Source · Prevention of Future Deaths

Mathew Moore

Ref: 2022-0249 Date: 9 Aug 2022 Coroner: Stephen Nicholls Area: Dorset Responses identified: 1 / 1 View PDF

An unsafe amount of benzodiazepine was remotely prescribed to a patient consuming excess alcohol, without a clear policy for such circumstances or documented communication of concerns. There was also a lack of follow-up for this remote prescribing.

Date 9 Aug 2022
56-day deadline 25 Nov 2022 est.
Responses identified 1 of 1
Alcohol, drug and medication related deaths Suicide (from 2015)

Coroner's concerns

AI summary
An unsafe amount of benzodiazepine was remotely prescribed to a patient consuming excess alcohol, without a clear policy for such circumstances or documented communication of concerns. There was also a lack of follow-up for this remote prescribing.
View full coroner's concerns
1. During the inquest evidence was heard that:
i. Mr Moore had a history of problems with alcohol.
ii. A CT scan in January 2021 revealed a fatty liver.
iii. Mr Moore was admitted to hospital on the 2nd May 2021 complaining of abdominal pain and vomiting. When discharged from hospital on the 7th May 2021 it was noted that he had been consuming a bottle of whiskey per day. On the 19th May Mr Moore was prescribed following a telephone conversation between a paramedic attending upon Mr Moore and a doctor at the surgery.

iv. On the 21st May Mr Moore’s sister wrote to the surgery summarising her concerns for her brother and querying the medication that he had been prescribed. The surgery had no consent from Mr Moore to release any information to his sister. The We Are With You charity that offers free confidential advice to people with drug, alcohol or mental health issues were currently engaging with Mr Moore, they also raised concerns about the medication following a e-mail from Mr Moore’s sister.

v. At a Significant Event meeting at the surgery when Mr Moore’s case was discussed by doctors, it was agreed that the amount of was potentially unsafe and a lesser amount should have been prescribed.

vi. The appears to be no documentation of Mr Moore being contacted and notified of these concerns.

vii. On the 27th May 2021 Mr Moore when was spoken to on the telephone by the surgery, there is no documentation that the concerns about were discussed with him.

viii. On the 29th July 2021 Mr Moore when was seen by a doctor at the surgery, there is no documentation that the concerns were discussed with him. Mr Moore told the doctor that he had no thoughts of suicide and was reducing his alcohol intake.

ix. Mr Moore continued to engage with We Are With You and had one to one sessions on the 27th July 2021 and the 3rd August 2021.

x. The use of and excess alcohol together could cause death.

2. I have concerns with regard to the following: i. There could be the death of a person in the future due to combined use of and excess alcohol and I request that consideration is given to creating a policy at the surgery to cover patients who are prescribed , at the same time as consuming alcohol to excess.

ii. I would request consideration is given as to the advice to be given in the circumstances where a patient is not being seen face to face, but via another healthcare worker.

iii. Further, consideration should be given to the amount and dosage that should be prescribed in these circumstances and whether there should be a documented process to highlight any concerns about the use of being brought to the patient’s attention as soon as possible.
iv. I would request consideration is given that within the policy there is provision for a follow up face to face meeting to review the medication.
v. I would request consideration is given to the policy being available to all healthcare staff in the surgery.

Responses

1 respondent
Swanage Medical Practice Other
9 Aug 2022 PDF
Action Taken

A protocol alert that triggers on the patient electronic record when any drugs in the prescribing group are issued has been created to warn the prescriber to consider the amount and dosage being prescribed, highlighting the risk of use of the drug combined with excess alcohol use and to consider arranging a face to face medication review with the patient. (AI summary)

View full response
Dear Teresa, Thank you for the letter and report of the 9th August 2022 from Stephen Nicholls, Assistant Coroner. As you will be aware, this incident has been discussed at a Significant Event Meeting at the Practice, where the GPs considered the amount of prescribed in such cases and also the difficulty where patients fail to engage with GP and Mental Health services. Another action point from the SEA was to arrange a meeting with the Purbeck CMHT lead. This has been arranged for the 30th September to discuss the challenges when patients fail to engage with services and to consider if any further actions can be taken. In response to Mr Nicholls concerns and suggestions of the 9th August, I can also confirm that we have now created a protocol alert that triggers on the patient electronic record when any drugs in the prescribing group are issued. This alert warns the prescriber to consider the amount and dosage being prescribed, and highlights the risk of the use of the drug combined with excess alcohol use. The alert also asks them to consider arranging a face to face medication review with the patient. This alert is available to all staff at the Practice who issue medications in the prescribing group. I trust these actions will meet with your approval. With kind regards Practice Manager

Report sections

Investigation and inquest
On the 13th August 2021, an investigation was commenced into the death of Mathew Christopher Moore, born on the 28th October 1961. The investigation concluded at the end of the Inquest on the 4th August 2022. The Medical Cause of Death was: 1a Hanging The conclusion of the Inquest recorded was Suicide.
Circumstances of the death
On the 7th August 2021 Mathew Christopher Moore died at , Bournemouth, Dorset having attached a rope as a ligature
Copies sent to
Care Commissioning Group

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Report details

Reference
2022-0249
Date of report
9 August 2022
Coroner
Stephen Nicholls
Coroner area
Dorset

Responses identified

Responses identified 1 of 1
All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 25 Nov 2022 (estimated).

Sent to

Swanage Medical Practice

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