This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at https://www.theguardian.com/society/2017/nov/24/mortuary-errors-avoidable-if-bodies-treated-like-living-patients
The article has changed 3 times. There is an RSS feed of changes available.
| Version 0 | Version 1 |
|---|---|
| Mortuary errors 'avoidable if bodies treated like living patients' | Mortuary errors 'avoidable if bodies treated like living patients' |
| (2 months later) | |
| Many serious mistakes – including identity mix-ups – could be avoided, according to study of 132 incidents reported in England | |
| Press Association | |
| Fri 24 Nov 2017 00.05 GMT | |
| Last modified on Mon 27 Nov 2017 13.14 GMT | |
| Share on Facebook | |
| Share on Twitter | |
| Share via Email | |
| View more sharing options | |
| Share on LinkedIn | |
| Share on Pinterest | |
| Share on Google+ | |
| Share on WhatsApp | |
| Share on Messenger | |
| Close | |
| Serious mistakes made in mortuaries – including identity mix-ups - might be avoided if the deceased received the sort of management standards given to the living, according to a study. | Serious mistakes made in mortuaries – including identity mix-ups - might be avoided if the deceased received the sort of management standards given to the living, according to a study. |
| Postmortems on the wrong bodies, and even people being buried or cremated by the wrong family, are some of the errors spotted by researchers who looked into 132 incidents reported in England to a national NHS database between 1 April 2002 and 31 March 2013. | Postmortems on the wrong bodies, and even people being buried or cremated by the wrong family, are some of the errors spotted by researchers who looked into 132 incidents reported in England to a national NHS database between 1 April 2002 and 31 March 2013. |
| Weaknesses in, or failures to follow, protocol and procedure, poor communication and informal working practices – all of which have been blamed in safety incidents involving living patients – were also found. | Weaknesses in, or failures to follow, protocol and procedure, poor communication and informal working practices – all of which have been blamed in safety incidents involving living patients – were also found. |
| Among the incidents discovered by the researchers who looked at the storage, management or disposal of deceased patient remains, were 25 errors in postmortem examination, or examinations on the wrong body, according to the study in the Journal of the Royal Society of Medicine. | Among the incidents discovered by the researchers who looked at the storage, management or disposal of deceased patient remains, were 25 errors in postmortem examination, or examinations on the wrong body, according to the study in the Journal of the Royal Society of Medicine. |
| There were 31 incidents involving the disposal of bodies, including 25 bodies which were released to an undertaker by mistake, with nine buried or cremated by the wrong family. | There were 31 incidents involving the disposal of bodies, including 25 bodies which were released to an undertaker by mistake, with nine buried or cremated by the wrong family. |
| They were 54 incidents linked to problems with the storage of bodies or body parts, while 43 incidents concerned problems with the management of bodies. There were three incidents which led to no harm and another which involved a report of thefts from bodies. | They were 54 incidents linked to problems with the storage of bodies or body parts, while 43 incidents concerned problems with the management of bodies. There were three incidents which led to no harm and another which involved a report of thefts from bodies. |
| Nearly a quarter of all reported incidents in the study involved foetuses, according to the research. | Nearly a quarter of all reported incidents in the study involved foetuses, according to the research. |
| Scandals such as the removal and retention of organs from children who died between 1988 and 1996 at Alder Hey children’s hospital centres in Liverpool, show the public outrage when organisations fail to respect the dead. | Scandals such as the removal and retention of organs from children who died between 1988 and 1996 at Alder Hey children’s hospital centres in Liverpool, show the public outrage when organisations fail to respect the dead. |
| The study points outs that “strictly speaking, a dead person cannot be harmed but civilised society expects that, after death, someone’s body will be accorded the same dignity and respect as during life”. | The study points outs that “strictly speaking, a dead person cannot be harmed but civilised society expects that, after death, someone’s body will be accorded the same dignity and respect as during life”. |
| It concludes: “Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. | It concludes: “Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. |
| “Safe mortuary care may be improved by applying lessons learned from existing patient safety work.” | “Safe mortuary care may be improved by applying lessons learned from existing patient safety work.” |
| Grieving friends and relatives were left “devastated” when told about the treatment of their loved ones and, in almost all cases, the hospital authorities were recorded as having informed the family of what had happened. | Grieving friends and relatives were left “devastated” when told about the treatment of their loved ones and, in almost all cases, the hospital authorities were recorded as having informed the family of what had happened. |
| Misidentification and cataloguing failures, problems in communication between the mortuary and other departments, poor written documentation, staff misconduct, refrigerator malfunctions, lack of leadership, fatigue, overwork and out-of-hours working, were identified as some of the contributory factors. | Misidentification and cataloguing failures, problems in communication between the mortuary and other departments, poor written documentation, staff misconduct, refrigerator malfunctions, lack of leadership, fatigue, overwork and out-of-hours working, were identified as some of the contributory factors. |
| The size of the deceased, ranging from them being too big to fit into standard refrigerators or small foetal remains, which were overlooked or incorrectly retained, were also among the storage issues. | The size of the deceased, ranging from them being too big to fit into standard refrigerators or small foetal remains, which were overlooked or incorrectly retained, were also among the storage issues. |
| Physical damage was caused in some instances when a “patient’s body was not refrigerated over weekend rendering body unsuitable for viewing by relatives”. | Physical damage was caused in some instances when a “patient’s body was not refrigerated over weekend rendering body unsuitable for viewing by relatives”. |
| The study also found: “Decomposition resulting from storing bodies for too long or at too high a temperature was the commonest reported cause, occurring in 15 incidents. | The study also found: “Decomposition resulting from storing bodies for too long or at too high a temperature was the commonest reported cause, occurring in 15 incidents. |
| “In two, the bodies decomposed before postmortem examination, and in the third, the coroner ordered a second postmortem that could not be undertaken due to the state of the body. | “In two, the bodies decomposed before postmortem examination, and in the third, the coroner ordered a second postmortem that could not be undertaken due to the state of the body. |
| “The other cases of decomposition caused distress to bereaved relatives; they were either unable to view the body or saw it in a mutilated state. Seven reports described bodies that were disfigured due to being accidentally dropped or struck while being moved around the mortuary.” | “The other cases of decomposition caused distress to bereaved relatives; they were either unable to view the body or saw it in a mutilated state. Seven reports described bodies that were disfigured due to being accidentally dropped or struck while being moved around the mortuary.” |
| Iain Yardley, the study’s lead author and a consultant paediatric and neonatal surgeon, added: “Serious incidents involving a dead body are uncommon. | Iain Yardley, the study’s lead author and a consultant paediatric and neonatal surgeon, added: “Serious incidents involving a dead body are uncommon. |
| “However, the findings of our study serve as a warning to those responsible for the management of mortuary services of the significant risks inherent in such services and the potentially devastating incidents that can occur if these risks are not mitigated and errors are allowed to go unchecked.” | “However, the findings of our study serve as a warning to those responsible for the management of mortuary services of the significant risks inherent in such services and the potentially devastating incidents that can occur if these risks are not mitigated and errors are allowed to go unchecked.” |
| NHS | |
| Health | |
| news | |
| Share on Facebook | |
| Share on Twitter | |
| Share via Email | |
| Share on LinkedIn | |
| Share on Pinterest | |
| Share on Google+ | |
| Share on WhatsApp | |
| Share on Messenger | |
| Reuse this content |