Wayne O’Neill

Dear Si Re: Waxne Patrick Q Neilldeceased Regulation 28: Rcport to provont futuro dgaths Thank for your letter and the enclosed regulation 28 report to prevent future deaths hope that the following is helpful to you and is of some comfort to the family of Mr O'Neill Before dealing with the substance of your report il is worth mentioning that t0 Mr 0 Neills inquest tha team at HMP Long Lartin were alroady very aware of the issues related to the prescribing of anti-psychotic medication ard had taken steps to addre3s the need for ECGs wen using these medicines and in particular when using these medicines in cortain comhination: or in combination with other medicines that interact to extend the QT interval Therelore All patients prescribed any sirgle or mulliple anti psychotic medication(s} and when prescribed in combination with other medications (such as tricyclic anti-depressants erythromycin etc ) that have a propensity t0 increase Ihe OT interval wil Teceive routine annual ECG as part of their package of care (there is a 12 monthly physical heallh Ievlem uf mental health service uaers and the ECG @om; part of this arrangement); This is already in place and was in place prior to Mr O Neills inquest The Lead Pharmacist at HMP Long Lartin will sarple audit this by 31 January 2016 to ensure Ihat all people who should received an ECG have dona 80. Patients who are prescribed anti psychotic medication; whose medlication is changed, will receive an ECG even if have already received their annual ECG. Cantan' Chrs BRuddon Cnie] Execubie: Sarh Dugan well GX RECEIVED 790 ^ AM CORONFR Way you prior have they

AIl stalf who are prescribers of anti-psychotic medication will receive a copy of the regulation 28 report, copy of tnis response an copy pf a Phamacist presentation which oullines the Iska associated with oxtended QT intervals associated with particular medicines and groups of medicines (we are happy to share this presentation with you If you wish) The issue of anti ~psychotic medication and extended QT intervals will be included in the HMP Long Lartin GP supervision session and the Mental Health MDT mceting to ensure appropriate exposure of clinicians to this area of concern All patients initiated on anti-psychotic medicines at HMP Lartin will receive an ECG booked at the time the prescription 13 made and all new receptions on anti- psychotic medications will receive an ECG within one month of arrival attha prison: Training will be provided to the whole Nursing team with regard to recognizing medicines that should indicate a referral for an ECG, These medicines might readily be recognized by a Mental Health Nurse but notnecessarily by & Primary Care nurse Whilst the combination of psychotropic medication had criginally been prescribed al HMP Birminghami, Ihe Medicines Healthcare Regulatory Authority aler relating t2 the prescribing of certain medications been shared with all of our proscribers at HMP Long Lartin to reinlorce awareness of prescnbing combinations of such medication; hope the above gives you somie reassurance that we have considered the regulation 28 letter carefully and to some extent we have 'gone beyond' the original issue of medication interactions to consider the broader Use of anti-psychotic medication with other groups or even in isolation: We hope that this will reassure you and also Mr 0'Neill's family that we take the care and treatment of our patients very geriously- We are happy to answer any further enquiries You might nave only sent this to yourself and shall be obliged if you could kindly fonwward to Mrs ONeill; As the issue raised may be of wider interest have no objections [0 this Tesponse being shared with the Chief Coroner or for wider circulation: