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

Even in understaffed wards nurses take breaks ime, they're actually really strict on it. Think it's some push to follow employment law or maybe a mental health thing (probably the former!)

I don’t know about the Countess of Chester NNU but there aren’t many areas of the NHS that aren’t. The U.K. is about 2/3s of the way down neo-natal mortality rate for Europe (the highest ranked with the lowest mortality rate). I don’t think that’s down to negligence or incompetence I think it’s just more stretched resources than other countries and lower numbers of doctors per capita.

I don’t know how much overstretch played a role in the Shrewsbury and Telford cases. There was certainly a culture of mismanagement whereby people were afraid to speak out. It was also noted that mistakes were not investigated and there was a failure of external scrutiny - which could be as much from lack of resources as from negligence, or a combination of the two.

I think the insulin issue in this case is distinct from the other cases as, assuming the test was accurate, it is concrete indication of malicious intent.

Sorry I missed this post. I remember this now. Thanks for reposting.

That's completely incorrect. I used to work 12.5 hour night shifts, almost always with no break. I know staff still there & nothing has changed. There just isn't time.

Is insulin a controlled drug? Surely they Would they know if there was a vial missing, if not at the time then at a stock take (or equivalent)

No, it's not classed as a controlled drug.

I wish! No break is the norm in many Trusts & on many wards & units. No one cares about MH of staff.

No it’s freely available in a lot of fridges. You wouldn’t do a stock take - i don’t know how you’d marry it up. I mean you could but it would be the most hideous job ever.

Completely agree.
I think that's what the prosecution will find hardest will be proving foul play by Letby.

But....

It's not just how many hands were on deck that night - it's also the skill mix/ seniority, how tired they were from doing extra shifts plugging the gaps in a threadbare rota for months on end and all the other things that go along with being chronically understaffed

And in the context of babies dying inexplicably on an almost weekly basis - it must have been an awful place to work?

According to the defence LL was doing a lot of extra shifts because she was young single and enthusiastic so was more present than other members of staff
maybe to her detriment? So I think it's important not to deny the issues in the RCPCH Service Review

In the end though, no matter how tired or overworked you might be, a massive dose of insulin doesn't just get given by mistake. It simply isn't feasible.

The report downgrading them because of not following protocols or procedures might give some support to the idea that the TPN bag might not have been changed when the line tissued.

Thing is with insulin is its incredibly potent and you need the tiniest of amounts to affect the blood sugars of a neonate. I doubt you would notice those amounts leaving a vial. In terms of shifts and breaks, there is the European time regulations (or some name to that effect) which dictates how long you can legally work before a break and how long you can work in a given number of hours. But I'm yet to work anywhere where that is actually followed, mainly due to staffing pressures.

Additionally, I do agree that the newer younger staff who perhaps have no other commitments and are happy to work 4 nights in a row, plus extras to cover, are the staff who are present on the nights and weekends when it is a "skeleton" service, meaning essentially they are more likely to be present when things go wrong, things are missed, and also simply due to them being at work more than anyone else.

Sorry if this has already been asked but is insulin ever put in a TPN bag for anyone? I get that it wouldn't be for a baby but what about an adult? Is there a possibility that there was a mix up in th pharmacy and the wrong TPN mislabelled and sent to the ward?

I would agree with you in the circumstances of this case, but in general wrong dose medication in hospital settings is fairly common.

Of 12 006 reported medication incidents, 1568 described 'wrong-dose' errors: 702 (44.8%) were prescribing errors, 223 (14.2%) were dispensing errors and 643 (41%) were administration errors.

Overdoses were reported more frequently than underdoses. 926 (59%) of reported wrong dose errors were overdoses, 464 (29.6%) were underdoses; the magnitude could not be determined in 178 (11.4%) of reports.

Twofold and 10-fold overdoses and underdoses were the most commonly reported error magnitude, although dosing errors across a wide range of magnitudes were reported.

Incidents were reported from paediatric wards (491, 31.3%), non-paediatric wards and clinical settings (880, 56.1%) and pharmacy (197, 12.6%).

Prescribing errors (702, 45.9%) were reported more commonly than administration (643, 41%) and dispensing errors (223, 14.2%). Drugs acting on the central nervous system, cardiovascular drugs and anti-infectives were the drug classes most commonly involved.

https://pubmed.ncbi.nlm.nih.gov/34426478/

My post was a response to this:

In the end though, no matter how tired or overworked you might be, a massive dose of insulin doesn't just get given by mistake. It simply isn't feasible.

It's not completely incorrect, you and I just have different experiences. I've worked in nine wards albeit only in one trust. You may have more varied experience than I do or it may simply be different experience

Highly unlikely. It will have been checked, double checked and triple checked. And then probably checked again for good measure.

And the bags are different sizes.

Actually, there was very recently an incident locally where a nurse administered 100 extra units of insulin. Which given that equals entire syringes of insulin you would think is impossible. I do, personally, think however that the insulin administration sounds deliberate. I could be wrong though. Interested to see if the defence tries to refute the idea of malicious administration or if they go down the path of trying to show that it could be someone other than Letby.

I’ve been following the updates

i know this is a weird question but if any of the nurses/midwife’s come back on:

I’ve been reading that gas in the bowel and tummy are released in prem babies - is this what colic is? Where babies are screaming in pain because they have trapped gas?

just seen a thread about a screaming baby and it’s got me thinking it must be horrendous as surely it’s screaming because of trapped wind

I’m sure it’s been discussed previously but insulin is a funny drug because it’s measured in units not mls. It has its own unique system - harking back to when it was first discovered.

You should never use a ml syringe to administer insulin. So 1u is 0.01ml - it’s the only drug I know of that has its own measurement (I’d love to know of others). A typical vial is 3ml or 10ml - so like @whatausername says you should cotton on quite quickly that you are possibly drawing up a lot! Children can use a LOT of insulin, as can adults… but neonates…?

Colic is not a medical condition. It’s a word used by some people to describe a healthy crying baby with no known cause. It’s just babies being babies.

@Quitelikeit

This explains colic really well.

www.babydoc.com.au/faq/colic-bore-your-baby-to-sleep/

Sorry to derail the thread a bit!

I was searching for this! It’s so, so good isn’t it? I must have regurgitated it (ha) to hundreds of families.

@AgathaMystery

Me too!