff sometimes when I know that meningitis can strike so quickly and the first signs are no different than a viral illness. The responsibility is enormous but I know that even if we sent every feverish child to A&E immediately it would not necessarily be picked up, but would worsen within hours of getting home. I advise mums to check little ones all through the night especially if they have only just become unwell. Im much happier if theyve been unwell a day or so!

I've given plenty of free advice on this child health topic and so far my advice has been right, and its so nice to hear the outcome, as we dont usually!!

PS Know what you mean about bad asthma I once helped deal with a girl in resus who was navy blue, I think its taken a bit for granted as its so common!

PPS The childrens health site is a learning resource for me!!