Serious incidents over medication errors in our hospitals are under investigation

PUBLISHED: 08:30 26 January 2019

Archant

Medication errors, delayed hospital admissions from the emergency department, and falls resulting in fractured bones are just some of the serious incidents recorded by the East and North Herts NHS Trust during a one-month period.

The trust, which runs Lister Hospital in Stevenage and the New QEII Hospital in Welwyn Garden City, recorded 12 serious incidents in November, according to its January board papers.

This compares to just six in October and one in September, and is more than double the target of five.

The NHS defines a serious incident as where a person “experiences serious or permanent harm”.

Recorded in November were three medication errors, two delayed transfers from the emergency department and one delayed radiology diagnostic.

Two patient falls were recorded as serious incidents because one resulted in facial fractures and the other in a fractured neck of the femur.

It was recorded that two patients developed hospital-acquired pressure ulcers, with one needing their toe amputated due to osteomyelitis. Pressure ulcers - or bedsores - are injuries to the skin and underlying tissue which usually affect people confined to a bed or chair, and can often be avoided by moving position regularly.

Other serious harm incidents included a patient’s deterioration and another patient’s treatment / pathway of care.

There was also one ‘never event’ recorded in November, when a patient was given a local anaesthetic injection to the wrong side of the body.

A ‘never event’ could cause serious harm or even death and is deemed by the NHS to be a largely preventable incident.

The trust said not all incidents reported in November occurred in that month and that they are still under investigation.

A spokesman said: “The trust has put a lot of focus on making it easier for staff to report incidents in a timely manner.

“It is important we learn from serious incidents so we can provide high quality and safe care for our patients.

“Every serious incident is investigated thoroughly and, once the investigation has concluded, an improvement plan is put in place and lessons learnt are shared with staff to reduce the likelihood of a similar incident happening again.”


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