Source · Prevention of Future Deaths

Harry Glibbery

Ref: 2016-wp25368 Date: 16 Aug 2016 Coroner: Andrew Cox Area: Plymouth Torbay and South Devon 1 response identified · 1 indexed addressee View PDF

AI-generated concerns summaryThe coroner noted a doctor did not prescribe Clexane according to protocol, and this error was not identified during pharmacy reviews. Concerns were also raised about difficulties in weighing patients, which is crucial for weight-dependent medication.

Date 16 Aug 2016
56-day deadline 10 Oct 2016 stated in the report
Responses identified 1 of 1
Hospital Death (Clinical Procedures and medical management) related deaths

Coroner's concerns

AI summary
The coroner noted a doctor did not prescribe Clexane according to protocol, and this error was not identified during pharmacy reviews. Concerns were also raised about difficulties in weighing patients, which is crucial for weight-dependent medication.
View full coroner's concerns
(1) The doctor who originally prescribed the Clexane did not do so in accordance with Derriford Protocol; (2) The doctor's prescription error was not identified during Pharmacy reviews intended to pick 1 Derriford Park, Derriford Business Park, Plymouth, PL6 5QZ Tel 01752 204636 | Fax up precisely this sort of shortcoming; (3) I was advised that during Mr Glibbery's admission he lost a substantial amount of weight estimated at between 6 10 kilograms. (who gave evidence) expressed their difficulties in having patients weighed. This is particularly difficult for patients who have undergone hip replacements where, I was told, a hoist that is available is not high enough to return patients back to their beds. The importance of this is obvious in patients whose medication is weight-dependent. It is believed that Mr Glibbery was on the cusp of requiring a downward review of the amount of Clexane prescribed to him.

Responses

1 respondent

Plymouth Hospital NHS Trust

NHS Trust
PDF
AI-classified response stance Action Planned
AI-generated response summary

• The Trust stated that protocols for therapeutic Clexane would be reviewed by the Thrombosis Committee, and clear guidance would be disseminated. • An electronic prescribing and medicines administration (ePMA) system is to be implemented in 2017, designed to ensure correct protocol selection and automated weight-dependent dose calculation. • A learning package is being delivered to all pharmacists, emphasising correct Clexane dosing and its weight dependency, and the Trust has discussed with nursing staff the importance of taking weight measurements.

Report sections

Investigation and inquest
On 15/04/2016 I commenced an investigation into the death of Harry Glibbery. The investigation concluded at the end of an Inquest on 15 August 2016. The narrative conclusion of the inquest was that Mr Glibbery died from a known complication (bleeding) of a necessary medical procedure (anti-coagulation)
Circumstances of the death
Mr Glibbery suffered with a chronically infected left total hip replacement. He was under the care Consultant Orthopaedic Surgeon whose efforts were greatly appreciated by of the family. Mr Glibbery had a number of wash-outs as well as two first-stage revisions. On 26th February 2016 he underwent a Girdlestone procedure. On 4 March Mr Glibbery complained of shortness of breath and chest pain. A CT PA on 8 March revealed multiple pulmonary embolii as a consequence of which Mr Glibbery was started on Clexane. At Inquest I was advised that the Derriford Protocol provides for patients to be prescribed 1.5 milligrams per 1 kilogram once daily. As a matter of fact, I found that Mr Glibbery was prescribed 1 milligram per kilogram administered twice daily. Upon admission into hospital Mr Glibbery weighed 80 kilograms and, as a consequence, he received 160 milligrams of Clexane daily instead of 120 milligrams. I was advised that the prescription was reviewed on 3 separate occasions by Pharmacy clinicians but the error was not identified. On 5 April Mr Glibbery deteriorated acutely and a CT scan revealed a catastrophic intracerebral haemorrhage from which he died on 7 April 2016. As a matter of fact I found that the over-administration of Clexane did not cause the death but it may have contributed to the outcome in the sense that once the intracerebral haemorrhage started it bled more profusely that would otherwise have been the case.

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Report details

Reference
2016-wp25368
Date of report
16 August 2016
Coroner
Andrew Cox
Coroner area
Plymouth Torbay and South Devon

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: 10 Oct 2016 (stated in the report).

Sent to

Plymouth Hospitals NHS Trust

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