Hospital equipment not replaced eight years after teen's death
HOSPITAL equipment partly responsible for an 18-year-old's death has still not been improved eight years after his death, MPs have been told.
Leukaemia sufferer Wayne Jowett died after a chemotherapy drug was injected into his spine instead of a vein at the Queen's Medical Centre in 2001.
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injected: Wayne Jowett
At a meeting of the Commons Health Committee last week, Professor Brian Toft, who held an inquiry into the tragedy, told the committee the connector he recommended in 2001 to prevent the mistake being made again had still not been produced.
He told the committee: "My conclusions regarding Wayne were that there had been procedure failures. There was inadvertent human error (that was certainly the case) but there was also systems failure."
The connector Prof Toft recommended would stop intravenous needles being mistakenly connected to spinal needles. He added: "Since that point in 2001, and we are now in 2009, we still have not got that connector."
Prof Toft cited a number of reasons for the delay, including finding a manufacturer to fund the creation of the syringe, and considering if the connector could lead to a patient death for another reason.
4 Comments
by Matt Root - InterVene Ltd, Sheffield
Monday, January 26 2009, 10:06AM
“I represent a syringe manufacturer and we have just successfully launched a female luer lock enteral syringe to avoid this kind of maladministration for enteral medication. I would be very happy to fund a project to develop a unique type of intrathecal needle / syringe to prevent this appalling tragedy ever happening again. If anyone has contact details for Prof Toft I would be very keen to make contact. Matt Root (mroot@ivltd.co.uk) 07976425653”
by A. Nottsdweller, Nottingham
Monday, January 26 2009, 8:37AM
“Why is there a need to buy "foolproof" items of equipment - surely the NHS should employ people whose native language is English and who can follow instructions - and not employ "fools" for whom this equipment is required?
What's next - blunt scalpels so that incompetent numpties don't accidentally cut off the wrong leg?”
by Bill, Keyworth
Sunday, January 25 2009, 10:00PM
“What the report fails to indicate is the number of cases over the past 10 years where a Luer syringe has been attached to a spinal needle with fatal consequences.
Which is going to save more lives, much more control and cross checking of the actual administration of the drugs in hospitals or a new design of needle?
With all the money at their command the petrol companies still haven't come up with fool proof fillers that prevent people putting the wrong fuel in their cars. I should imagine that needle and syringe manufacturers have a more difficult task.”
by Andyman, Derbys
Sunday, January 25 2009, 5:48PM
“Yet another failure by the NHS and Government, something so simple to redesign to make it foolproof has not been done. If we consider that £12M needs spending on hospital buildings, are we really surprised, but the financial costs cannot outweigh the fact that a young man entering the prime of his life has instead lost his life.”