The 12 most common NHS ‘never events’ revealed – from leaving drill bits INSIDE patients to removing the wrong organs

PATIENTS have had organs wrongly removed, drill bits left inside them and been scalded by hot water, official NHS data shows.

Some 179 serious, preventable safety incidents occurred at hospitals from April to September 2023, according to NHS England figures. 

GettyPatients on the NHS have had organs wrongly removed in surgery, official data shows[/caption]

The botched procedures included leaving vaginal swabs, drill bits and surgical needles in patients after surgery, the data shows.

Doctors and campaigners slammed the damning figures, saying the numbers are “worryingly high”.

A Royal College of Surgeons of England spokesman said: “These data show an unacceptable level of preventable mistakes are still happening in the NHS. 

“While these cases are very rare, never should mean never. 

“Learning from mistakes and using best practice and guidance to avoid such errors should be the priority of every medical and surgical team across the country.”

They added: “It is very important that there are enough highly skilled staff in surgical teams and across the NHS. They should also be well supported.  

“If the system is overstretched, there is a risk that mistakes will happen.

“More still needs to be done to develop a true learning culture in the NHS.

“The WHO pre and post-operative check lists are designed to prevent never events and should involve all theatre staff.”

Dangerous mistakes

The figures show so-called “never events” — dangerous mistakes that “should not occur if healthcare providers have implemented safety recommendations”, according to the NHS.

Moving procedures out of operating theatres into other care settings to address growing backlogs has caused a rise in the events at some hospitals, according to an official report.

Waiting lists have been steadily growing since before the Covid pandemic, with more than 8million Brits expected to be waiting for routine surgeries by next summer.

Prime Minister Rishi Sunak made cutting lists one of his five key priorities at the start of the year.

Foreign objects left in patients

The latest data show more than 32 mistakes were made a month on average between April and August this year — more than one a day.

In one case, a patient was scalded by a bowl full of boiling water left at their bedside for washing.

Another had an IUD wrongly inserted, with the patient not having consented to having it.

The most common mistake was biopsying or removing the wrong skin lesion on patients, which occurred 25 times over the period.

Overall, 92 surgeries were performed on the wrong part of the body, while 32 “foreign objects” were left in patients after operations.

Six patients were given the wrong knee implant, while five were given wrong hip implants.

Rachel Power, of the Patients Association, said: “Never events cause serious physical and psychological effects that can stay with a patient for the rest of their lives. 

“They’re called never events because they should never happen to anyone who seeks treatment from the NHS. There should be systems in place to prevent them. 

“The number of never events remains worryingly high from year to year, and we encourage the health service to learn from such events and share best practice.”

An NHS spokesperson said: “NHS staff work exceptionally hard to keep patients safe and thankfully never events are extremely rare.

“However when they do occur NHS trusts are mandated to investigate what has happened and take effective steps to improve as part of the NHS’ patient safety strategy.”

The most common NHS ‘never events’ from April to September 2023?

The 12 most common mistakes were:

Wrong site surgery (109 times)
Retained foreign object post procedure (37 times)
Wong implant/prosthesis (21 times)
Misplace naso or oro gastric tubes (15 times)
Administration of medication by the wrong route (nine times)
Transfusion or tasnplanattion of ABO-incompatible blood components or organs (seven times)
Overdose of insulin due to abbreviations or incorrect device (four times)
Unintentional connection of a patient requiring oxygen to an air flowmeter (three times)
Overdose of methotrexate for non-cancer treatment (two times)
Falls from poorly restricted windows (one time)
Failure to install functional collapsible shower or curtain rails (one time)
Scalding of patients (one time)

   

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