Lessons from Gosport: If you have concerns, make someone aware

Revelations about events at Gosport Memorial Hospital highlight the need for nurses to know the intended use of medicines, and to make someone aware if they have concerns

Revelations about events at Gosport Memorial Hospital highlight the need for nurses to know the intended use of medicines, and to make someone aware if they have concerns

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The review into hundreds of untimely deaths at Gosport War Memorial Hospital in Hampshire raises several important issues for nurses and other healthcare staff.

The Gosport independent panel report into deaths at the hospital in the 1990s, published on 20 June, found that 456 patients died after being prescribed opioid drugs which they did not need.

The report says that if the nurses who originally raised concerns had been listened to, these deaths could have been avoided. It is vital that we learn from this report as a matter of urgency.

Dangerous practices which are difficult to root out

Relatives of the deceased need to know the truth about what happened at the hospital, and healthcare staff across the UK need to be aware of the issues so they can examine their own practices.

Discussing the report, Sir Brian Jarman, head of the Dr Foster unit at Imperial College London, said it is likely that similar events were happening in other hospitals.

I agree. Around 1.5 million staff are employed by the NHS across the UK, and there will likely be dangerous practices which are difficult to root out. A hierarchical system persists that means questioning practices can sometimes be met with threats, or concerns disregarded by more senior staff.

What nurses need to know

In the case of Gosport Memorial Hospital, it appears that high doses of opiates were administered to patients who were not in pain, often via a syringe driver. But when a group of night nurses questioned the practice in 1991 – meeting with managers with support from the RCN – their concerns appear to have been disregarded.

This case has also highlighted the need for all nurses to be aware of the intended use and licences for medicines, as well as any side effects, normal doses and drug-on-drug interactions, as outlined in the ‘preserving safety’ section of the Nursing and Midwifery Council (NMC) code: ‘make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines’.

Knowing when to challenge

We also need to consider whether patients are opioid naïve (not used to taking these medicines) or whether they have developed a tolerance through continued and increasing use of these medications.

Renal and hepatic impairment must also be taken into account. This may reduce a patient’s ability to metabolise and eliminate opioid medications, resulting in an accumulation in the body with potentially lethal effect.

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Nurses need this information so that they know when to challenge practice. They also need to know how to challenge practice if they have concerns, but with the NHS remaining one of the most hierarchical organisations outside of the military, whistle-blowers can be silenced all too easily.

Effects of Shipman case

Agency staff don’t get rebooked, bank staff don’t get further shifts, and permanent staff are at risk of disciplinary action, with jobs and careers at stake. But it is important to remember that nurses have a responsibility under the NMC code to protect patients and the public, and raise concerns immediately and take appropriate action if they come across situations that put patients or public safety at risk.

Although cases like those seen at Gosport may make staff anxious about using certain medications, practitioners should not be afraid about using opiate medications appropriately.

I was involved in examining the crimes of Harold Shipman, the GP who was convicted of murdering patients under his care. During work on legislation to help prevent such crimes happening in the future, it became apparent that practitioners were certainly more cautious, which is no bad thing.

Unnecessary pain

But we don’t want patients being left in unnecessary pain due to clinicians’ fear of using this type of medication appropriately. Opiates are very effective for relieving pain and other symptoms, but we need to assess each individual patient, considering all of the contra-indications, cautions, risks and clinical need.

We also need to consider our own professional code, ensure appropriate policies and procedures are in place, and that organisations have considered their role with regard to clinical governance.

It may help to remember this rhyme: Prevent things getting worse. Work smart as a nurse. Concerns about care? Then make someone aware.

Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University 



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