Brenda Morris

19 Feb 2016 · Coroner ME Hassell · London Inner (North)

The coroner's concerns

1. lack of staff communication about leave conditions
“[the deceased] was allowed weekend leave on the basis that her partner was at home to keep an eye on her, but no member of staff told him this”
2. absence of routine feedback from family after leave
“The weekend before the weekend of her death, Ms [name redacted] partner felt that she had not been well during the weekend leave”
3. unclear medical authorisation process for unplanned leave
“There appears to be confusion about whether a doctor is needed to authorise unplanned leave of an informal patient”
4. inadequate nursing documentation of risk assessments
“Substandard documentation in the nursing records had already been identified before the inquest”

Stated action · before a patient goes on leave

“implement the use of template documentation to ensure that any leave has been appropriately agreed by a doctor”