Whittington patient’s death was not down to oxygen mix-up, review finds
PUBLISHED: 15:06 10 October 2019 | UPDATED: 15:06 10 October 2019
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An investigation by health chiefs has found that accidentally connecting a patient to medical air rather than oxygen did not contribute to their death.
A "never event" - a serious incident that is entirely preventable - was declared at the Whittington after the incident in August.
A patient who had been resuscitated after cardiac arrest was brought into the emergency department, but instead of connecting them to pure oxygen, a medic attached the ventilator to medical air - a mix of oxygen and nitrogen.
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The person died, and the hospital declared the huge mix-up, but it was found to not be to blame.
A spokesperson for Whittington Health Trust said: "While an initial review indicated that this incident had no effect on the outcome, the patient sadly did not survive.
"However, we take all incidents, regardless of the impact, very seriously and have already taken action to prevent this happening in the future."
All medical air outlets have since been checked and the six that were not labelled have been and ports that were no longer required have been removed.
Staff in the department were all made aware of the incident and the safety actions required.
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