Appendix A: ME 1 review form Category Questions Answer Death Expected Was this Death Expected Expected Highly Likely Death was a Possibility Death was Unlikely Very Unlikely Medical Response Appropriate management for Yes the diagnosed condition No Was the patient under the Yes care of an appropriate No specialty Was the patient on an Yes appropriate ward No Drugs Did any drug errors Yes contribute to death? No Falls and Untoward Were there any falls or Yes Incidents significant incidents of harm? No Did they significantly Yes contribute to death No Has there been any Yes complaints/conflict No documented? Is there evidence of Yes communication with No complainee to resolve issue? Operative Procedures Were any unpredictable Yes complications No N/A ICU/HDU Any delay in getting ICU Yes Opinion (Expectation is that No a review occurs within 60 Not Needed minutes) Was a bed available in a Yes timely manner No End of Life Plan Was there a holistic end of Yes life care plan in place in the No final 24 hours of life? Summary Overall during the patient’s Yes episode, is there a No recognisable medical plan of care On balance, might this death Yes reasonably have been Possibly prevented No RCP Methodology RCP Methodology Score 6 Definitely not – Avoidability Score Avoidability Score avoidable Score 5 Slight evidence of – avoidability Score 4 Possibly avoidable – but not very likely
Appendix A: ME 1 review form Category Questions Answer Death Expected Was this Death Expected Expected Highly Likely Death was a Possibility Death was Unlikely Very Unlikely Medical Response Appropriate management for the diagnosed condition Yes No Was the patient under the care of an appropriate specialty Yes No Was the patient on an appropriate ward Yes No Drugs Did any drug errors contribute to death? Yes No Falls and Untoward Incidents Were there any falls or significant incidents of harm? Yes No Did they significantly contribute to death Yes No Has there been any complaints/conflict documented? Yes No Is there evidence of communication with complainee to resolve issue? Yes No Operative Procedures Were any unpredictable complications Yes No N/A ICU/HDU Any delay in getting ICU Opinion (Expectation is that a review occurs within 60 minutes) Yes No Not Needed Was a bed available in a timely manner Yes No End of Life Plan Was there a holistic end of life care plan in place in the final 24 hours of life? Yes No Summary Overall during the patient’s episode, is there a recognisable medical plan of care Yes No On balance, might this death reasonably have been prevented Yes Possibly No RCP Methodology Avoidability Score RCP Methodology Avoidability Score Score 6 – Definitely not avoidable Score 5 – Slight evidence of avoidability Score 4 – Possibly avoidable but not very likely