Prevention of Future Deaths reports · 2019

Shirley Nightingale

Regulation 28 report to prevent future deaths, reference 2019-0431, written 16 Dec 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report16 Dec 2019
Reference2019-0431
DeceasedShirley Nightingale
CoronerAlison Mutch
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedTameside and Glossop Integrated Care 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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: Chief Executive of Tameside and
Glossop Integrated Care NHS Foundation Trust

CORONER

tam Alison Mutch, Senior Coroner, for the Coroner Area of Greater

Manchester South
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

INVESTIGATION and INQUEST

On 21* May 2019 | commenced an investigation into the death of Shirley
Anne Nightingale .The investigation concluded on the 215t November
2019 and the conclusion was one of Narrative: Died from the
complications of a gastro-intestinal haemorrhage contributed to by
neglect. The medical cause of death was 1a) Gastro-intestinal
haemorrhage

CIRCUMSTANCES OF THE DEATH

Shirley Anne Nightingale had Crohn's Disease which had
resulted in an inflammation that was treated with a reducing
dose of steroids - a recognised treatment. On 19th May 2019
she had both hematemesis and haematochezia and went to
Tameside General Hospital. In Accident and Emergency an
upper gastro-intestinal bleed was diagnosed and an urgent
endoscopy requested. Guidance indicated this should take place
within 24 hours. In the early hours of 20th May 2019 she had a
further episode of bleeding. On 20th May 2019 it was identified
she was not on the list for an endoscopy. It is unclear why not.
She was a high risk patient. It was agreed by the clinicians that it
could take place on 21st May 2019 outside the guidance period.

At 7pm on 20th May 2019 she suffered a catastrophic bleed and
died at Tameside General Hospital. Post mortem found the

source of the bleed was the lower oesophagus and stomach.
She had excisions and ulcers at the gastro/oesophageal junction

which had caused the bleed on 20th May 2019. An endoscopy
within the 24 hour timescale would have identified them and led
to urgent investigation and on the balance of probabilities
avoided the bleed on the evening of 20th May 2019.

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. The inquest heard that there was no clear system for escalation
/prioritisation by treating clinicians in relation to management of the
OGD lists and patient need where the OGD team said there was
no capacity;

2. The inquest heard that it had been identified in Accident and
Emergency that the OGD was required. The notes were marked
accordingly but there was no clear system to ensure that this was
followed up prior to the ward round on AMU the next day;

3. When a decision was made to depart from the recognised best
practice timescales the rationale was not recorded and there was
no system to ensure that a suitably experienced clinician agreed
with the decision.

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 10" February 2020. 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.

COPIES and PUBLICATION

| have sent a copy of my r hief Coroner and to the following
Interested Persons namel n behalf of the family, who may
find it useful or of interest.

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

to

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.

Alison Mutch OBE

HM Senior Coroner
16.12.2019

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