A hospital patient who went in for a bladder procedure came out with a circumcision instead after a hospital blunder.
His notes are believed to have been mixed up with those of another patient last September at the University Hospital of Leicester NHS Trust.
The unnamed man should have been getting his bladder inspected in a cystoscopy, according to a ‘never event’ report.
Never events are serious mistakes that could have been prevented and are considered so shocking they should never occur.
A report on never events by the Leicester City Clinical Commissioning Group also revealed that a swab was left inside a patient following nasal surgery.
In April one patient had surgery intended for a man with a similar name and a patient had a hip implant on the wrong side.
Other ‘never events’ at the hospital
January: Unintentional connection of a patient requiring oxygen to an air flow meter (measures how much air is moving through a tube)
March: Swab left in a child who underwent surgery to remove small lumps of tissue at the back of his nose
April: Unintentional connection of a patient requiring oxygen to an air flow meter
Man had incorrect surgery due to him having a similar name to another patient
May: Patient had incorrect surgery due to the consent process not being robust enough. Failure to learn from a previous never ever was listed as a factor
June: Patient had an X-ray on their blood vessels in an incorrect place. Failure to learn from a previous never ever was listed as a factor
September: Man was circumcised when he consented to a bladder inspection. Failure to learn from a previous never ever was listed as a factor
November: Hip implant was fitted to the wrong side of a patient
The report said: ‘Failure to demonstrate learning from never events has been a concern for Leicester, Leicestershire and Rutland commissioners and partners for some time.
‘The CCG [clinical commissioning group] has an important role in continuing to support UHL to achieve their quality and safety ambitions, and intends to do this modelling the comprehensive and collaborative approach described within the CQC [Care Quality Commission] report.
‘This will be achieved through continuing to strengthen our relationships and aligning our improvement approach around a common set of clinical priorities.’
The hospital’s director of safety Moira Durbridge said: ‘We remain deeply and genuinely sorry to those patients involved, and of course we have personally apologised to each one.
‘We are committed to learning and improving and have enshrined this work into our clinical priorities within our quality strategy for 2019/20.’
Director of nursing for the commissioning group said: ‘We appreciate the distress these incidents cause to patients and their families.
‘As commissioners, we monitor closely the number of patient safety incidents and serious harm reported during a patient’s stay at the University Hospitals of Leicester.
‘And are working with the trust to support them to improve quality and safety for patients.’
