Prevention of Future Deaths reports · 2018

Jean Griffiths

Regulation 28 report to prevent future deaths, reference 2018-0080, written 15 Mar 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report15 Mar 2018
Reference2018-0080
DeceasedJean Griffiths
CoronerJennifer Leaming
Coroner areaManchester (West)
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  The Secretary of State for Health, Jeremy Hunt MP, House of Commons, 

London  SW1A 0AA 

1  CORONER 

I am Professor M Jennifer Leeming, HM Senior Coroner for the Coroner Area of 
Manchester West. 

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 27th  of  July 2017 I  commenced an investigation into  the  death  of Jean 
Griffiths aged 70 years.  The investigation concluded at the end of the inquest 
on the 6th March 2018.  The conclusion of the Inquest was:- 

Natural Death  

4  CIRCUMSTANCES OF THE DEATH 

On  the  15th  July  2017  Jean  Griffiths  died  at  Salford  Royal  Hospital  having 
displayed  symptoms  of  Acute  Interstitial  Pneumonitis.    Her  oxygen  lead  was 
found to be disconnected at the time, but this did not contribute to her death. 

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 my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows:   

1.  In the course of the Inquest I heard evidence from 

 who 
is  a  consultant  in  Respiratory  Medicine  at  Salford  Royal  Foundation  NHS 
Trust.  
 referred in his evidence to the British Thoracic Society’s 
Emergency Oxygen Audit Report relating to a National Audit Period between 
the 15th August and the 1st November 2015. 

2. 

 stated that the Audit Report revealed a threat to patient safety 

due to poor prescribing practice in relation to the prescription of oxygen. 

1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3.  A  key  finding  of  the  report  was  that  42.5%  of  patients  receiving 
supplementary  oxygen  had  no  valid  prescription.    Without  a  valid 
prescription  which  includes  a  target  range, 
  stated  that  there 
was  a  danger  that  patients  might  be  given  too  little  oxygen  or  too  much 
oxygen and thus be placed at risk of increased mortality. 

4.  A copy of the relevant Audit Report is attached. 
5. 

 evidence was that the pace of changing this poor prescribing 

practice needed to increase. 

6.  Although  there  was  no  evidence  that  Jean  Griffiths’  lack  of  oxygen 
prescription  was  in  any  way  causative  of  or  contributory  to  her  death 
nevertheless this report is submitted with a view to preventing the deaths of 
other patients who might be at risk. 

6  ACTION SHOULD BE TAKEN 

In  my  opinion  urgent  action  should  be  taken  to  prevent  future  deaths  and  I 
believe that you 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 10th May 2017.  I, 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. 

8  COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following 
Interested Persons:- 

1.  The Chief Executive, Salford Royal Hospital 
2. 
3. 

 (husband) 

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. 
Dated 

Signed 

15th March 2018 

M Jennifer Leeming, HM Senior Coroner 

2

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 Department of Health (PDF)
a

Department
of Health

Your reference: MJL/YD/104-18
Our reference: PFD 1125206

Professor M Jennifer Leeming
HM Senior Coroner, Manchester West
HM Coroner’s Court
Paderborn House
Howell Croft North
Bolton
BL1 1QY
\\"May 2018

Door Kesfassor (gominp,

Thank you for your letter of 19 March to the Secretary of State for Health and
Social Care about the death of Mrs Jean Griffiths. I am responding as Minister
with responsibility for patient safety.

I was very saddened to read of the circumstances surrounding Mrs Griffith’s
death. Please pass my condolences to her family and loved ones. | appreciate
this must be a difficult time for them.

Your Report raises a matter of concern in relation to oxygen prescribing
practice in the NHS. Although I note there was no evidence that lack of an
oxygen prescription in Mrs Griffith’s case was in any way causative of, or
contributory to, her death, I am grateful to you for raising the concerns given in
evidence at the Inquest that this is an area of patient safety risk.

I have noted carefully the comments in your Report and the findings of the 2015
British Thoracic Society national emergency oxygen audit report.

While it is encouraging that there has been a steady rise in the number of
patients with a prescription, from 32 per cent in 2008 to 57.5 per cent in 2015, I
appreciate the importance of making further progress to improve patient safety
and reduce the risk of increased mortality.

I am advised that the British Thoracic Society (BTS) updated its 2008 guideline
for emergency oxygen use in adult patients in 2017', broadening its remit from
emergency oxygen use to most other oxygen use in healthcare settings, as well
as short term oxygen use by healthcare professionals outside healthcare settings.

I am further advised that the guidance is supported by increasing evidence of its
effectiveness in improving patient outcomes and reducing avoidable deaths.
The guidance is widely endorsed by professional bodies, societies and colleges
and forms an important resource for ensuring patient safety in the use of
oxygen.

In terms of disseminating best practice and use of the BTS guideline, I
understand the BTS has taken action to establish a network of Oxygen
Champions within all hospitals, has produced e-learning modules and learning
resources for ambulance services, and importantly, continues to undertake
clinical audits. I commend the excellent work done by the BTS in this area and
encourage that to continue in partnership with the relevant Royal College’s and
societies.

To see what further action might be taken in this area, my officials have sought
advice from the National Institute for Health and Clinical Excellence (NICE).

NICE guideline CG101 Chronic obstructive pulmonary disease’ includes a
section on oxygen therapy, which includes recommendations regarding
appropriate patient assessment. The guideline is in the process of being
partially updated and oxygen prescribing is one of the areas included in the
update. While the focus of the update has been on safety (regarding the risk of
explosions), NICE considers that a tightening of prescribing practice in this area
is appropriate and will bring this to the attention of the guideline developers.

The updated draft guidance is currently expected to go out for consultation with
stakeholders in the summer. I am informed that the stakeholders include the
BTS as well as relevant Royal Colleges. The BTS and other stakeholder
organisations will have the opportunity to participate in the development of the
guideline, and to comment on the draft guidance when it goes out for
consultation in the summer. This provides potential for a further opportunity to
ensure that guidance on oxygen prescribing reaches healthcare professionals.

" https:// www. brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-
adult-patients/

>

https:// www.nice.org.uk/guidance/cg101

a

Department
of Health

I hope that you find this information helpful. Thank you for bringing the
circumstances of Mrs Griffith’s death to my attention.

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