RF - DLS 316-085-001

Business Services Organisation

RE: INQUIRY INTO HYPONATRAEMIA RELATED DEATHS- RAYCHEL FERGUSON 1 have bean passed a sman me of papers NCentty located wl1hln the Westem Trust whfda relates to the Raychel fefguson case. I now enclose the following for your attention: ...

1) Undated handwritten note 1'her8sa Brown to Mmgaret Doherty: 2) Document entitled "Chiidren on Intravenous lln881f1JJid Replacemenr; . '

3) Neo Natal Intensive care Unit Auld Balance for I.V fluids; 4) AltnageMn Hospital Chlldnm'e Unit Auld Balance For I.V. Aulds; 5) Report Re: Raychel Ferguson W8Jd 6;

6) Report Re: Raychel Ferguson Ward 6;

7) Handwritten notes (5 pages) which are believed to have been made by Sr Catherine UWe;

8) Handwritten notes (3 pages) which are beUeved to have been made by Margaret Doherty, former Clinical Servlcn Manager (Paediatrics). 9) Neo Natal Intensive Care Unit Fluid Balance for I.V. Fluids- Raychel Ferguson Th June 2001;

10)Parenteral Nutrition Fluids Prescription Sheet.

Providinl) Support lo Health and Social Care

() IHVL\f(~ I!'< I'NWII'.

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- ' 12)Ptmmtend ~n F1ulda PlucripUon Shnt 13)Ag~Wd Actkm following Critical Incident Meeting 12 June 2001; 14)Penlcmal Data Sheet (this 18 Ukety to be a copy of a cover s11e&t of Raych8l felguson'&

medical NCOrds). . I am lmdluc:ted that Mrs MaJgaret Doherty. who no longer works fortha Trust, requested a senior member of Trust staff to look for documentation to ass1st herwfth comptetlcn of her witness statement. lhe member of staff found the endoHd documenldon In an old cabinet

which had been In use .wbfta MIS Doherty worked for the Trust. It was contained wilhln a folder with a tab marked -comp~a~nr on It ·an lnspedllm it became appanmt that Rayd1el felgusoJts name was on this me but was COWJ8d by the tab. The member of staff who found

these documents Immediately alerted the appropriate lndMdua1s who In tum advised us. You wiD note that many of the documenta.wUhln this file we simply copies of papers already held by the Inquiry. However, there are also documents which do not appear to have been prevtoualy disclosed to you. Please accept the Trust's apctogtu wlth regard to the previously undisclosed papara and accept my uswancea that Trust staff adat qu1ddy to bring same to our attention as soon as they went discovered.

--

RF - DLS 316-085-003

RF - DLS 316-085-004

t Fluid ba~ charts

/..AD urine eon ~l'"m and ~d ,/ v•w be~ and .ecordild c/'fUI'.!M mmU, moderate or ~to TOOOrd s.mMUrt of vomit if not.contmned m a

YM'Iit b~\\'l / Oui~ til) be giv-...n em tlmc to ~imwl.V fluids vi'Da1n:imt otLV fl.uW could directly rebWt to Y.'eP- U & ~post~ .. u lil - t:-.~~e:~.~t :;t~,.,.1:>.~

R.mew orftWd~ chart 1

2 Questkms

'Wti same baa of~ 18 reeomm~ced post ~a?·

~was commm.tsml at lOOO how's?

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RF - DLS 316-085-006

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LS316-085-007

ALTNAGELVJN HOSPITAL CHILDRENS FLUID BALANCE FOR I..V.. FLUIDS J~\t.. f~\.

.Na.rrae ••••••.•••••.•••••.••••••.•...••••••••••• -11 ••••••••••• .., Date .................. ·wt ........ , Age ••••••••• 1-l.osp:. No ... ,.., ...... ~·············· INTRAVeNOUS INPUT ORAL INTAKE OUTPUT ! SPECIFY UNE UNE UNE UNE u~

ASPtRATe VOWT STOOLS ~·~ YS!te& f FLUID [;~ ~ 1 2 3 4 ~~ sri aa v. 1 TiME Amll , Amt 1 T t I , Amt I Total .~!:JTotal Aml Total Aml Aml Amt. Total Total • f

I 08.00 09.00 !0.00 11.00 12.00 13.00.

i 14.00 . 15.00

16.00 ( (

17.00 i" I 18.00

19.00 20.00

l 2100 t J "" 22.00 '

23.00 24.00

! 01.00 02.00 \'

I

03.00 ! I 04.00 . 05.00

06.00 l 00.00

.• ;Intravenous Total J IQriuTOill I I •. i Oral Total OthuTotll --··

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LS316-085-008

v

IJ PAAI!NTERAL NUTR1?ff01\!· FLUIDS PRESCRIPTION

I I I I I NAMBand l)pe~ · · IVfluid Amount j TYPB OF AMOUNT of Rare Pmscribed by Baldi No. .oace.nme~ & c:ancdled

(ml) , fLUID ADDri'IVBS m1lhour serial number (siptare) Date of expriy I ereded by Cslpature) & (~) ~ L

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-----< .. -- .. L ____ __ <j __ •- ---- J @ Under IV comments - please state if site, red, inflammed, swollen or painful. o Please indicate clearly on front of chart when new bag of fluids erected. {) Please indicate clearly on front of chart if~-e in prescription of fluids. (initial time of change) o Please indicate clearly on front of chart if e in rate of fluids. o Please measure all urine output when pt on iv · ds and seek parents assistance. o Measure all vomitus. If unable to do so .. record as smalJ, medium, large and approx amount. @ If more than 1 infusion in progress - please label clearly each separate line according to rv guidelines. o If child is fasting, and is on a fluid which contains no glucose, then capillary blood sugar should be

checked every 6hrs. o If a neonate (less than 28 days) is fasting, they need capillary blood sugar checked 6hrly.

RF - DLS 316-085-009

Thm'sdaJ 7 ~ 2111

~ wu Edmitted to Ward 6 at9.00 amtm·7 June 2001 via Culmhy. ~ with a short 'h1stmy of ebdommal paiD. oim.me.Jteed as sudden onset ot 6.00 pm, ~as appendicitis, Cydomorph 2 mpiV given m L 20pm mA.ccidmrt and ~Depmtment.

On admissimn to the ward R.adm.el's ~were~ within rw:rmeJ limits. She WllS seen ODd~ by a kqpcm SHO and btoodswem mken. Redmel 'Was tBtm fasdDg fbr 'l'hemue. She was seen by the Annesthetist and PNpared for Theatre. Jmm:veuous ftuid of solution 18 was~ and.~ end set at 80tWs per hour.

~went to~ at 11.00 pm. f-ollowing the removal of a mildly ocmgested ~{see attadted notes), sbe returned to Wmd 6 at l.SS am (8.6.01). Post openit'iw ~were satisfactmy • wmmd site~' IV infwdon soluticm I 8 at 80 mls per hour in situ.

Pftday I Jlme lOOi

Voltoml12.S mp end Flagyl SOO mg given per recmm at 7.00 am.

R£chd was sea~ by the Sw'gica1 Team~ 9mm and llam (no time dowmented). Clear fluids aUowed. .

Vomited large amount m 10.25 am.

Vomited apia at !pm and 3pm.

Zofbm 2 mp IV presc:n'bed and e.dmimtered by Dr Dev!bl at approx.imntely S.30pm (time given not~.

Racbael mobilised well~ the day. Taking sips ofwmer by S.OO pm. During late evening R.admel complained ofheadacbe-~· 500 mas given at 9.30 pm and f12ayi SOO mg {4iveu per rec:tuDD at 10.00 pm.

Shortly after Rnchael became nauseated end vomited coffee grouwls x twice. Surgical J.H.O. ~ - Valoid 25 mgs IV prescribed and given at 10 1 S pm with effect; Rachael then settled and her parents went home. AU ~appeared stab!~ last teeOlded at 2.00 em.

~9Juu200t

Approximatlely 3.00 am Roobael wos observed by N/ A E Lynch to be restless and bad been incomi~ of urine. She then appeared to be fitting. The Paediatric SHO Jeremy JolmSton was em Ward 6 at the time and irmmdiately went to see R.admel . Stesolid S mgs given per rectum at~ 3.05 am with lrttle effect. Diazemuls 10 mgs IV given at 3.15 am with·somecfiect. Nursed em side with oxygen 15 1/min.

RF - DLS 316-085-010

SIN A Noblevddly ~ ao Sr .l..il* dfmshc kldcbaed ,upif nmiM bntween3.01 t~m ·3.30 am,~pupJ1swae~ fmd~10~ ·But Jeter

when~ by SIN Noble and Dr .r~on. tbq.wem slugbhlmt stiU~to

tipt. The ~.J.HA 'ftB~tmd ~Moods~ £.C..G. ~

mveatma~~E.C..O..;..M c~mDpmpnMma~Wdin&

~~cmseco:mdattm~pt. ~pn;amtat~e.t~y4.!S

am. ~ mmsr~ to the~ RADm at aa»pmxiu ... 4.30 am.

Dr&mi Tlldar .. lo.d tem1 ~ camem the~ spOke with Mr Fergwmt(fa1hm'),

Ula\~ SIN~ to~ Dr MoCmd.Badmd.'s~ was defmiomtfq ~.~duodlh.fastl*q. D.rTminor~

Radm£t•spupUS emdibmd uhem m be dii~Jld and 1ml'CS~

DrMtecmlud~xlpaemcm~ IMJmel•s~i~~to

~~ ~~JJy~s~auetume. Art.edml

&walso~by~

~C. T. sam aDd chestx..lfa)'~ by Dr McCcml ~~to be b:mlsfeln.d to

ICU ~ cr scan. Rscbaeileft Wn6 m eppmximate!y 5.45 am

Mi8&40011Biiv_o/_. CLOOCAL SERVICES MANAGER

RF - DLS 316-085-011

Thumlay 1 J~me 2001

Rshad was admitted to Ward 6 m 9 00 am on 1 June 2001 via Casualty. ~ with a short history of abdominal pain, commented as sudden onset at 6.00 pm, diap.oaed as oppendicitis, Cyclomorph 2 mp IV given at 8. 20 pm in Accident and Emergency Department

On admission to the ward Radv.wr's ~ \1JreJ'e recorded vd1hin normal limits. She was seen by the Anaesthetist ad prepared fur Theatre. ~ fluid of? solution J 8 was erected. (Fluid~ chart not available.)

R.adutel went to 'l11eaW at 11.00 pm. Following the remowl of a mildly~ appendix (see BUached notes), she tetumed to Ward 6 at 1.55 em (8.6.01). Post. operative obsemmons were satisfactory - ww:nd site satisfaetmy, IV infusion solution 11 at ao m1s pm- hour m situ.

!Friday 8 Jmte 2001

Voltoml12.5 mgs and f1agyl SOO mg giwn per rectum at 7.00 am.

Vomited large amount at 10.25 am. 1..ofum 2 mss IV prescribed by Dr Devlin - 1 also admmistered same - no time or details giYeD.

'- ' ,_

Raebad mobilised well throughout tbe day. Taking sips of water by 5.00 pm. During late eYCDiDg Radmel complnil!Od ofbeadnche-~~ SOO mas given at 9..30 pm md F1agyl 500 mg giYeal per rectum. I 0.00 pm.

Shortly after Raclur.d beemne I1Q1lSP91pd and vomited coffee grounds x twice. Surgic:al J.H.O. ~- Va!oki 2S mgs IV prescribed ad giyen at 10. IS pm with effect. Raebad then settled and her parems went home. All observations sppemcd stable. lost reccmled at 2.00 am.

~9Juul001

Approximately 3.00 am R.aclwcl was observed by NJ A E Lynch to be restless and had been incontinent. She 1heD appeared to be fittins. The Pnediatric SHO Jeremy Johnston was on Wmd 6 et the time and immediately went to see Raclmel • Stesolid S mas given per redum at approxbmaely 3.05 am with little effect. Diazemuls 10 mgs IV given at 3.1 S om with some effed. Nursecll on side with oxygen IS ~

SIN A Noble verbally reported to Sr Ut.tle that she bad checked pupil reaction between 3.00 am .. 3.30 am, both pupils were equal and reacting to light. But later when checked by SIN NoNe and Dr Jo!mston, they were sluggish but still R*ted to light. The surgical J.H.O. was contacted and visited, bloods mken, E.C.G. recorded l\1\lealmg abnmmal tracing. Repeated E.C.O. - no cbaDge to previous reading.

Purents comact.ed on second attempt, fmh.er present at Hospital at approximately 4.15 am. Rachael transferred to the Treatment Room at approxim.ately 4JO am. .

RF - DLS 316-085-012

Dr Semi Tminer,. 2nd term SHO, came to the wmd, spoke with Mr F~ (father),

thea~ SIN Noble to COJt1.ad Dr McConl, RacMcl's condition was ~ AMesthetist ~ thro. fast bleep. Dr Troin.or checked Radmel9s pupils and found them to be dilated anti~

Dr MeCmd md ~ x 2 present OD \\'ald. Redmel's oonditiao began to rapidly~ Imubated successtiilly by A.mlesthetist. m:e 6.0 et tube. Arterial liDe also~ by 1\mest'heti.St.

C.T. sam and chest x-ray ordered by Dr MeCold. Racbael to be transferred to ICU ro~ cr sam. ~I left Ward 6 at approximately 5.45 am

MRS M DOHERTY CUNICAL SERVICES MANAGER.

IDfommtion taken from IWtes and verbal smtemems from staff.

RF - DLS 316-085-013

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RF - DLS 316-085-014

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RF - DLS 316-085-015

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RF - DLS 316-085-016

RF - DLS 316-085-017

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RF - DLS 316-085-023

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RF - DLS 316-085-024

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RF - DLS 316-085-026

1 Review evidenoo f'or use of routine post-opemiw low electrolyte IV infusion mui s~ chmlges if evi&moo indicates. No dwlge m cmrent ue of Solution 18 mrti1 review.

Anlmge daily U&E on all post--operative children receiving lV mfuskmon Ward6.

• 3 Inform surgicaljtmior aft" to~ these re~wts promptly.

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4 An urinary output should be~ ami rooorded while IV infusion progress m progress.

~LdiOtt Sister rvun~

5 A chart for fluid! infusion ra\es to be displayed on We'd 6 to guide junim medical staff. J

RF - DLS 316-085-027