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recurance

Lee Hollman

26 Mar 2014 · Coroner Karen Henderson · West Sussex

The coroner's concerns

  1. 1. inaccurate medical records

    “Failure to maintain sufficiently accurate and updated medical records”
  2. 2. inaccurate repeat prescription records

    “Failure to remove Trazodone from the repeat prescription record”
  3. 3. outdated dosage information

    “Failure to delete the 'old' dosage of Quetiapine from the relevant medical records”
  4. 4. ineffective repeat prescription system

    “The lack of an effective system to issue repeat prescriptions”
  5. 5. non-compliance with repeat prescription guidelines

    “Failure to review patients within their own guidelines with regard to repeat prescriptions”

Responses

2014-0135-Response-by-Riverside-Surgery.pdf ↗· Royal College of General Practitioners

Stated action

“The medication prescribing process for patients under the care of the CMHT has been revised in the following key respects: 1. Upon seeing a patient recently reviewed by the CMHT, we consider whether we are in possession of the most up to date correspondence and record any issues arising. This informs further collaboration with the CMHT and promotes timely communication between the two organisations. 2. Correspondence received from the CMHT is sent to the GP responsible for ongoing prescribing of”
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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

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Lee Hollman · Recurance