Public BoD papers 28.04.22

1. Safe

1.3 – Moderate+ Incidents

March 2022 Reference

Grade

Description

Outcome

W68741

Moderate Patient lost to follow up following radiotherapy.

Clinical impact unknown at present. Progressing to full patient safety investigation

Treatment replanned and chemotherapy added to management plan. Progressing to full patient safety investigation.

W68210

Moderate Delayed PET-CT results showed suboptimal coverage of disease site, however radiotherapy had already commenced

W68187

Moderate Delay in commencing anti-cancer treatment because of delays in obtaining required pre-treatment tests.

Clinical impact unknown at present. Progressing to full patient safety investigation.

Clinical impact; patient developed clinical symptoms. Progressing to full patient safety investigation with input from Tameside and Glossop Integrated Care NHS Foundation Trust

W68192

Moderate Delay in scheduling venesection treatment at The Christie Haematology @ Tameside

Clinical impact; patient required further mobilisation and collection of stem cells. Progressing to full patient safety investigation.

W68343

Moderate Stem cells compromised during freezing process.

Clinical impact; patient has required additional procedures and critical care input. Review of unintended event via surgical and critical care mortality and morbidity processes.

W68408

Moderate Recognised, consented, but unintended complications of surgical treatment

30

9