Wrong Bowel Segment Removed in Cancer Patient
A cancer patient underwent surgery during which the incorrect part of their bowel was removed, according to a recent report.
This incident is among 10 "never events" recorded over the past 12 months by Betsi Cadwaladr University Health Board, the organization responsible for managing NHS services in north Wales.
Details of Never Events
The report categorizes the 10 never events as follows: five involved "wrong site" procedures, two concerned incorrect implants, two involved retained objects such as swabs left inside patients, and one involved medicine administered via the incorrect route.
Incident at Ysbyty Gwynedd
In one specific case at Bangor's Ysbyty Gwynedd, a surgeon identified a very visible tattoo or marking, which was assumed to indicate the location of the patient's tumour.
"This led the surgeon to take out the segment of bowel that did not have the cancer in it," said the report.
Following this, the patient has undergone further investigations in preparation for additional surgery.
Incident at Maelor Hospital
Another case involved a patient at Wrexham's Maelor Hospital who attended a dermatology one-stop clinic after being referred through an Urgent Suspected Cancer clinical pathway. The patient received cryotherapy treatment, which involves applying extreme cold to destroy cancer cells.
The patient was also scheduled for a minor operation on the same day. After this procedure, the patient informed the clinic nurse that the incorrect area had been treated, prompting further surgery to be performed that same day.
The report notes that the investigation into this incident is ongoing and is scheduled to be reviewed at a meeting on Thursday.
