Orkney hospital retrains staff after nosebleed death

Orkney’s Balfour Hospital, in Kirkwall, ordered an investigation after classing the fatality as an “adverse event”.

Marthinus Roos, medical director of NHS Orkney, said that an investigation had been carried out.

He said: “A review is always carried out after any serious clinical incident, the results presented to the family and any lessons learned shared with staff.”

No staff members were reprimanded but the investigators added that “staff education [had been] completed”.

It was one of 82 “adverse events” – meaning something that could have been avoided – in accident and emergency departments nationwide in the year from June 2013, with 37 in Lanarkshire, followed by Greater Glasgow and Clyde with eight.

A spokeswoman for the Scotland Patients Association said over-stretched hospitals and overworked staff were to blame.

The incident in Orkney on 30 November last year was reported as a “clinical care” issue, resulting in death by epistaxis, or nosebleed.

Adverse events are “any unexpected or avoidable event that could have resulted, or did result, in unnecessary serious harm or death of a patient, staff, visitors or the public”.

Lothian recorded six such incidents, as did Fife, where all were reported in Kirkcaldy’s Victoria Hospital. They included two “extreme” events where there was a lack of adequate equipment and where incorrect test results were released.

Four “major” incidents included equipment failure, delays in treatment and an attempted suicide.

NHS Borders, Tayside and Dumfries all recorded five events or fewer, while Grampian reported four incidents, including one where a patient suffered a seizure after going for a cigarette against staff advice.

Another episode saw a patient who had been discharged later collapse at home. And at the Royal Aberdeen Children’s Hospital, the “wrong details” were noted on a blood match but were spotted before a transfusion took place.

NHS Highland logged four adverse events and Forth Valley recorded one. In addition, the NHS boards received a total of 612 complaints regarding their A&E departments over the period.

A spokeswoman for the Scotland Patients Association, said: “Things can go wrong very quickly in a busy A&E department and if you have tired doctors they won’t make good decisions, so this has to be addressed.”

Scottish Conservative health spokesman Jackson Carlaw agreed that hospitals were “under immense pressure” due to a lack of funding and staffing.

“It is no wonder that has led to a catalogue of worrying incidents,” he said.

A Scottish Government spokesman said adverse events were “deeply regrettable” and said it had introduced a national framework to address the issue.

Nosebleeds are rarely fatal, accounting for only four of the 2.4 million deaths in the US in 1999.

Bleeds are due to the rupture of a blood vessel in the nose lining. Rupture may be spontaneous or caused by trauma.

Nosebleeds are reported in up to 60 per cent of the population, with peak incidences in those under ten and over 50, and occur in men more than women.