Prevention of Future Deaths reports · 2017

Carol Harvey

Regulation 28 report to prevent future deaths, reference 2017-0059, written 10 Mar 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report10 Mar 2017
Reference2017-0059
DeceasedCarol Harvey
CoronerJohn Gittens
Coroner areaNorth Wales (East and Central)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
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.

John Adrian Gittins
Senior Coroner for North Wales (East and Central)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: BCUHB, Ysbyty Gwynedd, Penrhosgarnedd, Bangor,
Gwynedd LL57 2PW

CORONER

lam John Adrian Gittins, Senior Coroner for North Wales (East and Central)

CORONER’S LEGAL POWERS

| 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.

INVESTIGATION and INQUEST

On 12/04/2016 | commenced an investigation into the death of Carol Ann Harvey, (DOB 6.4.42
DOD 9.4.16) The investigation concluded at the end of the inquest on the 7'* of March 2017 The
conclusion of the inquest was by way of a Narrative Conclusion as set out in paragraph 4 below

CIRCUMSTANCES OF THE DEATH

Carol Ann Harvey was a seventy four year old lady who had been receiving medical treatment at
the Wrexham Maelor Hospital. By the 6'* of April 2016 plans were being made for her discharge
home with care and support being provided to her by her family, carers and district nurses.

On the 6th of April 2016 here INR was higher than was clinically ideal and this was being
addressed by a reduction in her dosage.

At around 4.15pm on the 7' of April 2016, following a delay arising from some confusion relating
to a Tissue Viability Review, confirmation was received that Carol was to be discharged and a
telephone call was made to the generic health care team to advise them of this so that the care
plan could commence. A message was left on an answerphone to this effect but no confirmation
was obtained that these instructions had been received,

The answerphone was not checked until the following morning, notwithstanding that staff had
returned to the office briefly around 7.00pm that evening.

No carers attended Carol Harvey during the evening of the 7 of April and it is probable that in
the course of that evening and overnight she was in considerable pain as a result of a calf
haematoma and consequently took an accidental overdose of painkillers.

At around 7.40am on the 8" of April she was found, drowsy and vomiting and she had suffered a
large loss of blood which necessitated her readmission to hospital.

Despite appropriate treatment for her condition she continued to decline and passed away at the
Maelor Hospital in the early hours of the 9" of April 2016 due to a combination of the effects of
the paracetamol overdose and a pre-existing cardiac condition.

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to concern. In my
opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it
is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows. —
(a) That although a referral had been made to the District Nurse Team, there is no
procedure in place to ensure that such a referral has been both received and actioned.

Coroner's Office, County Hall, Wynnstay Road, Ruthin, LLI5 1YN
Tel 01824 708047 | Fax 01824 708048

(b) The Action Plan which has been produced by the Health Board following an investigation
into this death indicates that a Standard Operating Procedure for the safe discharge of
patients from the Acute Hospital environment is being developed, however it was not
possible to provide a completion and implementation date for this, notwithstanding that
the death was eleven months ago. | am concerned that delays in undertaking work of
this kind could place existing patients at risk.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | 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
05/05/2017. |, the coroner, may extend the 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

| have sent a copy of my report to the Chief Coroner and to the legal representatives of following
Interested Persons —
The Family of the Deceased

| 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.

Dated 10 March 2017

Signature Gicen Gt
Senior Coroner for North Wales (East and Central)

Coroner's Office, County Hall, Wynnstay Road, Ruthin, LLIS 1YN
Tel 01824 708047 | Fax 01824 708048

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 University Health Board (PDF)
Bwrdd lechyd Prifysgol
Betsi Cadwaladr

Zo University Health Board Ysbyty Gwynedd, Penrhosgarnedd, Bangor,
WALES Gwynedd, LL57 2PW

Ein cyf / Our ref: INQ2223

PRIVATE & CONFIDENTIAL @: 01248 384194

Mr J Gittins Gofynnwch am / Ask for: is

H M Coroner North Wales Ffacs / Fax: 01248 385318

veda oe 4 E-bost / Email: ConcernsTeam.bcu@wales.nhs.uk
ynnstay Roa . .

Ruthin, Denbighshire Dyddiad / Date: 5 May 2017

LL15 1YN

Dear Mr Gittins

Re: Regulation 28 letter in respect of Carol Ann Harvey

Further to your Regulation 28 notification to the Health Board following the inquest of
Carol Ann Harvey.

The Health Board has considered your concerns in relation to problems identified
that:

“Although a referral had been made to District Nurse Team, there is no procedure in
place to ensure that such a referral has been both received and actioned. The action
plan which has been produced by the Health Board following an investigation into
this death indicates that the Standard Operating Procedure for the safe discharge of
patients from the acute hospital environment is being developed, however it was not
possible to provide a completion and implementation date for this, notwithstanding
that the death was eleven months ago. | am concerned that delays in undertaking
work of this kind could place existing patients at risk”

Please therefore find enclosed a working action plan relating to this case
which will be monitored at the Secondary Care QSE meeting in July 2017 to ensure
timely progress and evidence of completion.

The accountable officer for the action plan will be the Director of Nursing for
Secondary Care.

Yours sincerely
Gl
Mrs Gill Harris

Executive Director Nursing and Midwifery
Enc — Action Plan

Cyfeiriad Gohebiaeth ar gyfer y Cadeirydd a'r Prif Weithredwr / Correspondence address for Chairman and Chief Executive:
Swyddfa'r Gweithredwyr / Executives’ Office,
Ysbyty Gwynedd, Penrhosgarnedd

Bangor, Gwynedd LL57 2PW Gwefan: www.pbc.cymru.nhs.uk / Web: www.bcu.wales.nhs.uk

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