Hyponatraemia inquiry: Nurses giving evidence

Nine-year-old Raychel Ferguson, who died in hospital in 2001, is one of the deaths being examined by the inquiry

Nurses involved in the care of a nine-year-old girl who died in a Belfast hospital in 2001 have been giving evidence to the inquiry into her death.

Raychel Ferguson died at the Royal Belfast Hospital for Sick Children, a day after having her appendix removed in Altnagelvin Hospital in Londonderry.

Her death is one of five being investigated by the inquiry.

It is examining the fluid levels administered before their deaths.

In the case of four of the children, an inquest stated that hyponatraemia was a factor that contributed to their deaths.

Hyponatraemia is the term for a low level of sodium in the blood stream causing the brain cells to swell with too much water.

Giving evidence to the inquiry on Tuesday morning Marian McGrath said it was, in 2001, common practice at Altnagelvin Hospital that the anaesthetist would not issue a new prescription for fluids for a child leaving the operating theatre.

In this situation, staff would simply carry on administering the prescription that had been issued before the operation.

Mrs McGrath said it was established practice in the paediatric ward of Altnagelvin to only to use a fluid called Solution 18.

Witnesses

Solution 18 is at the heart of criticisms made of Raychel's fluid management.

Expert witnesses have said she should have been given a different fluid, called Hartmann's.

Mrs McGrath said she had not been involved in any internal review process, adding that she was not surprised by this as there was, as she thought, no issue around the surgery.

She told the inquiry that, after Raychel's death, new systems were introduced which have clarified the procedure around prescribing fluids for children coming out of surgery.

The inquiry has already been told that aspects of Raychel's care were "confused and uncertain".

Management

It has also heard conflicting evidence about who was in charge of her post-operative care and the type and amount of fluids she was given.

As with the cases of the other children, the inquiry is paying special attention to the management of Raychel's fluid balance - in particular, whether she should have received the particular type of fluid and at the rate it was administered.

This is the second death the inquiry has so far heard evidence on. The first was that of nine-year-old Claire Roberts, who also died at the Royal Belfast Hospital for Sick Children (RBHSC), five years earlier in 1996.

She had been admitted to hospital following vomiting and drowsiness. Doctors prescribed intravenous fluids.

Two days later, Claire suffered a respiratory arrest and never recovered.

The inquiry is also due to investigate the death of Adam Strain, who was four when he died at the RBHSC in 1995.

The inquiry is also investigating the events following the deaths of Lucy Crawford, aged 17 months, who was initially treated at the Erne hospital in Enniskillen in 2000 and Conor Mitchell who was 15 when he died in the RBHSC in 2003.

In the case of four of the children, an inquest stated that hyponatraemia was a factor that contributed to their deaths.