Trust failed to explain reasons for not carrying out Serious Adverse Incident investigation
A woman whose father died in Causeway Hospital after removing his oxygen mask believed he should have been monitored more closely. She also questioned why the Trust did not commission a review into the incident.
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Report Recommendations
To help improve services and to prevent a repeat of the failings found during the investigation, we asked the Trust to:
- Look at whether any other complaints received about Medical Ward 2 in Causeway Hospital over the last three years included a request for Serious Adverse Incident (SAI) review. Where it did not commission one, the Trust should check whether it explained the reasons to the complainant.
- To take appropriate action to address any identified trends or shortcomings, and to report its findings to us.
- Carry out a random sampling audit of patients’ records within the Emergency Department of Causeway Hospital. This is to ensure that patients recorded as having pressure sores who spent in excess of 12 hours in the Emergency Department were suitably risk assessed with an appropriate care plan provided.
| Category | Health & Social Care
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|---|---|
| Organisation | Northern Health and Social Care Trust
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| Decision | Upheld
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| Case Reference |
202003319
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| Issue Date | |
| Format |
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