{"id":3425,"date":"2021-05-26T15:32:31","date_gmt":"2021-05-26T14:32:31","guid":{"rendered":"https:\/\/www.tayloremmet.co.uk\/blogs\/?p=3425"},"modified":"2021-05-26T15:32:31","modified_gmt":"2021-05-26T14:32:31","slug":"the-reclassification-of-never-events","status":"publish","type":"post","link":"https:\/\/www.tayloremmet.co.uk\/blogs\/the-reclassification-of-never-events\/","title":{"rendered":"The Reclassification of Never Events"},"content":{"rendered":"

What is a never event?<\/span><\/h3>\n

A Never Event is defined as a serious incident that could have been prevented from occurring. These incidents should have been prevented entirely, and can cause the patient harm, or in some cases, death. Guidance and recommendations are currently in place nationally and should act as a protective system if implemented by the healthcare sector.<\/p>\n

The number of Never Events that take place per year remains consistent and has not fallen recently. Each year approximately 500 Never Events take place that could have, and should have, been prevented.<\/p>\n

The revised Never Events policy along with an updated list of the event categories was published in 2018.<\/p>\n

Some categories and subcategories have been reclassified on the Never Events list. This was done as the strength of the barriers for this category may not be as strong as first determined. The review of the list was undertaken by experts, focus groups and different organisations that have a particular interest in Never Events.<\/p>\n

Why has there been a reclassification?<\/span><\/h3>\n

It has been more than 10 years since the first list of Never Events was published. Initially the list contained 8 categories, which shortly after, rose to 25 categories. In 2020, there was a list of 226 Never Events altogether, which encouraged a reassessment of the existing categories. The overall reasoning that has prompted recommendations of change, was that preventing certain events from occurring was too difficult, meaning they are not preventable and therefore do not fit the definition of a Never Event.<\/p>\n

What recommendations have been made?<\/span><\/h3>\n

The Healthcare Safety Investigation Branch, also known as the HSIB, published a report in January 2021 discussing the analysis on 10 investigations of Never Events. The HSIB\u2019s overall conclusion was that \u201cThe analysis of the 10 Never Events included in this report found barriers that were neither strong nor systemic. These events are therefore not wholly preventable and do not fit the current definition of Never Events.\u201d<\/p>\n

There were three overall recommendations made within the HSIB report:<\/span><\/h3>\n

1\u00a0 \u00a0 –\u00a0 \u00a0 \u00a0NHS England and NHS Improvement should revise the Never Events list to remove events that do not have strong and systemic safety barriers;
\n2\u00a0 \u00a0 –\u00a0 \u00a0 \u00a0Safety barriers to avoid incidents should be developed;
\n3\u00a0 \u00a0 –\u00a0 \u00a0 \u00a0The National Safety Standards for Invasive Procedures policy should be revised to standardise safety critical steps common across procedures.<\/p>\n

What has been reclassified or removed due to weak safety barriers?<\/span><\/h3>\n

A large category featured on the Never Event lists is for \u2018wrong site surgery\u2019. This, in a nutshell, is surgery that has been performed on either the wrong side of the body or on the wrong body part. Wrong site surgery as a category also covers surgery performed on the wrong patient or at the wrong level.<\/p>\n

\u2018Wrong tooth removal\u2019 falls under this category, but upon review and opinions from different dental associations, it has been found that barriers are not strong enough to prevent wrong tooth removals from taking place. Due to this, wrong tooth removal has been excluded from the wrong site surgery category since April 2021. Although this subcategory has been removed from the wider category, it should be mentioned that if this incident occurs, patients should still report it as a \u2018patient safety incident\u2019.<\/p>\n

Another category that has been excluded from the Never Events list this year, is \u2018wrong level spinal surgery\u2019. This is where a surgeon operates on either the wrong side of the spine or at the wrong level of the spine. The issue with this category is that there is a uniqueness when it comes to localisation of the spine, so even the most skilled and specialised surgeons can find spine surgery challenging. Therefore, it has been temporarily excluded from the list whilst improvement is made with the relevant organisations to develop stronger barriers to prevent wrong level spinal surgery from occurring.<\/p>\n

Earlier changes made to the Never Event List<\/span><\/h3>\n

In 2019 an amendment was made to the Never Event list for clarification on the exclusion of local anesthetic blocks for dental procedures. This was to be excluded specifically from the wrong site surgery category. Local anesthetic blocks relate to the injection carried out to numb the mouth before dental work takes place. The reason that it was excluded from the wrong site surgery category is because the barriers of avoiding numbing other arears of the mouth are not strong enough to prevent it from occurring. Therefore, this subcategory was amended in May 2019.<\/p>\n

In 2018, \u2018undetected oesophageal intubation\u2019 was suspended on the list whilst further clarification was investigated. Oesophageal intubation refers to a tube being incorrectly placed in the esophagus. This category is still suspended as a Never Event until further notice.
\nReaders may find it interesting that this list of categories are occasionally revisited.<\/p>\n

Categories that remain on the Never Event list today are:<\/span><\/h3>\n

Surgical<\/strong><\/span><\/h4>\n
    \n
  • Wrong site surgery<\/li>\n
  • Wrong implant\/prosthesis<\/li>\n
  • Retained foreign object post procedure<\/li>\n<\/ul>\n

    Medication<\/strong><\/span><\/h4>\n
      \n
    • Mis-selection of a strong potassium solution<\/li>\n
    • Administration of medication by the wrong route<\/li>\n
    • Overdose of insulin due to abbreviations or incorrect device<\/li>\n
    • Overdose of methotrexate for non-cancer treatment<\/li>\n
    • Mis-selection of high strength midazolam during conscious sedation<\/li>\n<\/ul>\n

      Mental health <\/strong><\/span><\/h4>\n
        \n
      • Failure to install functional collapsible shower or curtain rails<\/li>\n<\/ul>\n

        General<\/strong><\/span><\/h4>\n
          \n
        • Falls from poorly restricted windows<\/li>\n
        • Chest or neck entrapment in bed rails<\/li>\n
        • Transfusion or transplantation of ABO-incompatible blood components or organs<\/li>\n
        • Misplaced naso- or oro-gastric tubes<\/li>\n
        • Scalding of patients<\/li>\n
        • Unintentional connection of a patient requiring oxygen to an air flowmeter<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

          What is a never event? A Never Event is defined as a serious incident that could have been prevented from occurring. These incidents should have been prevented entirely, and can cause the patient harm, or in some cases, death. Guidance and recommendations are currently in place nationally and should act […]<\/p>\n","protected":false},"author":30,"featured_media":3118,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[332],"tags":[730,837,873,1083,1227],"class_list":["post-3425","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinicalnegligence","tag-experts","tag-healthcare-safety-investigation-branch","tag-hsib","tag-newer-event","tag-reclassification"],"yoast_head":"\nThe Reclassification of Never Events | Taylor&Emmet Solicitors<\/title>\n<meta name=\"description\" content=\"A Never Event is defined as a serious incident that could have been prevented from occurring. 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