Prevention of Future Deaths reports · 2015

Jean Hannon

Regulation 28 report to prevent future deaths, reference 2015-0458, written 30 Sep 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report30 Sep 2015
Reference2015-0458
DeceasedJean Hannon
CoronerMichael Singleton
Coroner areaBlackburn, Hyndburn and Ribble Valley
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedEast Lancashire Healthcare NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:
The Chief Executive Officer

East Lancashire Healthcare NHS Trust
Trust Headquarters

The Royal Blackburn Hospital
Haslingden Road
Blackburn BB2 3HH

CORONER

I am Michael Singleton, Senior Coroner for the Coroner area of Blackburn, Hyndburn
& Ribble Valley.

2 CORONER'S LEGAL POWERS
I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act
2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
3 INVESTIGATION and INQUEST

On the 23% December 2014 I commenced an Investigation into the death of Jean
Helen Hannon aged 75. The investigation concluded at the end of the Inquest
which was held on the 23 September 2015. The conclusion of the Inquest was
that Jean Helen Hannon died from a rare but recognised complication of surgical
treatment.

CIRCUMSTANCES OF THE DEATH

On the 27" August 2011 Jean Hannon who was suffering from altered sensations in
her hands due to degenerative changes in her cervical spine underwent a
laminectomy at the Royal Preston Hospital. As a consequence of the procedure
Jean Hannon became quadriplegic and developed autonomic dysreflexia.
Subsequently she had a number of admissions to the Royal Blackburn Hospital but

thediagnosis of autonomic dysreflexia was not sufficiently highlighted in the medical
record such that when she was admitted to the Royal Blackburn Hospital on the 19"
December 2014 with a history of not having opened her bowels for some 13 days
the consultant physician (was unaware of the previous diagnosis
of autonomic dysreflexia.

CORONER’S CONCERNS

During the course of the Inquest the evidence revealed matters giving arise to
concern. In my opinion there is a risk that further deaths will occur unless action is

taken. In the circumstances it is my duty to report to you the MATTER OF .
CONCERN is as follows: - H

That the medical records retained at the Royal Blackburn Hospital failed to
sufficiently highlight the previous diagnosis of a condition that is potentially life
threatening.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you
have the power to take such action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 25" November 2015. I, the Coroner, may extend this period.

Your response must contain details of action taken or proposed to be taken, setting
out the timetable for action. | Otherwise you must explain why no action is
proposed.

COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following interested
person, namely:

I am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary
form. He may send a copy of this report to any person who he believes may find it
useful or of interest. You may make representations to me, the Coroner, at the
time of your response, about the release or the publication of your response by the
Chief Coroner.

30 September 2015 Signed by: ™) aDeastbiiinscnsagesssssasbenscenasarsronces

H M Senior Coroner for Blackburn,
Hyndburn & Ribble Valley

i

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from East Lancashire Hospitals NHS Trust (PDF)
East Lancashire Hospitals INHS)

NHS Trust

Enquiries to PY Quality and Safety Unit
Telephone 01254 733361 Park View Offices
Ext 83361 Royal Blackburn Hospital
Fax Haslingden Road
Email Blackburn

BB2 3HH
24" November 2015
PRIVATE & CONFIDENTIAL
Mr MJH Singleton
HM Coroner

Fieldings/Porter Solicitors
7 Richmond Terrace
BLACKBURN

BB1 7BB

Dear Mr Singleton

Regulation 28 Report to Prevent Future Deaths: Jean Helen Hannon
(dated 30/9/15)

| am writing in response to the regulation 28 report received by East Lancs Hospitals
NHS Trust in relation to the above deceased patient, which was forwarded to me. A
review of Mrs Hannon’s medical records has been undertaken in light of your report,
this was conducted by Consultant Physician.

On review of the case-notes it is noted that Mrs Hannon had a spinal cord injury
following a laminectomy in 2011, following which she suffered with quadriplegia.

It is the belief of EE tht Jean Hannon did not have autonomic dysreflexia,
and that there is no substantiating evidence in the case-note to say that she did.

The only time autonomic dysreflexia was mentioned was during a case conference
on the 12" March 2012 where the family of Mrs Hannon were present and no
physician was present. At the case conference the condition was mentioned by Mrs
Hannon’s daughter where she asked what would be the implications on her mother's
care of autonomic dysreflexia. The documented agreed plan following the case
conference did not mention this condition, and nor does it appear in the records to
have been mentioned to the ward staff afterwards who would have been able to
discuss it in more detail. If this opportunity had arisen then the staff would have been
able to explain that there was no evidence of autonomic dysreflexia.

It is believed that Mrs Hannon suffered a condition more accurately termed
autonomic instability. Autonomic dysreflexia syndrome differs significantly from
autonomic instability, with this latter diagnosis being a common finding in patients
who have had spinal cord injury.

Safe Personal Effective

East Lancashire Hospitals INHS

NHS Trust

Dr Wilson has noted that Mrs Hannon’s GP does not reference the condition as a
past medical history during admissions to Royal Blackburn Hospital and so adding to
our view that this was not a confirmed and actual working diagnosis.

Of greater concern to us is the issue relating to the capture of chronic and on-going
conditions for patients presenting urgently to our services. In order that clinical staff
treating patients are fully aware of such conditions we have we have undertaken a
number of actions:

1. The Trust now has access to a case summary from the patients GP notes via
an electronic system called ‘EMIS web’. This means that a printed summary
of the case record is included as part of the patients case notes for every
urgent and emergency admission. For planned admissions this information is
gathered during the pre-admission processes. These arrangements have now
been in place since April 2015.

2, ii a consultant geriatrician, is piloting the use of daily problem lists
as a technique for documenting on-going concerns during ward rounds and
daily assessments. This has been used in other hospitals specifically to
address the issue of relevant clinical information not being passed on. This is
currently in the pilot phase and will be rolled out to other areas after
evaluation.

| hope that this clarifies the clinical confusion and also our response to the wider
issue of the capture of important clinical information. If you feel that there is anything
more we can do in this instance then please do not hesitate to get in touch with me.

Kind regards.

Yours sincerely

Deputy Medical Director (Quality, Safety and Workforce
Development/Education)
Consultant Anaesthetics and Critical Care Medicine

Safe Personal Effective

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