Prevention of Future Deaths reports · 2017

Paul Barber

Regulation 28 report to prevent future deaths, reference 2017-0184, written 2 Mar 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report2 Mar 2017
Reference2017-0184
DeceasedPaul Barber
CoronerVeronica Hamilton-Deeley
Coroner areaBrighton and Hove
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.

VERONICA HAMILTON-DEELEY DL,
LL.B.

Her Majesty’s Senior Coroner

for the.City of Brighton & Hove

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD
BRIGHTON

BN2 30B

Assistant Coroners

CATHARINE PALMER LL.B (HONS)
KAREN HENDERSON, BSC,BM,MRCPIFRC. .
GILVA D.J.TISSHAW, BA(LAW)HONS

Telephone: Brighton (01273) 292046
Fax: Brighton (01273) 292047

CORONERS SOCIETY OF ENGLAND AND WALES
ANNEX A
REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This form is to be used after an inquest.

THIS REPORT IS BEING SENT TO:

1. Brighton and Sussex University Hospitals NHS Trust
HE Medico-legal Services Manager

2. Evelyn Barker, Chief Executive, Brighton and Sussex University
Hospitals NHS Trust

1 CORONER

| am Veronica HAMILTON-DEELEY, Senior Coroner, for the City of Brighton and
Hove
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 12" August 2016 | commenced an investigation into the death of Paul William
BARBER. The investigation concluded at the end of the inquest on 24" February
2017. The conclusion of the inquest was a Narrative Conclusion — please see
attached Record of Inquest

4 CIRCUMSTANCES OF THE DEATH

See Record of Inquest

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

VERONICA HAMILTON-DEELEY DL, THE CORONER’S OFFICE
LL.B. WOODVALE, LEWES ROAD
Her Majesty’s Senior Coroner BRIGHTON
for the City of Brighton & Hove BN2 3QB

Assistant Coroners

CATHARINE PALMER LL.B (HONS)
KAREN HENDERSON, BSC,BM,MRCPI,FRC. .
GILVA D.J.TISSHAW, BA(LAW)HONS

Telephone: Brighton (01273) 292046
Fax: Brighton (01273) 292047

taken. In the circumstances it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows. —

(1) Samples being sent to microbiology in the wrong containers and to elaborate on
that Mr Barber had a recently diagnosed aggressive lung cancer on the back of
which he developed pericarditis. By the 21° July 2016 it was clear that there
was a Collection of fluid around his heart which was susceptible to draining.
This was done and sampling of the fluid was sent to the microbiologists for
analysis. However, it was sent in the wrong container, this meant that it needed
incubation before it could be dealt with giving a potential delay for results of
between 24 — 48 hours. If it had been sent in the correct pot there is a good
chance that full results would have been available the same day it was sent as
the laboratory is open and testing until 7 p.m.

(2) Delay in reporting important results to clinicians. On the 22" July bacterial
growth was detected in the bottles and gram staining showed gram positive
cocci — this information was passed to the medical team looking after Mr Barber.
On the next day, Saturday 23% July, the laboratory found the sample growing
two organisms. This indicated that Mr Barber had a bacterial pericarditis — this
was a very unusual situation and the identification of the organisms ought to
have been given on the Saturday as soon as it was known to the medical team.
For some reason the organisms were not reported until Tuesday 26" July
shortly after Mr Barber's death.

Had these results been given appropriately on the 23% July appropriate steps
could have been taken to treat the patient with antibiotics.

It is right to say that in this particular case on the balance of probabilities the two
failings mentioned above did not affect the outcome — however it is right to
report this so that these mistakes are highlighted and do not occur again either
in this Hospital Trust or any other.

6. ACTION SHOULD BE TAKEN

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

7 YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 25" May 2017 I, the coroner may extend the period.

Your response must contain details of action taken or proposed to be taken, setting

VERONICA HAMILTON-DEELEY DL, THE CORONER’S OFFICE
LL.B. WOODVALE, LEWES ROAD
Her Majesty’s Senior Coroner BRIGHTON
for the City of Brighton & Hove BN2 3QB

Assistant Coroners

CATHARINE PALMER LL.B (HONS)
KAREN HENDERSON, BSC,BM,MRCPILFRC. .
GILVA D.J.TISSHAW, BA(LA W)HONS

Telephone: Brighton (01273) 292046
Fax: Brighton

out the timetable for action. Otherwise you must explain why no action is proposed.

8 COPIES and PUBLICATION

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

4.
2

3. Secretary of State for Health, Department of Health
4. Simon Stevens — Chief Executive NHS England

| 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.

9 Date: 2°" March 2017 . SIGNED, 75

Senior Coroner Brighton and Hove

a

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 Respondent Not Named (PDF)
Brighton and Sussex

Your ref: VHD/ST/INQ 13/17 (307/16) University Hospita Is
23 May 2017 The Royal Sussex County Hospital
Eastern Road
Brighton
BN2 5BE

Miss Veronica Hamilton-Deeley
HM Senior Coroner

Coroner's Office

Woodvale

Lewes Road

BRIGHTON

BN2 3QB

Tel: 01273 696955

RECEIVED |
9 & WAY 2017

oe a ao ae a Em er see |

Dear Miss Hamilton-Deeley

The Late Paul Barber, date of birth: 09/02/1962

Thank you for your letter and report of 6 March 2017, and for drawing your concerns to the
attention of this Trust. As you know, we are always willing to review our practices, to ensure
we learn from experience.

| was very sorry to learn about the circumstances of Mr Barber's death and the issues you
have highlighted concerning the use of incorrect containers for microbiology samples, and a
delay in reporting important results from the laboratory to ward-based clinical staff. | agree
that, even though you had concluded these matters did not cause or contribute to the death of
Mr Barber, it is still important to address them.

In order to ensure that as many staff as possible learn from these events, a message has
been circulated to all Trust staff reminding them that normally sterile body fluids, such as
pericardial or ascetic fluid, should only be submitted to the laboratory in a sterile white capped

_Aontainer and not in a blood culture bottle. The same message made it clear that only blood
and peritoneal dialysis fluid should be inoculated into blood culture bottles at the bedside.
Secondly, the standard operating procedure within the laboratory has been altered so that, if
such a specimen is received in the wrong container, an educational message is now sent

/ advising on the correct container to be used in such circumstances so that the staff learn from
this.

| note the initial blood culture result was notified to a doctor in the team caring for Mr Barber,
who documented a plan about antibiotic treatment should the clinical situation warrant it. Mr
Barber was reviewed each day by a consultant so that his condition could be closely
monitored. Very unusually for any patient with bacterial pericarditis, sepsis was not a
significant factor in Mr Barber's clinical condition.

Concerning the delay in updating the clinicians caring for the patient about the new laboratory
findings, the microbiology and infection department have discussed Mr Barber's case in detail
at their clinical governance meeting, as part of training for microbiology registrars to help them
discriminate effectively in prioritising urgent follow up for appropriate specimens.

With our partner
ey brighton and sussex
S$ medical school

Thank you once again for raising these concerns. Finally, please pass on my condolences to
the family and friends of Mr Barber on their sad loss.

Yours sincerely

Dr George Findlay
Executive Medical Director

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