Investigation at Blackpool Victoria after "medical swab" left inside patient

An investigation is underway at Blackpool Victoria Hospital after a medical swab was left inside a patient that had given birth.

The trust that runs the hospital has reported it as a "never ever" event - meaning it should never have happened.

A hospital report states the incident happened in July this year.

The woman was taken into theatre after suffering a haemorrhage shortly after giving birth, in order to be examined under anaesthetic.

A Bakri balloon and vaginal pack were inserted to control the bleeding before the mother was transferred back to the delivery suite for further care.  She was sent home with the swab still in place when it should have been removed.

The report, which was presented to a meeting of the board of the Blackpool Teaching Hospitals NHS Foundation Trust, says: “The Bakri balloon was removed, with no documentation of the vaginal pack being removed and the mother went home with this still in situ.

“The next day, the mother rang the maternity unit to inform that she had removed the vaginal pack and that she was not aware it was there. The mother was advised to bring the pack with her the following day to her appointment in the maternity day unit.”

While an initial review of the incident found some immediate lessons could be learned, the report adds: “A Patient Safety investigation is in progress and stakeholders including the CQC (Care Quality Commission) and ICB (Integrated Care Board) have been informed of the incident being a ‘Never Event’.”

The board meeting also heard Blackpool’s Maternity Unit has a shortfall of 11 midwives, but despite this members were assured the unit is safe.

Part of the reason for the shortfall is the increasing complexity of health issues from expectant mothers which puts more pressure on the maternity team.

A recent independent review had recommended a birth to midwife ratio of 21.3 births per midwife, whereas in 2022 the ratio was almost 23 births per midwife.