Investigation Into Never Event At Norfolk And Norwich Hospital

Medical Negligence Lawyer Says Never Event Incidents “Simply Should Not Happen”

14.12.2015

Dave Grimshaw, Press Officer | 0114 274 4397

An investigation is underway after a ‘never event’ occurred at Norfolk and Norwich University Hospital (NNUH).

The NHS Never Events list highlights 14 problems which simply should not happen within hospitals. It includes operating on the wrong part of the body, leaving surgical instruments inside patients and overdoses of medication such as insulin.

In the latest incident Doctors meant to place a naso-gastric tube through the patient’s oesophagus but accidentally put it in the patient’s trachea, where it could cause a blockage.

The tube was not removed immediately because the normal checking process didn’t identify that the tube had entered the trachea straight away. The tubes are used for feeding or giving medicines to patients who are unconscious or unable to swallow.

The patient was unconscious at the time and is not believed to have been harmed by the mistake. It is understood to be the second never event at the hospital this financial year and the NHS Trust said they were investigating whether it was human error or some other cause and said they would learn lessons from this incident. It has launched a “Root Cause Analysis”.

Expert Opinion
“Incidents on the never events list are named as such because they just should not happen. But sadly we continue to receive enquiries about such issues and as this incident shows, they are still happening too often. Thankfully in this incident it seems as though the patient was not harmed by the mistake, but on other occasions people have suffered life-changing injuries in incidents which could and should have been avoided.

“It is imperative that everytime a never event occurs it is thoroughly investigated and that information shared across the NHS so that they can eliminate these incidents once and for all.”
Guy Forster, Partner

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