The Rising Trend in Medical Negligence claims regarding Iron Infusions
Taylah McGregor
Medical Negligence Lead | NSW Business Development at MedicoLegal Assessments Group Pty Ltd
Hi,
I hope that your September has been pleasant!
Thank you once again for your patience over the past few months as we experienced a few changes in our Medical Negligence Team.
Ellie who was one of our part time law student team members has moved onto a position with Brydens Law Firm in early August, whilst we sincerely miss her, we’re excited to see her flourish and continue to grow.
Stephanie joined our team in July and is now confidently assisting specialists and clients alike with medical negligence claims.
Our Lovely Rose, who was assisting us whilst understaffed received a promotion and no longer was able to devote time to assist us. We miss her as well but congratulate her on her promotion and enjoy watching her succeed!
And lastly, earlier this month we have welcomed our newest recruit, Anh! A big thank you to everyone who welcomed her with open arms.
First of all, I just wanted to share the statistics for our Medical Negligence Triage Service from August 2024.
In August there were 50 Medical Negligence Triage Cases lodged through our service!
Out of those 50 cases, 34 of them requested Free Preliminary Opinions, 7 of them proceeded to teleconferences, 6 of them proceeded to a full report while 46 of those requests are still currently in progress.
6 out of the 34 Free Preliminary Opinions requested received a “negligence not probable” response from the specialist and did not proceed any further.
We are happy to have been able to provide the plaintiffs with the closure they need as well as helping them avoid the emotional and financial burden of proceeding straight to a report, only to receive an unfavourable/unsupportive opinion
This month’s topic is The Rising Trend in Medical Negligence claims regarding Iron Infusions
For this month’s issue I wanted to give two of our specialists a platform to discuss a topic that is a growing trend I’ve noticed becoming increasingly common since I started in the Medical Negligence field.
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Iron infusion is a procedure in which iron is delivered to your body intravenously. Iron infusions are generally prescribed by doctors to treat iron deficiency (anaemia). Treatment for Iron Deficiency is typically treated with dietary changes such as ingesting more iron rich foods, and iron supplements. Iron Infusions should only be implemented if a person cannot take iron orally, cannot absorb iron adequately through the gut, cannot absorb enough iron due to suffering blood loss, or need to immediately increase iron levels to avoid a more severe health issue.
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Iron deficiency is a fairly common nutritional deficiency in Australia, I myself am iron deficient and take oral supplements to treat it. Statistically about 8% of adult women are iron deficient, with less than one-quarter of that being anaemic. Lifestyle choices such as dietary restrictions can affect your iron levels. As a vegetarian I have been diagnosed as iron deficient since 2018 and have been taking oral supplements in addition to eating more iron rich foods since to treat this.
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As with any form of medical treatment, there are side effects that could potentially be experienced such as headache, nausea, joint pain, metallic taste in mouth and changes to blood pressure.
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Skin staining is a side effect that can occur when receiving an iron infusion. Skin staining may occur due to a leakage of iron into the tissues around the needle site. It is one of the less common side effects, however the stain can be long lasting or even permanent which can lead to emotional distress and self-image issues.
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Here at MAG, we’ve noticed a rise in medical negligence claims concerning skin staining as a result of an iron infusion, which is why I’ve invited Ms Emma Gambrell-Ball, Nurse as well as A/Prof Stephen Shumack, Dermatologist to provide their insight as to the increase in iron infusion skin staining claims and their impact on the individual claimants.
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As an expert nurse and midwife with extensive experience in managing extravasation injuries, particularly following intravenous iron administration, I have observed a significant increase in skin staining claims. This rise points to key issues related to patient care, procedural techniques, and informed consent.
One primary reason for the increase in claims is technical errors during the administration of iron infusions. Improper IV cannula insertion or leakage of the infusion solution outside the vein (extravasation) can lead to iron deposits in the surrounding tissue, causing skin staining. This issue is exacerbated by the inadequate training and experience of some healthcare professionals. All staff involved in prescribing, administering, and monitoring intravenous iron must be thoroughly trained and competent. Following a set protocol that outlines best practices for intravenous iron administration, including skilled cannulation and vigilant monitoring for adverse effects, is crucial.
Additionally, patients may not be fully informed about the potential risks and side effects of iron infusions, such as skin staining. Informed consent should involve a thorough discussion of all possible outcomes, ensuring that patients understand the risks involved. This step is essential to reduce the likelihood of legal claims if complications occur. There should always be a clear indication for using intravenous iron, and patients must be well-informed about the procedure and potential adverse effects, including skin staining.
The impact of skin staining on patients can be profound.
Psychologically, the discoloration can cause significant distress due to its potentially permanent nature, affecting self-esteem and body image.
Physically, some patients experience discomfort or pain, particularly if there is tissue damage or inflammation at the staining site.
Socially and professionally, visible skin staining can affect a patient’s interactions and work life, leading to feelings of embarrassment and social withdrawal.
Financially, patients may face additional medical costs for treatments like repeated laser sessions over one to two years to reduce or remove skin staining, although staining can sometimes be permanent. They may also incur indirect costs, such as lost wages if the condition impacts their ability to work.
To minimise the risk of iron staining, several strategies should be implemented.
Healthcare professionals must ensure appropriate vein selection, secure the cannula, administer an IV flush prior to commencing, and closely monitor the infusion site, during. Patients should be advised to report any pain, irritation, or swelling at the infusion site immediately. In cases of extravasation and persistent staining, prompt management is necessary to mitigate the extent of damage. Additionally, healthcare providers should avoid administering infusions to patients who are unable to report symptoms, such as those who are anesthetised.
By implementing comprehensive staff training, enhancing patient education, and adhering to established best practices for intravenous iron administration, the incidence of iron infusion-related skin staining can be significantly reduced.?
Utilising patient information brochures about iron staining, such as those provided by the BloodSafe organisation, which are available in multiple languages, can further support informed consent. When intravenous iron is indicated, and patients opt for the infusion, it is crucial to document the discussion about all potential risks, including discoloration or staining.?
This thorough approach will improve patient outcomes and satisfaction and ultimately decrease the number of medical negligence claims associated with this procedure.
领英推荐
~Ms Emma Gambrell-Ball, Expert Nurse & Midwife
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As indicated above by both Ms Gambrell-Ball and Ms McGregor, permanent staining from Iron infusions is becoming much more common over the last few years. ?This is because these infusions are themselves becoming more common as the facilities for doing them expand, and a one-off infusion are often seen as the “easy way out” compared to long tern oral Iron supplements and their often-mild GIT upset.
A common theme that I encounter with the negligent claims that I see is the lack of recognition of this issue by the infusion nurse and thus the lack of an immediate response to the patients’ complaints of pain and swelling at the infusion site. ?If the infusion had been stopped at the first indication that it may have tissued, the often-extensive areas of staining could have been significantly contained. ?This is very important as these patients are often young females where the significant cosmetic impact of extensive Iron staining on the arm can be devastating.
Treatment of the Iron staining involves multiple specialist laser sessions over a period of many months, which can be painful, and rarely results in compete clearing of the stain.
~ A/Prof Stephen Shumack, Dermatologist
Spotlight on our Medical Negligence Specialists
Dr Milan Djeric is a general surgeon employed at the Royal Hobart Hospital since 2003 as a VMO, and locum VMO from 1997 to 2003. he is currently attached to the acute surgical unit and also perform elective surgery and participate in the 'on call' general surgical roster. he is also involved in teaching surgical trainees and students.
From 1997 to March 2019, he worked at his own private practice, based at the Hobart Private Hospital, where he performed elective lists and consulting.
Since July 2018, he has been doing locum general surgical work at various hospitals in QLD, NSW and VIC
Dr James Muir is a life-long resident of Brisbane who qualified as a specialist dermatologist in 1994. Besides practicing at South East Dermatology, he is the Director of the Department of Dermatology at the Mater Hospital, South Brisbane. As the dermatologist for ‘Telederm National’, a website run by the Australian College of Rural and Remote Medicine, Dr Muir also delivers dermatological care to all parts of Australia via the internet. Dr Muir has a special interest in skin cancer and skin disease in the elderly. He is actively involved in medical education he regularly lectures on dermatology to other specialists, general practitioners, medical students, pharmacists and the general public.
Ms Kimberly Flood is a Registered Nurse with 14 years’ experience working in NSW and Victorian rural and remote areas, emergency nursing and critical care nursing. Experience in clinical governance, serious incident investigation, root cause analysis team leader, plaintiff expert reports for medical negligence matters. Bachelor of Nursing, Graduate Certificate Critical Care, Master of Nurse Education, previous lecturer and assessor for the First Line Emergency Care Course, Australian College of Nurses, previous member of multiple NSW Health state committees.
Please do not hesitate to contact me with any queries, questions or concerns?via my direct line or email address.
Kind regards
Taylah McGregor
Medical Negligence Lead & NSW Business Development
Direct Line: (02) 9056 4471
Medical Negligence Bookings & Queries: (02) 8090 7616
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