Saturday 24 August 2019

100 people die in 'serious incidents' in health service

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Eilish O'Regan

Eilish O'Regan

A series of 233 serious incidents across the health service over the course of just 19 months resulted in 100 deaths, a new report has revealed.

And many of the reported incidents, which also left people injured and harmed from March 2014 to September last, were preventable, it is claimed.

Others need to be investigated to find out if safety issues were to blame.

Some 174 of the cases happened in hospital, 28 occurred in mental health services and 30 in social care, such as nursing homes.

Sixteen of the deaths involved babies, and three happened in a nursing home. Eighteen people died after a fall.

Four people died either on the operating table for after surgery.

Other deaths happened after failures in the use and function of a medical device.

A substantial number of deaths were recorded in mental health facilities. Some involved patients who absconded from a healthcare facility.

The tragedies are outlined in a report by the Health Service Executive (HSE) which was forced to set up a system of reporting these incidents amid growing concern for patient safety.

The HSE conceded that not all incidents are being reported nationally.

Some services are only reporting them locally.

The highest number of incidents are reported in the Ireland East Hospitals Group, followed by the RCSI Hospital Group covering north Dublin and the north east of the country.

Because of the variance, it is not possible to draw conclusions that one set of hospitals is more risk-prone than another.

"Reporting is improving each month. Until there is a greater confidence about levels of reporting, individual service areas with high numbers of reported incidences should not be interpreted as these having a higher number of serious safety incidents," it said.

The HSE said that "many services in Ireland already have an established culture of reporting safety incidents".

"Internationally, it is accepted that where there is a high incidence of reporting patient safety incidents, this also generally reflects a strong patient safety culture.

"As part of the ongoing implementation of the SRE process, the HSE is working with individual services to improve reporting - and a significant improvement in reporting has been seen in 2015.

"This work is supported by the implementation of the National Incident Management System, which is a joint initiative between the HSE and the State Claims Agency."

Hospitals and other parts of the health service continue to face criticism from patients or families who frequently face a wall of bureaucracy if they want to find out what happened to a loved one.

Despite this, the HSE claimed yesterday that each service is required to ensure they promote an open, timely and consistent approach to communicating with people and their families when things go wrong.

Health Minister Leo Varadkar recently announced that the long-awaited National Patient Advocacy Service - as recommended in the Hiqa investigation report into failures at Portlaoise Hospital - will be set up next year.

The Health Information and Patient Safety Bill will make it mandatory to report events which result in death or serious harm.

It is planned to extend the remit of Hiqa to monitor safety in private hospitals as well as cosmetic surgery clinics.

A patient safety office will be set up to oversee patient safety measures and advise agencies such as the HSE and Hiqa, it is believed.

It will also report directly to the Minister for Health.

Irish Independent

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