West Midlands Ambulance Service NHS Trust
NHS / Health Body
Action Taken
West Midlands Ambulance Service is changing its electronic patient report software to include a clearer statement about refusing treatment/transport. They have also updated their policy on refusal of care and revised the patient discharge advice leaflet. (AI summary)
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Dear Mr Bennett
Re: Regulation 28 Report to Prevent Future Deaths – Emma Langley (Deceased)
Thank you for your email attaching the report to prevent future deaths.
Please find our response below.
Matter of concern - The deceased/her family were keen for her to be admitted to hospital. The paramedic asked the deceased’s partner to sign the ‘non-conveyance’ statement on his EPR tablet after summarising a 1 hour 45-minute attendance. The rejection of medical advice was diluted by other details. The deceased’s partner stated he did not appreciate what he was signing. He was distressed and emotional and the room had been busy with family members, the paramedics and his ill partner. In my judgment, the facts of this case demonstrate the current system of signing a screen on a tablet after a generic summary, does not adequately amplify to a patient/their family (who might be distressed and emotional) they are rejecting medical advice to be admitted to hospital. Response – We are currently in the process of changing the software on our electronic patient report to include a statement that will be visible on the screen where patients, family or carers will see and read prior to signing. This statement clearly sets out that they are signing to acknowledge the refusal for treatment and/or transport to hospital and/or referral for further care against the advice of the attending ambulance clinicians. It also goes on to state that the risks of this has been explained to them by the attending clinicians and they understand those risks.
A review of the Trusts policy has also been undertaken in relation to the refusal of a patient to receive care and changes have been made to provide clarity to all our clinicians over the expectations on them where a patient declines treatment. Changes have also been made to the patient discharge advice leaflet which will provide clearer advice and guidance to patients who are left on scene following our attendance. Can I please take this opportunity to pass on my sincere condolences to the family of Ms Langley. I hope this provides you with the appropriate level of assurance that WMAS has dealt with the issues highlighted within the report to prevent future deaths. If you require any further information, please do not hesitate contact me.
Re: Regulation 28 Report to Prevent Future Deaths – Emma Langley (Deceased)
Thank you for your email attaching the report to prevent future deaths.
Please find our response below.
Matter of concern - The deceased/her family were keen for her to be admitted to hospital. The paramedic asked the deceased’s partner to sign the ‘non-conveyance’ statement on his EPR tablet after summarising a 1 hour 45-minute attendance. The rejection of medical advice was diluted by other details. The deceased’s partner stated he did not appreciate what he was signing. He was distressed and emotional and the room had been busy with family members, the paramedics and his ill partner. In my judgment, the facts of this case demonstrate the current system of signing a screen on a tablet after a generic summary, does not adequately amplify to a patient/their family (who might be distressed and emotional) they are rejecting medical advice to be admitted to hospital. Response – We are currently in the process of changing the software on our electronic patient report to include a statement that will be visible on the screen where patients, family or carers will see and read prior to signing. This statement clearly sets out that they are signing to acknowledge the refusal for treatment and/or transport to hospital and/or referral for further care against the advice of the attending ambulance clinicians. It also goes on to state that the risks of this has been explained to them by the attending clinicians and they understand those risks.
A review of the Trusts policy has also been undertaken in relation to the refusal of a patient to receive care and changes have been made to provide clarity to all our clinicians over the expectations on them where a patient declines treatment. Changes have also been made to the patient discharge advice leaflet which will provide clearer advice and guidance to patients who are left on scene following our attendance. Can I please take this opportunity to pass on my sincere condolences to the family of Ms Langley. I hope this provides you with the appropriate level of assurance that WMAS has dealt with the issues highlighted within the report to prevent future deaths. If you require any further information, please do not hesitate contact me.