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Reporting nerve injuries and other reportable notifiable incidents

HOMECHECK
Ideally after any surgery you should contact your patient within 12 hours to see how they are. This is the best possible opportunity to undertake excellent reliable audit of the quality of your care.


EARLY MANAGEMENT
Surgical intervention URGENT treatment is necessary if your patient has sustained persistent IAN injury in relation to third molar surgery, implant or endodontics, you should arrange to remove retained roots, endo or implants causing the injury within 36 hours.

 

Medical intervention There is no evidence for providing high dose steroids and NSAIDs to minimise neural inflammation instead of surgery but may be useful in adjunct or where surgery is not indicated. Patients may benefit from taking early medical treatment;

  • steroids (Prednisolone step down over 5 days (50/40/30/20/10ms)
  • non-steroidal anti-inflammatories (Aspirin or Ibuprofen 400-600mg TDS) to reduce any nerve related inflammation

in addition vitamins B 12 complex (injections or oral) may assist minimising damage to your nerve but there is limited medical evidence to support these supplements.


if the patient complains of severe pain nortriptyline or Pregabalin may be indicated (always check that patient’s medical history does not prevent them taking these drugs).


If your patient has sustained persistent tongue nerve injury in relation to surgery or injections monitoring is advised but referral to specialist is recommended as surgery may be recommended within 12 weeks.

 

REFERRAL
We would advise that you contact us for further information so that we can offer your patient a consultation and or treatment should they need it. You will also be able to provide us with your information about the surgery and any events increasing the risk of nerve injury which will help us treat your patient and with our research. Contact Us


REPORTING patient safety incidents (includes; Adverse events/incidents, clinical incident, critical incident, medical error, clinical error, medical mistake, sentinel event). These events may result in high, moderate, low or no harm (near misses).


All PSIs should be reported anonymously to NRLS and local primary care commissioners should be informed. Permanent harm is defined by NPSA as- arising directly to the incident (surgery) and not related to the natural course of the patient’s underlying condition is defined as permanent lessening of bodily functions, sensory, motor, physiologic or intellectual, including removal of the wrong limb, organ, tooth ad brain damage.


Duty of candour It is a legal requirement that health care providers report nerve damage occurring relating to treatment of your patients.


Care quality commission Dentists and their managers are reminded of the requirements to notify the Care Quality Commission of injuries to the nervous system that last longer than 21 days. These can be reported to the CQC using the form which can be found at www.cqc.org.uk under “Organisations we regulate”.


NEVER EVENTS Clinicians and Patients can report their injuries directly to the NPSA National patient safety agency dataset- *NRLS -National Reporting \nd learning system).HELP desk 0207 927 9500 www.npsa.nhs.uk/staffreports


NRLS records unplanned harm related to NHS treatment

  • Wrong site surgery (includes permanent dentition only, use of LA block on wrong side, initiation of surgery (not necessarily completed extraction)
  • Wrong implant
  • Retained foreign object ( inhaled. swallowed, maxillary antrum displacement)
  • Overdose of midazolam use of Flumazenil to reverse Benzodiazepam overdose
  • Adjacent tissue damage burnt lip, damage to adjacent teeth, nerve injury
  • https://report.nrls.nhs.uk/nrlsreporting/ Or attached primary care reporting sheet (e form attached)


ADVERSE EVENTS Reporting to MHRA of adverse reactions to medications and medical devices (including implants).Yellow card reporting system

 

SENTINEL EVENT StEIS ’Strategic Executive Information System Clinicians in secondary care will report vis DATIX (or similar incident reporting system) for uploading of serious event recording. Incidents included in this data set include:

  • Accident occurring in during attendance for NHS care
  • Assault leading to permanent harm to patient or staff member
  • Confidential information leak
  • communicable infectious diseases
  • Failure to obtain consent where the procedure or treatment results in permanent harm to one or more patients or where the outcome requires lifesaving intervention or major surgical medical intervention or will shorten life expectancy
  • Delayed diagnosis
  • Drug incident wrong IV administration, anaphylaxis
  • Hospital equipment failure
  • Medical equipment failure
  • Safeguarding vulnerable adult
  • Unexpected patient death
  • Allegation professional member of staff shows gross disrespect for dignity of a patient or deceased patient and are considered serious when;
    • verbal and or physical aggression
    • criminal acts involving patients
    • complains about a member of staff or primary care contractor where adverse media interest could occur
    • breach of confidentiality
    • Fraud

http://www.nrls.npsa.nhs.uk/report-a-patient-safety-incident/serious-incident-reporting-and-learning-framework-sirl/

 

 

Useful documents 

URGENT referral documnet LINK 

Care Quality Commission 

Serious injury to a person who uses the service LINK

 

REFERRAL of Trigeminal nerve injury  

LINK