Coroner calls for change after co-codamol overdose

A coroner is calling for paramedics to have GP records "readily available" after the death of a 57-year-old who accidentally overdosed on co-codamol.

Susan Young died at her home in West Sussex having taken too many of the pain killers she had been prescribed for an ear infection.

Penelope Schofield, senior coroner for West Sussex, Brighton and Hove, told NHS Sussex Integrated Care Board that action needed to be taken to prevent future deaths.

NHS Sussex said all record sharing systems were correctly set up at Mrs Young's GP practice.

Ms Schofield's report said: "Sadly due to the pain she was in Susan took too many tablets over a short period of time and this led to a fatal toxicity."

She said there was no evidence that her death in December 2022 was "a deliberate act to end her life".

An inquest found there was a short time when an antidote could have been given, but paramedics were not aware she had been prescribed the painkiller.

A South East Coast Ambulance Service NHS Foundation Trust (Secamb) spokesperson said: “We are in the process of providing a full response to the coroner.

“With our system partners, we are working to provide greater access to patient records, when of benefit, to improve patient care.”

Ms Schofield said expert evidence heard at the inquest had said "there was a good chance that Mrs Young would have survived" had the overdose been recognised earlier.

She added: "As the ambulance service did not have the GP records readily available to them this meant that there was a missed opportunity to treat Mrs Young appropriately."

The chief nursing officer at NHS Sussex said the ambulance service did not appear to be accessing record reviews from the GP practice "as often as other providers do".

They said further enquiries may be needed to understand Secamb's "systems, processes and their understanding of what is available to them".

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