Wrong device was fitted among 117 ‘serious’ incidents
Falls, inserting the wrong medical devices and delayed diagnoses are some of the serious incidents which took place at hospitals in west Kent.
Maidstone and the Tunbridge Wells hospitals reported 117 ‘serious untoward incidents’ (SUIs) in 2014-2015 to the National Patient Safety Agency.
SUIs include acts or omissions in care resulting in unexpected or avoidable death or injury, or incidents preventing the delivery of an acceptable quality of care.
Of the 117 two were ‘never events’ – described as serious, wholly preventable situations which should never occur.
These were the wrong insertion of a chest drain and the fitting of an incorrect prosthesis/implant.
There were 45 falls resulting in serious injury, 22 delayed diagnoses, nine allegations against healthcare professionals and three cases of MRSA.
The trust reported four other cases which relating to choking and incorrect diagnosis.
There was one unexpected inpatient death and one child death.
To put the figures in context, from April 2014-March 2015 more than 44,000 people had planned procedures in Maidstone and Tunbridge Wells Hospitals.
More than 47,000 were separately admitted in an emergency and 130,000 people were seen in A&E.
A trust spokesman said while the number of incidents is low compared to patient nunmbers, each report is taken seriously.
Avey Bhatia, chief nurse at Maidstone and Tunbridge Wells NHS Trust, said: “We believe our hospitals are inherently safe places and we are making them safer still by being open and transparent about instances which we can learn and improve upon.
“Responding appropriately and learning lessons when they happen is the key to continually improving our services.
“We have robust systems for identifying and reporting incidents when they occur.
“They all undergo a thorough investigation to identify why the incidents happened and what lessons can be learnt.
“The executive level scrutiny ensures the lessons identified are disseminated throughout the organisation.”
Improvements made already include better handling of confidential documents and introducing new sepsis screening tools in A&E.
A report showed there were 397 SUIs across Kent, of which six were never events.
Darent Valley Hospital in Dartford recorded the most, with 120 serious incidents.