A girl who died following a routine operation should have been assessed by a doctor hours earlier, an inquiry has heard.
Elizabeth Millar, a nurse in charge of the ward where Raychel Ferguson (9) was treated, told an inquiry she would have asked a doctor to examine the little girl when medication failed to stop her vomiting.
The Londonderry schoolgirl died in June 2001, 36 hours after she was admitted to Altnagelvin Hospital with stomach pains and nausea.
She had suffered prolonged vomiting after an operation to have her appendix removed.
On June 8, 2001, Ms Millar finished her shift at around 6pm.
Yesterday, she told an inquiry into Raychel's death, and the deaths of four other children, that she would have prompted a doctor to test the level of salt in the little girl's body, if she had been on duty that night.
"If I had been on duty at 9pm (on June 8, 2001) I would have been prompting a doctor to do her electrolytes (to test the level of salt in her body)," Ms Millar told the inquiry.
"She had vomited again. She had not settled despite the antiemetic (drug to prevent her vomiting)."
The inquiry already heard evidence that a doctor came to the ward to give Raychel medication for her vomiting on the night of June 8, but did not speak to nurses or Raychel's father.
Yesterday, Ms Millar told the inquiry that medical staff at the hospital "fell down" in their documenting of Raychel's condition.
However, she added that documenting certain fluids was not common practice in the hospital at the time.
"Raychel received the same care that any other child on the ward would have been given," she told the inquiry.
Mr Martin Wolfe, the inquiry's junior counsel, pointed to the findings of an expert, who concluded that medical staff failed to accurately record how much fluid Raychel was receiving.
"I accept that, yes," Ms Millar said.
The inquiry has heard that Raychel received too much fluid after the operation to have her appendix removed.
A death certificate recorded excess fluid on the brain as one factor which led to the girl's death. The other factor was hyponatraemia, a condition which occurs when there is a low level of salt (sodium) in the bloodstream.
Mrs Millar recalled overhearing consultants talking informally about a possible link between Raychel's death and the passing of 17-month-old Lucy Crawford a year earlier.
The death of the baby in April 2000 and four other children are currently being investigated by the inquiry.
Hyponatraemia is the common thread connecting the deaths.
THE Hyponatraemia Inquiry is examining the deaths of three children – Raychel Ferguson, Adam Strain and Claire Roberts.
It is also investigating the events following the death of Lucy Crawford and specific issues arising from the treatment of Conor Mitchell. Lucy and Conor also died in hospital, in April 2000 and May 2003 respectively.
The inquiry is currently focusing on the death of Raychel Ferguson in June 2001. The issue of fluid management – and the issue of hyponatraemia – is central to the cases of each of these children.