A man successfully underwent heart surgery and then died after he fell in a hospital toilet, an inquest heard yesterday.
The inquest found that there was no gross failure in the way father- of- three Mohammad Akram Latif, aged 51, was treated by Heartlands Hospital.
But Birmingham Coroner Aidan Cotter said the hospital should introduce a consistent and sensible form of note-taking after hearing that a nurse and doctor had failed to record vital information relating to Mr Latif's care.
Mr Latif, from Fernley Road, Sparkhill, was admitted to the hospital on October 8 last year after collapsing in a supermarket, the inquest was told.
After undergoing tests, doctors established that Mr Latif had suffered a heart attack and was at severe risk of suffering a fatal attack.
On October 11, the former factory worker underwent routine angioplasty surgery and an insertion was made to hold a blocked artery open.
Mr Latif suffered a haematoma at the site of the puncture and was prescribed anti-coagulant medication before he was sent back to the ward to recover.
At 8pm the same day, he was examined by a nurse who took his blood pressure but never recorded it because she was called away to the telephone.
Mr Latif was then allowed to walk to the toilet on his own where he fell and suffered a fatal head injury.
He was immediately attended to by nurses and was placed on half hourly to hourly observation by a doctor.
In the early hours of the next day, Mr Latif complained of a severe headache and was checked by a doctor some time between 1.45am and 4am but an accurate note was not taken, the inquest heard.
At around 4am Mr Latif collapsed after suffering a respiratory arrest and a CT scan carried out at 4.30am revealed significant bleeding to the brain. He died the same day.