The Westmanland region reported an event according to Maria's medicine, where the patient suffered a delayed treatment of diabetes.
A man in his 50s is associated with the health center because of that. problems with urinating, severe swelling and increased thirst. During medical visits, 30 kg of unwanted weight loss, strong thirst and high levels of sugar and ketones (acid) appear in the urine. The patient's symptoms are thought to be caused by diabetes, but no acute blood sugar is taken, but the patient is required to return to two fixed sugars in the blood.
Inbound test responses to HbA1c (long-term blood sugar level) show a very high value of 183, which, however, is not followed or worried about.
The patient is contacting the health center again, because he does not feel well and has high blood sugar levels. The patient announces that the worker has stated that he smells like acetone. First of all, the patient should immediately visit the emergency department where he is hospitalized. The patient receives drip, insulin treatment and monitoring, as well as contact with a diabetic nurse and a dietician, and can then be printed with both tablets as an insulin treatment for continuous monitoring at the health center.
The health center has taken several measures to prevent the recurrence of the incident, among other things. how they relate to the answers to the tests.
For more information, contact
Margareta Ehnebom, chief doctor of the Västmanland region
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Every day, 4,000-5,000 visits are made within the care of Västmanland. The vast majority of contacts work well, patients receive good care and good treatment. But in some cases, something goes wrong.
Every patient who is hurt in the care is too much. That's why the Westmannland Region has a zero vision in patient safety work – no patient should be injured in health care. The publication of Lex's reports is part of the long-term and systematic work of the region to improve patient safety.
Lex Maria means that all health professionals have an obligation to report serious mistakes and mistakes in the care or risk of serious injuries. The purpose of Lex's notification is to improve health care through the investigation that is being done and that the Health and Nursing Services Inspectorate makes an impartial assessment of the event. The investigation means that caring can be learned from the mistakes that occur so that they do not recur and that the affected patients and their relatives get clarity about what actually happened.
The region's main task is to contribute to a good life for Westerners. We do this by working with health and medical care, dental care, education, culture, business problems, public transport, regional development and the environment. Västmanland has a central location in Mälardalen. Here you will find good accommodation, services and communications, as well as good conditions for rich free time.