76 ‘serious incidents’ recorded at Harrogate Hospital last year

tis  Harrogate District Hospital exterior.  101020M1b.

tis Harrogate District Hospital exterior. 101020M1b.

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There were 76 ‘serious incidents’ at Harrogate Hospital last year, figures have revealed.

Figures released under the Freedom of Information Act have shown that there were 76 serious incidents in the year 2014/15 and 102 in total since 2010/11.

A serious incident is defined as an incident or accident when someone suffers a ‘serious injury, major permanent harm or unexpected death’.

Between January 2014 and April 2015 there were two cases of missed diagnosis, two medication errors as well as a delayed diagnosis, intrauterine death and an unexpected death.

However, chief nurse at the hospital, Jill Foster, explained that there was such a significant increase in serious incidents last year because of a change in the reporting of pressure ulcers and falls.

She said: “We are fully aware and that the number of reported SIRIs has increased over the last year.

“This is due to our change in approach last year when, in agreement with our commissioners, the Trust changed how pressure ulcers and falls are reported and investigated.

“When a SIRI is declared a detailed investigation is undertaken including root cause analysis and an action plan is developed to prevent similar occurrences for future patients.

“The findings of these investigations are shared with patients or their personal representatives and across the organisation.

“The Trust is a learning organisation that ensures that all incidents are reported promptly, investigated fully and, where appropriate, change in practice identified, approved and put place.”

There were 49 category three and four pressure ulcers reported in 2014/15 and 16 fractures following falls.

Other serious incidents over the past five years have included missed and delayed diagnosis, death following surgery, wrong prosthetic and a missing patient.

The hospital were unable to provide any further details of the serious incidents as to do may compromise patient confidentiality.

According to Ms Foster, a serious incident could also be reported where there is a risk of death or injury in a hospital or where actions of the health service staff are likely to cause ‘significant public concern.’

She explained that the potential for learning is so great during a serious incident, or the consequence to patients, families and carers is so significant, they warrant additional resources for a ‘comprehensive response’.

She said: “Serious incidents can extend beyond incidents which affect patients directly and include incidents which may indirectly impact patient safety or an organisation’s ability to deliver ongoing healthcare.”