Lessons can be learned from mother's death in hospital, say family following inquest
The family of a woman who died hours after falling from her hospital bed hope lessons learned by the health trust following her death will help save the lives of others.
After a "frustrating" four-year battle, the children of Rosaline McEneaney say they feel they have finally got justice in memory of their mother.
The mother-of-five from Co Armagh died in September 2012 at Craigavon Area Hospital with the inquest into her death concluding yesterday in Belfast.
During the two days of the hearing serious concerns were raised over staffing levels, the height of the bed Mrs McEneaney slept and rested on and delays in CT scan results.
She had been admitted on September 21 to South Tyrone Hospital after her weight dropped but suffered two falls - both unwitnessed - before she died at Craigavon A&E on September 29.
On the night before she died there were two nurses and an auxiliary nurse on duty treating 15 patients in the ward.
Mrs McEneaney fell at around 11.10pm on September 28 and was found by a nurse bleeding heavily from her head and with a broken hip.
She arrived at a "very busy" Craigavon A&E after midnight but did not receive any pain relief until 2.40am.
The family were then devastated to learn their mother had terminal cancer. She died surrounded by family at 9.25am.
Coroner Joseph McCrisken heard evidence from the trust that it had been working under guidelines for staffing levels.
It emerged there is currently no guidance for the number of nurses who work in older people's wards in the evenings.
Evidence was also heard that steps had since been taken by the trust to improve services and there are now four nurses working at the ward.
A bed rail policy was also adopted to prevent falls.
Concluding the inquest, Mr McCrisken said he was not identifying failures by any one person but the "failures are system failures".
He said that he appreciated that the number of falls had decreased and that the reduction cannot just be attributed to staff levels, but he said he was "convinced" that additional staff make a difference.
Cause of death was identified as "intracerebral haemorrhage, ischaemic heart disease, fracture left neck of femur and carcinoma of the lung".
Speaking after the inquest the family said: "We were speaking up for our mother and we hope it has now made a difference to the care of others and hopefully it will save lives."