Northdoc provides doctors for D Doc, the out of hours GP care or surgery for patients in North Dublin with urgent medical problems who need to contact a doctor after GP surgeries close. The service operates from 1800hrs through 0800hrs Monday to Friday and 24hours Saturday, Sunday and all bank and public holidays. For appointment call 1850 22 44 77.
It is recommended that all patients requesting alcohol detoxification be referred back to their own GP. The main reason for avoiding doing alcohol detoxification in an out of hours setting is being unfamiliar with the patient. Does he/she live alone and are they truly motivated to stop? If they are not motivated, taking benzodiazepines on top of alcohol and possibly other drugs could lead to overdose and death. Even if they are properly motivated, there should be one other responsible adult supervising the detox who can call for help if there are any seizures etc. Only the patient’s own GP would be sufficiently familiar with the patient’s circumstances to initiate treatment.
Geographical area
The main geographical area to benefit must be within the area covered by Northdoc.
Aim
It must be related to improving the health of specific groups or assisting a group at a particular disadvantage, be this to fund awareness of a condition, a screening programme, education of HCPs, equipment, patient education or support services.
Current status
Indicate if your project is a currently running or a new start. If it is currently running, please outline what it already does.
Significant potential benefit
Your application must describe the issue you wish to address, the new service or practice that you wish to introduce and why you believe that it has the potential to address the issue. You must also describe the anticipated improvements in people’s health or wellbeing that you believe can be delivered by the new service or practice that you wish to introduce.
Robust approach to evaluation
Your application must describe how the anticipated benefits of the project will be measured and evaluated, including how you will demonstrate that the anticipated benefits are attributable to the work of the project. You must also describe how the evaluation will support you to reflect on progress during the work of the project.
Effective plans for delivering the project
Your application must provide evidence of high-quality planning, designed for effective and efficient delivery within clearly understood timescales.
Value for money
Your application must clearly set out what funding you are seeking from us and describe what other sources of funding you are seeking to secure [i.e. who are Northdoc in partnership with on this funding]. If we are a part funder of your work, what is the percentage of total budget that we are funding? If you are not seeking other sources of funding your application must set out why you believe we should be the sole funder of your work.
Time frame:
Your application must state if you will need funding for more than 1 year and if you intend to apply to Northdoc for continued funding after that period. It is easier for Northdoc to assist with initial capital outlays, rather than ongoing running costs.
Exclusions
This donation should not go towards funding what would be considered to be the normal operating expenses.
The donation cannot go towards funding a project already completed i.e. a debt
Ethical Responsibilities of Northdoc:
This donation is made on the understanding that Northdoc shall not seek to influence or gain reward for itself by making this donation. Northdoc respects the independence of the organization receiving the donation and shall not impose further conditions on the recipient after the donation is made.
Indemnity
You indemnify Northdoc and its board for an eventuality that may occur in the using of the grant.
Issue By the board of Northdoc Medical Services 25 March 2015
for PDF version click here -> Northdoc charitable funding policy and criteria
Guideline for rest breaks for GPs in D Doc GP Out of Hours |
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| Session duration | Break | Guidance | |
| 4 or 5 hours | 15 Minute break | if you taking a break be sure and let the receptionist know | |
| 6 Hours | 30 Minutes of breaks | (can be two of 15 minutes duration) If a break takes place in the last hour of the session it should be only of 15 minutes duration | |
| 8 Hours or 10 hours | two 30 minute breaks | Two non-consecutive 30 minutes breaks – none should take place in first and last hour | |
Dentistry makes up a very small component of our undergraduate training, yet, we often see common dental problems in general practice. Patients often present to the OOH setting as they cannot access a dentist out of hours. Below is a guide to management of the commoner presentations. We should always advise the patient that we are not dentists and encourage them to seek dental advice as soon as possible.
Many patients take drugs which may theoretically compromise oral haemostasis, but in practice, haemostasis can usually be achieved by following the advice above. Patients on dual antiplatelet therapy should not have these drugs ceased for invasive dental surgery.
Patients on aspirin and NSAID drugs can safely undergo minor, routine outpatient procedures without modifying their platelet altering medication.
The management of dental patients taking warfarin has changed in recent years. Patients on Warfarin who have teeth extracted in hospital and whose INR is < 4 do not have clinically significant bleeds. Complications resulting from cessation of anticoagulation therapy may be greater than the small risk of postoperative haemorrhage.
References:
Dental Hospital out-of-hours service
Ask the patient to call 6127200 and leave a message on the answering machine with contact details etc. An on call dentist will ring them back between 9am and 11pm S/S/BH and arrange to see them. This service is free to medical card holders and costs 100 euros for everyone else.
Table 1: Tooth Ache please click here
Table 2: Traumatic tooth avulsion please click here
Northdoc can be contacted by email, fax or telephone (See below).
Our office address is:
Northdoc Medical Services Ltd
Unit 211 The Capel Building
St Mary’s Abbey
Dublin 7
If you would like to get in touch with us after using our service you can email us at info@northdoc.ie during normal office hours or call 01 8727438 or you can fax us at 01 8726954.
IMPORTANT if you are looking for a doctors appointment please use the 1850 22 44 77 number. Our admin office has no way of making daytime appointments for patients.
Our admin office does not respond outside normal daytime working hours.
general Practice algorithm for Emerging Viral Threats: Avian influenza, MERS-CoV, Viral Haemorrhagic FeversEmerging Viral Threats: Avian influenza, MERS-CoV, Viral Haemorrhagic Fevers:
The Health Protection Surveillance Centre (HPSC) contains useful up-to-date information on Ebola. The full list of advice on managing Ebola for General Practitioners is located on the HPSC website.
This link has three documents of particular relevance to GPs that would be advisable to read, print off and keep with your PPE packs so that everything you need is assembled should they be required.
1. Fact sheet on the three emerging viral threats Ebola, MERS CoV and avian flu A (H7N9). 2. GP assessment algorithm. 3. Frequently asked questions for health professionals.
GP surgeries and Out of Hours Centres can telephone triage suspected cases using the following questions:
The following questions help decide if the patient had significant exposure to Ebola.
Has the patient:
If you feel there is a high risk of Ebola then the patient should be advised to remain at home and to isolate themselves from others pending assessment. The GP can then contact their local Emergency department triage at their nearest designated hospital to inform them that they have a suspected patient with Ebola and make appropriate arrangements for the patient to be medically assessed in hospital.
The GP can also contact their local public health department hot line numbers for further advice if required at:01-635 2145 or 021-420 9848
If you are interested in further information an overview of Ebola specifically for health care workers can be found on YouTube.
Appropriate Antibiotic Prescribing
Antibiotic prescribing in pregnancy
Antibiotic prescribing in suspected Meningococcal Disease
A Guide to Antibiotic prescribing in DDoc
For more information from “Guidelines For Antimicrobial Prescribing In Primary Care In Ireland” please click here.
In pregnancy, avoid tetracyclines, aminoglycosides, quinolones and high dose metronidazole.
In particular, avoid trimethoprim in the first trimester (folate antagonist) and nitrofurantoin use at term (risk of neonatal haemolysis).
Give i/m or i/v benzylpenicillen:
1200mg for over ten years of age.
600mg for children aged 1-9 years
300mg for children under one year
For those allergic to Penicillen
Cefotaxime for an adult by slow push i/v to maximum of 2grams.
For children cefotaxime 75mg/kg
If intramuscular injection preferred, use ceftriaxone (Rocephin).
The following infections show little or no benefit from antibiotics:
Sore throat – Majority are viral, pain will last for 8 days on average and good quality pain relief is the best treatment. Even with streptococcal infection, penicillin will only make the patient better 8 hours faster than without the antibiotic.
Otitis media – Doctors need to treat 20 children>2 years of age and 6 children <2 years to make one child better in 24 hours. Antibiotics do not decrease pain, protect against deafness or future recurrences. Most resolve in four days and a deferred antibiotic script is reasonable even in the under twos. Suppuration and bilateral otitis media may lower your threshold for an antibiotic. Sinusitis – 69% get better without an antibiotic and 84% get better with an antibiotic.
Bronchitis – Cough with sputum when auscultation of the chest is clear is usually acute viral bronchitis. Antibiotics have little or no value unless your patient has a pre-existing chest condition like emphysema etc. Cough with sputum may be an exacerbation of asthma and commencing or increasing inhalers may be the best option.
Conjunctivitis – Antibiotic treatment for conjunctivitis has a number needed to treat (nnt) of 13. Most patients recover by day 7 whether they get antibiotics or not.
Doctors know many infections are viral. The dilemma is how do you communicate this to a patient you have never seen before without appearing to minimize their suffering.
Prescribing an antibiotic suggests the doctor has made a definitive diagnosis, has communicated he/she understands how sick the patient is and has done something decisive about it. You need to consider reproducing this when you decide not to prescribe an antibiotic.
Consider deferred prescribing.
In each Centre and car there is a Mims and an Irish National Formulary to advice on appropriate antibiotics and dosages for various infections.
Things to remember on your shift
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The D Doc doctor is responsible for CONFIRMATION rather than the “certification” of death.
The patient’s own GP is responsible for CERTIFICATION of death except where the death is reportable to the Coroner.
The doctor on call does not have to contact the coroner in the event of an expected death. That is the responsibility of the patient’s own GP, or the nursing staff, if the deceased resided in a nursing home. Once you have confirmed death, the relatives can contact the funeral directors.
If you are called upon to confirm a sudden death, try not to disturb the scene, i.e. don’t touch, move or disturb anything. You must contact the Gardaí in the following circumstances:
When you suspect the death was sudden, unexpected or unexplained e.g. suicide, violent death, road traffic accident, sudden infant death syndrome, drug overdose or death in the workplace, there is no need for you to contact the Coroner directly as this will be done by the Gardaí. The Gardaí will, where appropriate, arrange for transfer of the deceased to the city morgue.
The response time of the car doctor to arrive for pronouncement of death is very important to relatives who have just been bereaved. Please try to attend as soon as possible.
Disposal of sharps
It is the duty of the doctor who opens any sharps materials to dispose of it correctly bearing in mind the safety of patients and our medical and nursing colleagues. At the end of each shift the doctors’ bag or Centre desk should be checked for sharps and disposed of by the duty Doctor. Doctors need to be careful with the safe disposal of sharps. There is always a sharps bin in the car.
All Doctors should ensure that they have had full hepatitis B vaccination and that Antibody levels are > 100miU/ml.
Needle stick injury is not the only risk of blood born infection.
Mucocutaneous exposure to blood i.e. splashes of blood on the lips, mouth, eyes, extensive splashing of blood on intact skin and human bites, in which the skin is breached, should also be treated as a risk of blood born infection.
Immediate actions
In case of needle stick injury, encourage puncture site to bleed freely by squeezing gently under warm running water.
Wash with soap and warm water and cover with waterproof dressing.
Splashes to the eyes should be irrigated copiously with sterile normal saline.
Splashes to lips/mouth should be rinsed thoroughly with warm water – remember not to swallow water.
Report the incident to the D doc supervisor 1850 2244 77.
Complete an incident report form available from the receptionist. Record details about the sharp or needle; whether there is visible blood contamination; the depth and location of injury; where and for what purpose the needle was used. If the source patient is identifiable, record their details.
Management of the injured person
Best advice is that the injured person report to the closest A&E Department, where the on-call medical team will assess the risk and manage as appropriate.