Patient discussions
Children and young people
Discuss potential long-term effects and likely patterns of recovery with the child or young person and their parents or carers; provide opportunities to discuss issues and ask questions.
Offer children and young people and their parents or carers information about and access to further care immediately after discharge. Provide contact details of patient support organisations including meningitis charities. Meningitis Research Foundation Opens in new window Meningitis Now Opens in new window
Consider their follow-up requirements, taking into account potential cognitive, neurological, developmental, orthopaedic, skin, hearing, psychosocial, education, and renal complications:[48][49]
Refer patients to psychological services for cognitive and psychological support if follow-up needs have been identified
Refer patients with skin and orthopaedic complications (e.g., amputation) to rehabilitation services for assessment as needed; coordinate management with tissue viability and community nursing services, and consider referral to psychological services
Offer an audiological assessment within 4 weeks of recovery
Refer patients taking anti-epileptic drugs for a medicines review 3 months after hospital discharge, with a clinician with an interest in epilepsy, an epilepsy specialist nurse, or a neurologist
Refer patients with cognitive, neurological or developmental complications for community neurodevelopmental follow-up
Arrange for a review with a paediatrician at 4-6 weeks after discharge from hospital. The review should cover:[48]
The results of their audiological assessment, and whether cochlear implants are needed
Damage to bones and joints
Skin complications (including scarring from necrosis)
Psychosocial problems
Neurological and developmental problems, in liaison with community child development services
For babies aged under 12 months, arrange a further paediatrician review for 1 year after discharge to assess for possible late-onset neurodevelopmental, orthopaedic, sensory and psychosocial complications.[48]
Community child development services should follow up and assess the risk of long-term neurodevelopmental complications for at least 2 years after discharge.[48]
Adults
Provide assessment and arrange follow-up according to regional guidelines on rehabilitation after critical illness for any patient treated in a critical care setting at any point during their illness.[49]
The UK National Institute for Health and Care Excellence (NICE) recommends taking into account potential cognitive, neurological, developmental, orthopaedic, skin, hearing, psychosocial, education, and renal complications:[48][49]
Refer patients to psychological services for cognitive and psychological support if follow-up needs have been identified
Refer patients with skin and orthopaedic complications (e.g., amputation) to rehabilitation services for assessment as needed; coordinate management with tissue viability and community nursing services, and consider referral to psychological services
Offer an audiological assessment within 4 weeks of recovery
patients found to have severe to profound deafness should be offered a ‘fast-track’ assessment for cochlear implant.[49]
Refer patients taking anti-epileptic drugs for a medicines review 3 months after hospital discharge, with a clinician with an interest in epilepsy, an epilepsy specialist nurse, or a neurologist.
Arrange for patients who have had confirmed or probable bacterial meningitis to be given a medical follow-up appointment within 4-6 weeks after discharge.[48][49]
Agree a rehabilitation plan with any patient with rehabilitation needs, and their family/carers.
Provide patients and their families with the contact details of support organisations. Meningitis Research Foundation Opens in new window Meningitis Now Opens in new window
Patients seen in hospital or the community and not admitted to hospital
If your initial assessment rules out any suspicion of meningococcal disease and you decide the patient can be managed in the community, ensure you give safety netting advice.
Encourage the parent/patient to trust their instincts and seek medical help again if the illness gets worse, even if this is shortly after the patient was seen.
Give advice on accessing further healthcare.
Provide information on symptoms of serious illness, including how to identify a non-blanching rash and the Tumbler test.[108]
Ask them to return for further assessment if they develop new symptoms, if a rash changes from blanching to non-blanching, or if existing symptoms get worse.[48]
Suggest follow-up within a specified period (usually 4-6 hours) if you consider this to be appropriate.[108] Use your clinical judgement.
Ensure the parent/patient understands how to get medical help after normal working hours.
Liaise directly with other healthcare professionals if you have concerns about a patient who is not being sent to hospital.
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