HME713 Clinical Governance


A patient underwent total hip replacement for osteoarthritis.   “TIME-OUT” was performed in the operating theatre and the instrument count was checked and correct.   The operation was uneventful.   After the operation, staff revealed a broken drill bit with a loss of 1 cm at the tip.   The surgeon was informed and following an x-ray examination showed a shadow.  The broken drill bit was later removed from the patient’s lesser trochanter.
The HA identified 19 inpatient suicide cases (including home leave) during the reporting period.    Of the 19 inpatient suicides, 7 inpatients committed suicide by hanging (at curtain rail, door beam or metal rods in toilets / bathrooms using waist belt, strip of cloth torn from bed linen, nylon rope or plastic chain), by bleeding or by stabbing.
“Needle stick injuries occur around the globe, across all staff working within a healthcare environment and in all settings where needles are used” (Gottwald and Lansdown 2014, p.23)
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