Brian Gillard

1. 1. patient transfer without oxygen supervision

   “During his admission to the Royal Bolton Hospital on the 28" February 2015 his oxygen requirements increased and he was seen by the Respiratory Nurses who arranged for him to have increased Ambulatory Oxygen at home following his discharge from the Hospital on the 14" March 2015”

2. 2. inadequate handover of oxygen needs

   “There was no handover in relation to Mr [name redacted] transfer from the Emergency Department at the Hospital to D1 Ward at the Hospital, particularly in relation to his need for Ambulatory Oxygen and subsequently he was taken to the toilet without the use of Oxygen”

3. 3. systemic review of transfer protocols

   “The evidence raised concerns that to review the above issues”

No published response was found on judiciary.uk.