Acute General Medicine mortality review template



Mortality & Morbidity formal review templateReviewer:Review Meeting date:Reason for review:Death(pre-selected)Death(randomly selected)ComplaintUntoward incidentPatient detailsName:Hospital number:DOB:(sticker)Date of admission to ward:Ward:Date of death/ transfer:Responsible consultant:Description of case:Describe any care quality concern(s), specifying domain where applicablePre-Haematology careYes/ NoAcute management Yes/ NoWard ManagementYes/ NoDTU ManagementYes/ NoOutpatient management Yes/ NoDiagnosisYes/ NoInvestigationsYes/ NoEscalation of careYes/ NoPalliative phaseYes/ NoOUH care prioritiesHCAI Pressure area Nutrition Falls VTEMental capacity issuesYes/ NoDepartmental prioritiesWithin 30 days of Chemotherapy Within 100 days BMTHTA compliance Jacie ComplianceYes / NoCommunicationFamily Patient Clinical teams OthersYes/ NoDrug/ medication-relatedYes/ NoInteraction with other servicesGP Triage ED ITU OtherYes/ NoHaematology team workingSkills Supervision Work-load Nursing-related Handover OtherYes/ NoOtherYes/ NoConclusionFor all deaths, complaints and untoward incidents:Were any care quality concerns raised?Yes/ NoSuboptimal care: but different management would have made NO DIFFERENCE to the outcome. (Death unavoidable)Yes/ NoSuboptimal care: different management MIGHT have changed the outcome. (Avoidable death possible)Yes/ NoSuboptimal care: different management WOULD PROBABLY have changed the outcome. (Avoidable death probable)Yes/ NoAre there departmental learning’s?If yes please list in action plan.Yes/ NoAction plan (to be documented in Clinical Governance minutes and actions table)Action agreedPerson responsibleDate for completionPresented at Clinical Haematology Clinical Governance meeting (date): Management of M&M review process and confidentiality:Speciality coordinator to Dr Peniket will receive ward based ‘Screening table (H.66)’ for discussion at the service meeting from both clinical teams electronically.The Screening table is displayed and reviewed at the Service meeting and deaths for formal review (H.74) are allocated to non-treating team or consultant/Senior SpR. The formal reviews (H.74) are received by the secretary to Dr Peniket from the reviewer, before the day of the Service meeting.The Speciality coordinator will display the review at the service meeting.The action plan from the review will form part of the meeting minutes and actions.The reviews will be filed with the Service meeting minutes and action plans (securely in paper and electronically) but will not be circulated with the minutes of the meeting. The anonymised formal review will cut and pasted into the meeting minutes.Local learning will be shared at Directorate Clinical Governance, where appropriate this will be escalated to Divisional Clinical Governance.Author: Sandy Hayes, Quality manager Clinical Haematology.OUH approval: Dr Ian Reckless, Assistant Medical Director (Clinical governance)ReviewNameRevisionDateVersionReview dateSandy Hayes, Quality managerCompliance with OUH ‘Conclusions’ section. Revision of M&M management pathway to include notification forms.April 20132.0March 2015Sandy Hayes, Quality managerDesignation change, I RecklessMay 20132.1May 2015Sandy Hayes, Quality managerInsertion of mental capacity. Review of processApril 20162.2April 2018 ................
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