NHS extends never events list and introduces cost penalties

BMJ 2011; 342 doi: (Published 25 February 2011) Cite this as: BMJ 2011;342:d1263
  1. Susan Mayor
  1. 1London

The NHS has extended the list of preventable events that should never happen during the care of patients by NHS services and introduced financial measures to penalise service providers when these events do occur. But critics have warned that it is not clear how these events will be reported and investigated and how the NHS organisation will learn from them.

The Department of Health announced that it is extending the “never events” list from eight in the previous list to 25. These are defined as very serious, largely preventable patient safety incidents that should not occur if health service providers have put appropriate preventive measures in place.

The new events added to the list include severe harm or death caused by misidentifying patients by failing to use standard wristband identification processes, severe harm or death due to transfusing the wrong type of blood, and severe scalding. Several relate to the incorrect use of drugs. The list was developed after consultation with …

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