Prevention of Future Deaths reports · 2017

Kymberley Holden

Regulation 28 report to prevent future deaths, reference 2017-0105, written 4 Apr 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report4 Apr 2017
Reference2017-0105
DeceasedKymberley Holden
CoronerElizabeth Didcock
Coroner areaNottinghamshire
CategoryCommunity health care and emergency services related deaths
Organisation namedUniversity Hospitals of Derby and Burton NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

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:

1. The Ivy Grove Surgery, Derbyshire
2. The Chief Executive, Derbyshire Community Health Services (DCHS)

It
1 | CORONER

| am Dr Elizabeth Didcock, Assistant Coroner, for the Coroner area of Nottinghamshire

2 | 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.

3 | INVESTIGATION and INQUEST

On the 28" February 2015, | commenced an investigation into the death of Kymberley
Holden, aged 27 years. The investigation concluded at the end of the inquest on the 23
March 2017. The conclusion of the inquest was a Narrative as follows:

On the 26" November 2014 Kymberley Holden died from Oxycodone toxicity. This drug
had been prescribed for pain arising from her neurological condition. The dose
prescribed for her, was significantly higher than intended, and contributed to her death.

4 | CIRCUMSTANCES OF THE DEATH

Kymberley had a chronic neurological condition, that of Devics Disease, similar to
Multiple Sclerosis. She was under the care of the Neurology team at Derby Hospitals
NHS Trust. She suffered with chronic pain.

Her GP prescribed a dose of a strong Opiate, Oxycodone, for pain, at a concentration
that was 10 times the intended dose. An alert on the prescribing screen, advising that
the medication was a concentrated solution was overridden.

The suggestion to prescribe this medication, which was used rarely in general practice,
came from a Specialist Nurse working for a different Health Trust, that of Derbyshire
Community Health Services. This nurse did not discuss her suggestion of Oxycodone
with the Hospital team, who were advising on all other medications. -

Further detail of my findings in relation to these issues is included in the written
judgment in this case, which is attached to this document.

5. 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 therefore my statutory duty to report to you.

Essentially the serious and outstanding matters of concern are as follows:

1. The continuing risk of unsafe prescribing of controlled drugs by the Ivy Grove
Surgery, and the limited understanding of the duty to report serious prescribing
incidents.

2. The continuing risk of poorly coordinated management and prescribing in
neurological patients under the care of both DCHS and the Derby Hospital

During the Hearing, | heard evidence in relation to these matters, and the oral evidence
and documents went some way to addressing the concerns raised.

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 the 1* June 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.

For the avoidance of doubt, | will require a response from Ivy Grove Surgery to 1) above,
and from the DCHS in relation to 2)

However, respondents are at-liberty and encouraged to respond to all of the issues
raised. Respondents may consider it advantageous to consider some of these issues
jointly as well as individually. Should respondents favour supplementing their individual
responses to all the above issues with a joint response, such a collaborative approach
would be greatly welcomed but there is of course no obligation to do so.

COPIES and PUBLICATION ;
| have sent a copy of my report to the Chief Coroner and to the following Interested
Persons:

MEE «yr02reys father

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.

4” April 2017 Dr-E A Didcock GISTs |

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