Hospital on Trial 15/10/2014. Objectives. The players
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1 Objectives Hospital on Trial Guys and St Thomas NHS Foundation Trust DAC Beachcroft LLP Understand How things can go wrong The importance of acting on information Where human error might move to negligence and beyond Organisation and individual culpability Use an illustrative (fictitious) case study... by putting individual professionals and a hospital in to the Court Room! Our case today... Uses real professionals Doctor, pharmacist, nurse, Chief Operating Officer Advocate Louise Wiltshire from DAC Beachcroft solicitors - leading international lawyers and UK health specialists Judge Head of Healthcare Regulatory at DAC Beachcroft Fictitious, but based on events that are very real The players The doctor - Adrian Hopper, Guys and St Thomas NHS Foundation Trust The pharmacist - Alice Oborne, Guys and St Thomas NHS Foundation Trust The nurse - Bernice Redley, Assoc. Professor, Richmond, Victoria The Chief Operating Officer Patricia Snell, Guys and St Thomas NHS Foundation Trust The prosecutor - Louise Wiltshire, DACB The judge - Corinne Slingo, DACB We start... Mrs A Young mother of 4 children < 10 years old Runs her own design business Husband is freelance journalist, specialising in medical misadventure for tabloids Setting Acute teaching FT General ward Problems Mrs A has been admitted for a routine operation She has a known allergy to penicillin Anaphylaxis years ago Saved by St Elsewhere Ambulance Service Admission to our Emergency Department then general ward Developed a non life-threatening infection Deteriorating obs escalating Modified Early Warning Score (MEWS) Delay in seeking medical input by nurses 1
2 Problems cont. Working diagnosis: pseudomonal septicaemia Solution Call the experts: Infectious Diseases team Delay in Dr attending once called The timeline 5.15 pm (Eventually) seen by the Infectious Diseases team New prescription not stock on ward Nurse was asked to give 1 st dose immediately 5.40 pm Prescription sent to pharmacy, after closing time 6.00 pm Prescription and drugs sent back to ward The timeline 6.15 pm Injection was prepared by nurse Administered to Mrs A Mrs A goes in to anaphylactic shock. Emergency call is sent ( crash call ) 6.20 pm Crash team arrive 6.45 pm Mrs A declared dead Internal investigation Mrs A - despite known anaphylaxis, was Prescribed, dispensed and administered a medicine (piperacillin with tazobactam or Tazocin ) that contained a penicillin Policies and Procedures had not always been followed There had been previous similar incidents Post Mortem Histopathologist report found: The Court Criminal charges Acute hypersensitivity reaction Prescribed penicillin the likely cause The case is referred to the police.. Trust Corporate Manslaughter Doctor Gross Negligence Manslaughter Nurse Gross Negligence Manslaughter Pharmacist Gross Negligence Manslaughter 2
3 The Court The process we will follow Explore the issues it will feel like prosecution to our professionals! Prosecution will sum up Judge will advise the jury on legal issues YOU... will be the jury Our judge will pass a sentence and comment on the learning from incidents like this First Defendant Consultant in Infectious Diseases 3
4 Second Defendant Pharmacist 4
5 Third Defendant Matron at time of incident and was the administering nurse Nurse s Entry in the Clinical Record 5
6 Fourth Defendant Chief Operating Officer Previous incidents Surgical patient needing admission to ICU Presentation at meeting open to all staff Other no-harm green incidents Learning + Actions from these incidents Orange allergy stickers on all inpatient charts Put on by the person who first starts the medication chart PENICILLIN ALLERGIC Penicillin type drugs include: co-amoxiclav (Augmentin), meropenem, Tazocin 6
7 Separate storage of penicillins Still testing changes New prescription chart Hand held patient allergy record Warnings through electronic drug cabinets And evaluating these Summing Up and Verdict Guilty or Not Guilty? Discussion Points/Panel Q&A We are what we repeatedly do. Excellence, then, is not an act but a habit. Aristotle, BC 7
8 8
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