Shocking toll of patients put at risk in hospitals
16 POTENTIALLY FATAL ‘NEVER EVENTS’ IN EIGHT MONTHS
SIXTEEN potentially deadly failures were reported inside Greater Manchester hospitals and health providers in just eight months, the M.E.N. has learned.
The failures – which happened between April and the end of November last year – are known as ‘never events,’ because they are considered so serious that they should never happen.
Manchester was recorded as the joint-seventh worst local authority in England for the events, which shouldn’t occur if the ‘available preventative measures have been implemented.’
Two incidents at Manchester University NHS Foundation Trust involved the misplacement of a tube running from a patient’s mouth or nose to the stomach, which can carry a risk of death or severe harm.
One of those included a misplaced nose to stomach tube at Wythenshawe Hospital’s Intensive Care Unit.
Other failures at the Trust included surgery performed on either the wrong patient or on the wrong part of the body, whilst the fourth incident involved a patient being given the wrong implant or prosthesis.
A spokesman for the Trust said: “Manchester University NHS Foundation Trust is a large complex organisation delivering care across a number of locations and offering a wide range of specialist services. We encourage a strong reporting culture and our incident reporting rate reflects a commitment to learning from incidents, with over 99 per cent of incidents reported being low or no harm.
“The Never Events reported have been investigated and the learning used to develop both our own safety programmes.”
An incident at Wrightington, Wigan and Leigh involved a patient being hooked up to an air flowmeter, when they actually required oxygen.
Two further failures involved involved surgery on the wrong area, while the fourth mistake was recorded as ‘retained foreign object post procedure.’
This includes items such as swabs, needles, instruments and guidewires, left inside the patient’s body after surgery or other medical procedures.
A spokesman from the Trust said: “We take all ‘never events’ extremely seriously and report them in line with the national requirements by NHS improvement. However, it would not be appropriate to comment on the four ‘never events’ that are stated in the report, as due to a small numbers, patients could be potentially idetinfiable.
“We would like to reassure patients and the public that immediate actions are taken to try and mitigate the risk of re-occurences of ‘never events.’
“Investigations commence, action plans are completed and lessons learned implemented.”
Two incidents at Bolton NHS Foundation Trust involved surgery being performed on the wrong patient or the wrong part of the body.
Bolton NHS Foundation Trust were contacted for comment.