A further review is to take place into prescribing at a Birmingham hospital trust after five patients died from drug blunders within two years.
Despite a Care Quality Commission (CQC) report this week ruling there are “no immediate concerns” at Heart of England NHS Foundation Trust, hospital bosses are working with grieving relatives and doctors to tighten up procedures.
Lisa Dunn, Trust director of Heartlands, Solihull and Sutton Coldfield’s Good Hope hospitals, said: “We have invited those specially affected by medication errors to work with us on an independent review surrounding prescribing and administrating medication within the Trust.
“Because of the very serious nature of these incidents and to ensure that all possible lessons are learned, in addition to a full internal investigations we invited Care Quality Commission to undertake a review of patient safety as an independent external body.
"To further enhance patient safety, we are commissioning a further external review of our medicines management, which was sited in the report as the most common cause of incidents within our Trust.”
CQC inspectors said the Trust had carried out action plans following each death and worked on improvements such as an early warning system, particularly in paediatrics, and ensuring junior doctors contacted consultants as soon as a patient showed signs of deteriorating.
The report showed there were 27 serious untoward incidents between March 2007 and last June, including five deaths from medication errors and a baby which was over-medicated.
Deaths included cancer patients, Paul Richards, 35, from Sutton Coldfield, and Baljit Singh Sunner, 36, from Small Heath, who died at Heartlands after being given five times the normal dose of fungal infection medicine amphotericin in July 2007.
Mr Richards’ widow Lisa Richards Everton, who has been invited to take part in the new review, said of the CQC findings: “This report isn’t worth the paper it’s written on. One death is too many, but there have been five medication error deaths, so how can these inspectors say there is nothing wrong?”
Other deaths were Sian Jones, 15, from Stirchley, who died at Heartlands in August 2007 from peritonitis when medics failed to diagnose her in time and pulmonary fibrosis sufferer Rosemary McFarlane, 64, from Kingshurst, who spent ten days in ‘burning agony’ and died after her lungs were injected with ten times the recommended strength of a drug at Heartlands.