Recurring concern
Unsafe management of significant bleeding
- Reports that mention this concern
- 8
- Times this concern has been raised
- 10
- Stated actions linked to this concern
- 17
What this concern includes
Includes failures of controls specifically dedicated to preventing, recognising, assessing, escalating, investigating or treating significant bleeding, including bleeding associated with medicines, procedures or defined clinical hazards.
What is not included
- Excludes generic staff training, documentation, communication or staffing deficiencies not explicitly tied to significant bleeding management.
- Excludes unrelated medication, diagnostic, procedural or deterioration concerns where bleeding is not the specific hazard being controlled.
- Excludes the mere absence or use of clinical guidance when the guidance is not specifically concerned with significant bleeding.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Reports and published responses 8 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised2
Omission of covert bleeding from the Trust Drills & Skills Booklet
Failure to consider bleeding as a cause of maternal deterioration
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Mid and South Essex NHS Foundation Trust
- Royal College of Obstetricians and Gynaecologists
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
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Mid and South Essex NHS Foundation Trust
Embed deterioration recognition, concealed-bleeding assessment and escalation training in PROMPT, induction, local teaching, drills and written staff communications.
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Royal College of Obstetricians and Gynaecologists
Provide guidance on preventing and managing postpartum haemorrhage, including clinical assessment, monitoring, escalation and multidisciplinary response.
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Royal College of Obstetricians and Gynaecologists
Provide guidance on maternal collapse, including early-warning observation, systematic cause identification, ongoing assessment and concealed-haemorrhage diagnosis.
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Mid and South Essex NHS Foundation Trust
Implement the OBS UK obstetric bleeding care bundle covering risk assessment, quantitative blood-loss measurement, escalation, and rapid clotting tests.
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Mid and South Essex NHS Foundation Trust
Implement the national MEWS observation package and escalation policy, including trigger-team referral and mandatory maternity-inpatient use.
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Concerns raised1
Failure to treat bleeding in pregnancy as potentially serious until proven otherwise
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Sherwood Forest Hospitals NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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Sherwood Forest Hospitals NHS Foundation Trust
Update, ratify and disseminate the Antepartum Haemorrhage guideline, including immediate assessment, worst-case assumptions, telephone triage, escalation, and documentation requirements.
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Sherwood Forest Hospitals NHS Foundation Trust
Disseminate the RED React, Escalate, Diligent prompt cards and associated guidance on managing and escalating bleeding.
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Sherwood Forest Hospitals NHS Foundation Trust
Provide individualised support and training to staff who do not understand the amended guideline.
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Sherwood Forest Hospitals NHS Foundation Trust
Continue multidisciplinary review of Antepartum Haemorrhage cases through the weekly Triggers meeting, escalating incidents and learning when required.
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Concerns raised1
Upper GI Bleeding Management and Principles of Care guidance no longer fit for purpose
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Betsi Cadwaladr University LHB
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Betsi Cadwaladr University LHB
Update the Upper GI Bleeding Management and Principles of Care guideline to align with NICE and British Society of Gastroenterology guidance.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Betsi Cadwaladr University LHB
The upper gastrointestinal bleeding guideline was updated, follows NICE and British Society of Gastroenterology guidance, and is scheduled for review.
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Concerns raised1
Failure of MPDS to account for the duration of persistent bleeding
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- International Academies of Emergency Dispatch
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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International Academies of Emergency Dispatch
Implement new language defining SERIOUS Haemorrhage and structuring its Key Question to identify persistent, uncontrolled bleeding more definitively.
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Concerns raised1
NICE guidelines inadequately addressing slow intracranial bleeding after falls in elderly patients
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- National Institute for Health and Care Excellence
- Shaw Healthcare Limited
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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National Institute for Health and Care Excellence
Conduct the ongoing surveillance review of the head injury guideline to determine whether it requires updating.
-
National Institute for Health and Care Excellence
Publish the final surveillance review decision in September 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
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Shaw Healthcare Limited
NICE guidelines do not apply to the organisation, so it will not undertake work to address their adequacy.
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Shaw Healthcare Limited
The Chief Executive of NICE is responsible for responding to concerns about the adequacy of NICE guidelines.
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National Institute for Health and Care Excellence
Existing NICE head-injury guidance already applies to injuries caused by both direct and indirect trauma.
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Concerns raised1
Lack of literature informing anticoagulant therapy patients about the steps to take in response to a brain bleed
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised2
Lack of staff knowledge, application and implementation of guidelines for managing bleeding associated with thrombolytic therapy
Lack of staff knowledge, application and implementation of protocols for managing massive blood loss
Linked response
- Pennine Acute Hospitals NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Pennine Acute Hospitals NHS Trust
Circulate and maintain the new thrombolysis policy on the Trust intranet.
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Pennine Acute Hospitals NHS Trust
Deliver thrombolysis and bleeding-risk training to Critical Care staff.
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Pennine Acute Hospitals NHS Trust
Deliver mandatory training on thrombolysis policies and associated bleeding risks to medical staff.
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Concerns raised1
Lack of defined assessment and management steps for variceal bleeding
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Cardiff & Vale University LHB
- Leeds Teaching Hospitals NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Leeds Teaching Hospitals NHS Trust
Share Leeds emergency variceal-management guidelines with referring trusts.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
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Cardiff & Vale University LHB
The concerns cannot be pursued personally because involvement would create an obvious competing interest in the index case.
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Cardiff & Vale University LHB
The concerns should be directed to the BSPGHAN President, because they concern complex liver disease and portal hypertension beyond endoscopic banding alone.
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Cardiff & Vale University LHB
Organisations such as RCPCH, JAG, NICE or the NHS are better placed to advance and compel the requested national change.
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Leeds Teaching Hospitals NHS Trust
Current guidelines are considered sufficient for post-operative care and management of bleeding varices, including after prophylactic banding.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026