I had no concerns over fluid solution we gave to Raychel, nurse tells child deaths probe
A nurse who "dissuaded" a doctor from prescribing a rehydration fluid to a young girl before she died has defended herself at an inquiry.
Ann Noble – who was in charge of the ward where Raychel Ferguson (9) was being treated in 2001 – gave evidence for the first time yesterday.
The Hyponatraemia Inquiry sitting in Banbridge heard that Nurse Noble corrected a surgeon when he prescribed a different fluid for Raychel than that normally used at Altnagelvin Hospital in Londonderry after she had her appendix removed on June 7, 2001.
The inquiry's chairman, John O'Hara QC, said it was the second time that doctors were "dissuaded" from prescribing Hartmann's solution to the child.
He asked Mrs Noble: "So twice within a few hours, doctors who intend to prescribe Hartmann's (solution) are dissuaded from prescribing Hartmann's on the basis that that's not the practice in Altnagelvin (Hospital)?"
"Yes," she replied.
Solution No 18 was instead prescribed in the early hours of June 8 – which is administered to patients losing or at risk of losing water and sodium.
The solution is at the centre of concerns being investigated by the inquiry about the management of fluid given to Raychel and three other children in Northern Ireland.
Raychel died 36 hours after being admitted to Altnagelvin's children's unit complaining of stomach pains and nausea on June 7, 2001.
She was given Solution No 18 before and after an operation to have her appendix removed.
The inquiry has heard that Raychel was also being administered too much of the rehydration fluid.
Her death is one of five in children across Northern Ireland which is now being investigated by a public inquiry.
Mrs Noble told yesterday's inquiry that she did not anticipate any problem with using Solution No 18 as Raychel had been "a fit and healthy child".
"No other children seemed to come to any harm having been on that solution," she said.
She told the inquiry that she pointed out to the surgeon treating Raychel that administering Solution No 18 to child patients such as Raychel was "common practice on the ward".
An anaesthetist was told the same thing by a nurse and an another anaesthetist hours later, the inquiry heard.
"I told Mr Makar that was what was commonly used (Solution No 18) if he would be happy enough to change it, and he agreed to do so," Mrs Noble told the inquiry. "Had they insisted on a different fluid, it would have been put up."
She said that Solution No 18 was the solution of choice in child patients before and after operations in 2001 in the hospital, recalling how senior nurses had questioned previous deviations from the practice.
Mrs Noble said that while she knew what the term hyponatraemia meant in 2001, she did not know how to treat it.
She cited a series of changes introduced as a result of Raychel's death, including to the documentation and management of a patient's fluid in the hours after an operation.
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 died in hospital in April 2000 and May 2003 respectively. The issue of fluid management, and the issue of hyponatraemia, is central to the cases of each of these children.