Letby Case (part 2)

[OneFrenchEgg]

www.mumsnet.com/talk/_chat/4652340-lucy-letby-court-case?reply=121815754

follow up, remember rules around discussion of active cases

Thanks, that’s very helpful.

Effectively, the whole of baby F case hinges on the blood test result - specifically the C-peptide - insulin level divergence.

How many times was that specific test repeated - does anyone know?

I’m thinking about all the areas I work in and how medication security varies from department to department even in the same Trust.

it’s the first time I’ve really reflected on how absolutely not fit for purpose the locks on drug fridges are. They are hopeless aren’t they? The keys are always on a massive bunch, which hang over the seal when the fridge is open (of locked on the top not the side) and frequently get trapped in the door. And I bet we’ve all bent the keys when we are in a real hurry.

our front door lock is a key code specific to each person (me & DH, DC, cleaner, cat sitter) & if I wanted to, I could go online and see when we all entered the house. Why don’t we have keypad locks with our own code on the drugs room and fridges?? Hell, DC school has codes for each staff member AND pupils on the doors!!

The insulin level was only done once not long before the TPN was stopped

It wasn't repeated because it took a week for the results to come back by which time everything had returned to normal. The 3/4 full TPN bag had been binned by then

£400 billion in NHS 'efficiency savings' over the last 12 years?

Gotta hope that sample wasn’t compromised in any way or misplaced.

I guess that's why the prosecution called a chemical pathologist from the lab in Liverpool to describe the chain of custody and analysis of the sample, @Mirabai

Would a nurse know that labs can differentiate between synthetic insulin and naturally occurring insulin?

I don’t know. My specialism is a niche specialism within diabetes so it sounds lame but I can’t remember if you’d know that if you weren’t specialising.

Swipe access with ID cards would be better than the current key system.

I needed to do a fit note for a patient a while ago, they were stored in the CD cupboard to prevent fraud. It took me 30 minutes over shift because the nurse with the keys had taken them on his break by accident. When he did get back, he just gave me the keys to get it myself. If something had happened and there’d have been an investigation, no one would have known I’d ever had the keys as normally it would just be the nurses who had them.

Sure, but you’d still want that test repeated 2 or 3 times.

@MrsFionaCharming I agree. This is totally outing so I've name changed. I worked in stepping hill where Victorino Chua killed 3 patients and poisoned dozens (about 19).

On my unit we used to use our staff ID badges to buzz into the meds room, where there are cctv cameras. Then buzz in again on the cupboard. Then again on the fridge door behind the cupboard.

We did have keys for the fridges but the charge nurse held these and had to accompany you to get the medication out etc.

Hospital policy. It was a sackable offence to deviate past this. Also had to have 2 nurses making up and signing for all medication in front of the cctv and those 2 nurses had to administer all of the medication together.

Crumbs. That’s good standard. Imagine having the staff for that today.

*gold standard

@AgathaMystery I only left 6 months ago. We had to have agency for the meds rounds to literally just sign off. Or take staff from other wards.

It really didn't work!!

Nothing would be added to TPN on the ward where I work.
You would run an extra infusion if anything else was needed. There would potentially be possible for it to be contamination from prior to getting on the ward (during the preparation process in the aseptic unit) but I would say that's incredibly unlikely. On the ward, if added it would be deliberately.

I can only think of one possible way of having an idea of who the bag might go to, but it would still be a small chance.
When started on TPN you have a starter bag for 48h, then maintenance after that.
If you only have 1 baby on TPN when you leave, and contaminated a maintenance bag then unless a baby was transferred in on TPN it would be that baby who got the bag.
That would rely on the bespoke bag being changed for a stock one, and the one chosen being the contaminated one though. Unless all bags in the fridge were contaminated I guess.

Everywhere I've worked has been similar.
Door codes are readily given out to everyone, sometimes (often tbh) even written on the door frame next to the lock. The cupboards / fridge are sometimes left unlocked, and especially the fridge locks are crap. You can open the fridge lock without the key pretty easily in most wards, some you can literally just twist with your hand.

Apologies if this has been covered before, but do we know for definite that the original TPN bag &/or infusion set were discarded when the long line was re-sited? Obviously they should have been, and it would have been very shoddy practice not to, but I feel it needs to be verified by the prescription and fluid charts.

@Pharmacistquestion in fairness to my experience which is out of the ordinary there were actual deaths caused by tampering of saline bags so even they were locked up behind a badge lock.

It was awful at the time though. Everyone was suspicious of everything and everyone. I'm glad he got caught.

That's what happens in neonates & paeds. 2 nurses check absolutely everything, including everyday meds like vitamins, and check patient ID together. No matter how busy, that's what you do.

Pretty quickly.
I would expect it to be an insulin called "actrapid", which as the name suggests works quickly and also leaves the body quickly. When an infusion is stopped it would start leaving the body within minutes.

Jeez that must've been awful. The only issue we ever had was tramadol going missing on an adult ward about 6-7 years ago. We just restricted ordering of it to the pharmacy technician only and made sure it was treated as a fully controlled drug and signed in and out.
Luckily nobody was harmed in any way. I don't think they ever did find out who it was.

Oh and re the 2 nurses checking everything, that happens with all prescribed meds but you don't have to be in 2s constantly so contamination could happen if someone was alone.
You wouldn't be able to overdo an injection with someone watching, but you could inject alone unobserved if that makes sense?

So you couldn't double dose while being watched but in theory there would be nothing stopping you adding something to a bag, then calling someone in after you have done it to "make up the bag", and then watch you do it, them thinking it's a fresh bag and being prepared not realising it already had something in it.

Thanks for your reply, I thought as much! So, there's no way around insulin being administered in some way after the long line was resited, is there?

About 25 yrs ago we had a case where drugs were going missing from the CD room on the postnatal ward. There are all sorts of goodies in there. The ward sister was the one who realised & she & the Matron of course went to Mgt & the police were involved. CID fitted cameras & the midwife was caught & disciplined (was not struck off or reported to NMC).

I’ve always behaved like there were cameras in every CD room. I’m always paranoid/horrified when colleagues need a paracetamol & take one from the drug cupboard. You know?!