UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #9

[ColourPurple]

Here is a quick summary of the above long post:



Between June 15 and June 23, Lucy Letby had been on holiday in Ibiza.

on June 23rd, LL returns to work. [presumably no collapses or deaths in that week]

Child O weighed 2.02kgs, which was good for a premature triplet. He was in good condition and made good progress.

He was stable up to June 23, when he suffered what medical expert Dr Dewi Evans said was a “remarkable deterioration” and died.

Letby had fed him last @ 12:30 pm and signed off on that feeding.
In a note made by the doctor at 1.15pm, there was '1x vomit post feed' with 'abdomen distended'.

A colleague suggested that O be moved to room 1, and LL resisted that move and wanted him to stay with her in rm 2.

at 2.39pm, the door entry system recorded her coming into the neonatal unit.

Within a few minutes of that, Child O suffered his first collapse.

Letby called for help, having been alone with Child O in room 2 at the time.

A breathing tube was inserted by the medical staff and he was successfully resuscitated. He was kept on a ventilator.

Child O suffered a further collapse at 4.15pm which required CPR. Those efforts were unsuccessful and Child O died soon after treatment was withdrawn at 5.47pm.

A consultant doctor noted Child O had an area of discoloured skin on the right side of his chest wall which was purpuric.



SO THIS^^^ WAS THE DEATH OF CHILD O, WHO WAS A TRIPLET. HIS BROTHER, P, WAS MURDERED THE NEXT DAY, in a very similar fashion.

So two babies, both doing very well, considered healthy and doing well, for the week prior , both died unexpectedly and suddenly, the day LL returned from vacay.

And the following day she allegedly attempted to murder Baby Q. I hadn't realised before that the gap in the charges in June coincided with LL going on holiday. So there's the cluster of alleged attempted murder charges for Baby N .

3 June 2016 - Alleged attempted murder of Baby N
15 June 2016- Alleged attempted murder of Baby N
15 June 2016- Alleged attempted murder of Baby N

Baby N moved to another hospital and recovers - LL goes on holiday till 23 June

23 June 2016- Alleged murder of Baby O
24 June 2016 -Alleged murder of Baby P
25 June 2016- Alleged attempted murder of Baby Q


Three alleged murder attempts over three days with two being "successful". That is so hard to comprehend. If guilty, IMO it's like some frenzied compulsion. If all had resulted in deaths, how would anybody think three deaths in three days would not be noticed? And IF GUILTY, would the attempts have allegedly continued if LL hadn't been spooked by Dr G asking questions? Not long after these events LL was moved to a clerical role.

Baby Q
(LL) texted a doctor at 10.46pm and asked "do I need to be worried about what Dr G was asking?"
The doctor sought to put her mind at rest and told her that Dr G was only asking to make sure that the normal procedures were carried out. She replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G had been asking the other nurse who was present in the room (when Child Q had collapsed) and how quickly someone had gone to him because she (LL) had not been there....

Other than three days the following week, that was the last time Lucy Letby worked in the neonatal unit at the Countess of Chester Hospital, the court is told....

In Letby's home search, officers recovered the handover sheet from the morning of June 25 whic included Child Q's name. This was a document which should not have left the hospital.

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Tortoise]

I've actually got a timeline for babies O, P & Q, based on what we've got from opening statements, so I'll pull it up.

 

[ColourPurple]

I've actually got a timeline for babies O, P & Q, based on what we've got from opening statements, so I'll pull it up.

Excellent. Do we know what day the triplets were born? I have a vague feeling it was only the day before LL came back from holiday but I can't find anything to confirm that.

 

[Dotta]

This alleged killing spree after holidays is simply staggering

As if (allegedly) slipping into madness.

Who can understand this?

JMO

 

[Tortoise]

Timeline for babies O, P and Q based on opening speeches

16-22 Jun 2016 – LL in Ibiza


21 Jun 2016, Tue

Child O and Child P were born, two boys of a set of triplets.


22 Jun 2016, Wed

Child Q was born, premature but a good weight. He was on CPAP for the first 20 hours. He was admitted to the NU room 1 but was initially stable. He had an umbilical catheter but he was well enough to commence feeding via his NGT.


23 Jun 2016, Thu

7.30am – LL arrived at the unit.

8am – LL’s day shift – LL designated nurse for two-day old triplets O and P in room 2. LL was supervising a student nurse that day. The other triplet was in room 1 as he was the most needy.

9.30am – no concerns noted.

12.30pm – LL fed baby O.

1.15pm – O vomited and had a distended abdomen. Doctors treated him for suspected NEC.

After 1.15pm - a colleague said “he doesn’t look as well now as he did earlier. Do you think we should move him back to room 1 to be safe?” LL did not agree.

2.30pm – Data from LL’s phone shows she was sending facebook messages and wasn’t in the unit at the same time that she recorded O’s observations - normal breathing rates and 100% oxygen sats.

2.39pm – the door entry system recorded LL entering the unit. A few minutes later he suffered his first collapse. She was in room 2 alone with him when she called for help. His heart rate and sats had dropped to dangerously low levels. He had purple and red blotches/rash. He was resuscitated and placed on a ventilator.

3.49pm – O desaturated again and LL called for help. Doctors re-ventilated him.

4.15pm – O collapsed again.

4.30pm – a consultant noted discolourations which had gone by 5.15pm.

5.47pm – Baby O died soon after treatment was withdrawn at 5.47pm. Post mortem found free blood in the abdomen from multiple injuries on and in his liver, which the pathologist observed “could have been asphyxia, trauma or vigorous resuscitation”. Alleged impact trauma – and air injected into bloodstream and NGT - murder charge. Dr Evans says the liver injury was probably the reason for his symptoms through the morning. Reviewing pathologist didn’t think the bleeding was the result of CPR, he thought it was impact trauma. The defence say - "the allegations are "various. An air embolus is not accepted and the defence point towards an infection, along with CPAP belly. The "liver injury" was "caused during resuscitation", the prosecution do not accept that."

6pm – LL fed triplet P milk, about 13 minutes after his brother O had died.

6pm – Dr Gibbs reviewed triplet P because O had died in unusual circumstances. He noted abdomen full, mildly distended.

8pm – LL’s shift ended.

8pm - feed of triplet P – after LL’s handover to another nurse, produced a 14ml milk acidic aspirate.

8pm - X-ray showed striking gaseous distension in stomach and bowel.

8.24pm – LL was still in the unit as she wrote up her nursing notes. On that night shift milk feeds for P were stopped and air was aspirated from the NG tube and it was on free-drainage.

After 8pm
LL messaged the doctor on facebook and her colleague: “[baby O] had a big tummy overnight but just ballooned after lunch and went from there”


24 Jun 2016, Fri

6.39am – nurse recorded P’s abdomen was soft and non-distended. The problems from the night before had been resolved.

8am – LL’s day shift – LL was P’s designated nurse, in room 2, with the third triplet. Care of the third triplet was transferred to another nurse during the day as events unfolded. LL claims (to police) that at around 8am she could see loops in his tummy and brought these to the attention of the doctor, and made retrospective notes later in the day (9.18pm to 10pm) “abdomen full, loops visible, soft to touch, registrar arrived to carry out ward round”. This runs contrary to the night shift observations. Prosecution says LL’s notes were factually false entries to cover herself.

8.30am –
LL texted a doctor that she was sending her student with a baby who needed a MRI scan.

9.35am – P collapsed and stopped breathing, with a distended abdomen and mottled skin. Doctors arranged to transfer him to Arrowe Park hospital.

11.30am – P collapsed again.

11.57am – an x-ray identified a punctured lung and treatment followed.

3pm – the transport team arrived. LL said to a doctor “he’s not leaving here alive is he?”

3.14pm – P collapsed for the final time.

4pm – Baby P died at 4pm. Air allegedly injected into stomach via the NGT - murder charge. The post mortem concluded sudden unexpected postnatal collapse, cause of death prematurity. Dr Evans and Dr Bohin – air in the stomach could have splinted the diaphragm compromising his breathing. The defence "agree the collapse could have occurred by a splinted diaphragm, but do not agree with how it was caused. The defence say Optiflow is a cause. The defence agree once Child P collapsed, it was unclear why he did not respond to resuscitation, but that did not point to deliberate harm."

LL spent time with the parents and had taken a photo of O and P together in a cot at some point.

8pm – LL’s day shift finished.

8pm Night shift – Baby Q’s designated nurse monitored him through the night and was content with his condition but his blood gases deteriorated slightly so she referred the results to a doctor. The doctor was not concerned.

9.18pm to 10pm – LL was still in the unit, writing up retrospective notes for baby P for 8am that morning.


25 Jun 2016, Sat

3am – Child Q was fed 0.5ml of milk

5am – Child Q was fed 0.5ml of milk

7am – Child Q was fed 0.5ml of milk

8am – LL’s day shift – LL was Q’s designated nurse in room 2. Handover sheet for morning of 25 Jun 2016 for baby Q was found at LL’s home. LL made notes on Q’s fluid/feeding chart. He was receiving nutrition Babiven via his UVC.

9am – Q’s feed time. Q’s heart and respiratory rates increased. LL left the feeding chart unfinished; prosecution say she left halfway through doing it. Numbers are noted for fluids but no record for feed or signature. Another nurse agreed to keep an eye on Q.

About 9.02am – Q’s monitor alarms went off. Q vomited. Air and fluid allegedly injected into stomach via NGT - attempted murder charge. He desaturated. The nurse called for help. The defence say "there was viral-drawn aspirates, indicating a bowel problem, supported by a diagnosis of NEC. A poorly functioning bowel had led to Child Q vomiting."

9.04am – LL signed for medication for another baby.

9.10am? – another nurse noted on baby Q's chart: "brady,desat,fit? “NGT used to aspirate stomach by L Letby”. LL did the aspiration but made no note of doing it herself, yet she did make notes in other babies’ records at about that time. Prosecution query whether she was trying to create an alibi in the records. She wrote “attended to by nurse xx, air++ aspirated from NG tube.”

9.17am - LL appeared with the doctors responding to the call. Q was mottled and a substantial amount of air was aspirated from his stomach via the NGT. There would not have been air if LL had aspirated his stomach before the 9am feed.

8pm - end of LL’s shift.

10.46pm –
LL text to a doctor: do I need to be worried about what Dr G was asking?
Doctor replied that Dr G was only asking to make sure that the normal procedures were carried out.
LL replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G was asking a nurse 'who was present when Child Q collapsed and how quickly someone had gone to him because LL had not been there'.
She continued her texts to the doctor, telling him that she had needed to go to her designated baby in room 1.

 

[Tortoise]

I'm a little confused by the conflicting information for baby Q about LL aspirating his stomach at 9.10am but turning up with the doctors at 9.17am, so we'll have to wait to hear the evidence to clarify that one. That's why I've marked it with a ?

 

[ColourPurple]

After 1.15pm - a colleague said “he doesn’t look as well now as he did earlier. Do you think we should move him back to room 1 to be safe?” LL did not agree.

2.30pm – Data from LL’s phone shows she was sending facebook messages and wasn’t in the unit at the same time that she recorded O’s observations - normal breathing rates and 100% oxygen sats.

2.39pm – the door entry system recorded LL entering the unit. A few minutes later he suffered his first collapse. She was in room 2 alone with him when she called for help. His heart rate and sats had dropped to dangerously low levels. He had purple and red blotches/rash. He was resuscitated and placed on a ventilator.

So the prosecution are suggesting that, after the colleague suggested Baby O should go back to room 1, the"normal " observations LL wrote down were basically made up, as she wasn't even in the unit when they were recorded , let alone with Baby O?. She was on messenger.

And although there's no attempted murder charge for Baby P on the day Baby O died (only the murder charge the following day), the prosecution seem to be suggesting that LL may have done something to Baby P, when she fed him just 13 minutes after Baby O's death?

6pm – LL fed triplet P milk, about 13 minutes after his brother O had died.

6pm – Dr Gibbs reviewed triplet P because O had died in unusual circumstances. He noted abdomen full, mildly distended.

8pm – LL’s shift ended.

8pm - feed of triplet P – after LL’s handover to another nurse, produced a 14ml milk acidic aspirate.

8pm - X-ray showed striking gaseous distension in stomach and bowel.

8.24pm – LL was still in the unit as she wrote up her nursing notes. On that night shift milk feeds for P were stopped and air was aspirated from the NG tube and it was on free-drainage.

 

[Tortoise]

So the prosecution are suggesting that, after the colleague suggested Baby O should go back to room 1, the"normal " observations LL wrote down were basically made up, as she wasn't even in the unit when they were recorded , let alone with Baby O?. She was on messenger.

And although there's no attempted murder charge for Baby P on the day Baby O died (only the murder charge the following day), the prosecution seem to be suggesting that LL may have done something to Baby P, when she fed him just 13 minutes after Baby O's death?

I think there's some information missing from the reporting. Dr Evans said baby O's liver injury would explain his symptoms throughout the morning but we haven't got anything about those symptoms in the reports.

It does look as if they're saying she made it up the observations. Someone else must have been with him though if she wasn't there, so I think there's much missing.

Perhaps they didn't feel the information about P was clear enough to make a charge in respect of the first occasion?

 

[ColourPurple]

I think there's some information missing from the reporting. Dr Evans said baby O's liver injury would explain his symptoms throughout the morning but we haven't got anything about those symptoms in the reports.

It does look as if they're saying she made it up the observations. Someone else must have been with him though if she wasn't there, so I think there's much missing.

Perhaps they didn't feel the information about P was clear enough to make a charge in respect of the first occasion?

Thanks for the info and for the confirmation that the triplets were born on 21 June and were two days old when LL came back from her holiday. It'll be interesting to hear the rest of the details once the case resumes.

 

[katydid23]

23 June 2016- Alleged murder of Baby O
24 June 2016 -Alleged murder of Baby P
25 June 2016- Alleged attempted murder of Baby Q

That^^^ just blows my mind. That is so reckless and out of control, if it happened as the prosecution describes it allegedly did. Especially when you consider it had been happening for a year already and Q was the 16th alleged victim.

By the time the defense stands up to set forth their case, it will be important for them to try and explain this repetitive pattern of alleged attacks. I am not sure it will be easy to say it was a coincidence that their client was there so much of the time, and that the cluster of deaths was because of suboptimal care by the hospital in general.

I think they will need very specialised medical experts who can successfully rebut these medical reports that are being given to the jury, claiming that these babies are being poisoned, internally prodded and injected with air to create embolisms. These are very disturbing accusations.

 

[katydid23]

I'm a little confused by the conflicting information for baby Q about LL aspirating his stomach at 9.10am but turning up with the doctors at 9.17am, so we'll have to wait to hear the evidence to clarify that one. That's why I've marked it with a ?

Here is what The Standard has as their timeline for baby Q:

Child Q - attempted murder allegation

Child Q was born on June 22 - the day after Child O and P. He was premature but a good weight, and on CPAP for the first 20 hours.

He was admitted to the neonatal unit as he needed breathing support, but was initially stable.




LL comes on duty on June 25th:

The day shift on June 25, Letby was on duty and was Child Q's designated nurse. Child Q had been moved into room 2.


8 am= Letby made notes on Child Q's fluid/feeding chart at 8am. Child Q was receiving nutrition Babiven via a UVC.

9 am=Just after 9am, Letby and the nurse were together in nursery 2, and it was feeding time. The other nurse attended to another child in the room.

According to the record, Child Q's heart and respiratory rates both increased for a short period of time.

But, the prosecution say, the feeding chart shows something 'unusual'.

That chart is shown to the court. The 9am fluid chart, in Letby's handwriting, appears unfinished, with numbers noted for fluids, but no record for the feed or Letby's signature initials at the bottom of the 9am column.

The prosecution suggests something caused Letby to leave halfway through doing this.

9:04 am----
Letby signed for medication for another baby at 9.04am.

[The other nurse agreed to keep an eye on Child Q at 9am.]

9:10 am---A few minutes later, Child Q's monitor alarms activated to alert staff to a deterioration in his condition.

The nurse called for help and was joined by another nurse. Child Q had been sick and nurses used a suction catheter while respiratory support was given.


9:17 am---Lucy Letby appeared soon afterwards together with doctors who were responding to the call for help.

Medical notes indicates doctors were called to the unit at 9.17am as Child Q had "just vomited" and oxygen saturation levels were in the "low 60s".




The prosecution say medical staff gave him assistance with breathing using a Neopuff device and applied suction to clear his airways. The records indicate not only had his oxygen dropped but also his heart rate. He is described as “mottled” in appearance and, most significantly, a substantial amount of air was aspirated from his stomach via the NGT.


[Mr Johnson: "We say that Lucy Letby had sabotaged [Child Q] and had injected him with air and a clear fluid into his stomach via the NGT. She was trying to kill him."]

Mr Johnson tells the court the air had been put in there by Letby, as if the feeding chart had been followed correctly at 9am, the person feeding - Letby - would have aspirated Child Q's stomach to check there was nothing there before administering the 0.5ml milk feed.



Another nurse's medical note on an 'apnoea/brady/fit chart' notes: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++.

"O2 via neopuff given post suctioning. Dr... emergency called to attend.

"NGT used to aspirate stomach by Nurse L Letby”

The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.

Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

 

[Tortoise]

Here is what The Standard has as their timeline for baby Q:

Child Q - attempted murder allegation

Child Q was born on June 22 - the day after Child O and P. He was premature but a good weight, and on CPAP for the first 20 hours.

He was admitted to the neonatal unit as he needed breathing support, but was initially stable.




LL comes on duty on June 25th:

The day shift on June 25, Letby was on duty and was Child Q's designated nurse. Child Q had been moved into room 2.


8 am= Letby made notes on Child Q's fluid/feeding chart at 8am. Child Q was receiving nutrition Babiven via a UVC.

9 am=Just after 9am, Letby and the nurse were together in nursery 2, and it was feeding time. The other nurse attended to another child in the room.

According to the record, Child Q's heart and respiratory rates both increased for a short period of time.

But, the prosecution say, the feeding chart shows something 'unusual'.

That chart is shown to the court. The 9am fluid chart, in Letby's handwriting, appears unfinished, with numbers noted for fluids, but no record for the feed or Letby's signature initials at the bottom of the 9am column.

The prosecution suggests something caused Letby to leave halfway through doing this.

9:04 am----
Letby signed for medication for another baby at 9.04am.

[The other nurse agreed to keep an eye on Child Q at 9am.]

9:10 am---A few minutes later, Child Q's monitor alarms activated to alert staff to a deterioration in his condition.

The nurse called for help and was joined by another nurse. Child Q had been sick and nurses used a suction catheter while respiratory support was given.


9:17 am---Lucy Letby appeared soon afterwards together with doctors who were responding to the call for help.

Medical notes indicates doctors were called to the unit at 9.17am as Child Q had "just vomited" and oxygen saturation levels were in the "low 60s".




The prosecution say medical staff gave him assistance with breathing using a Neopuff device and applied suction to clear his airways. The records indicate not only had his oxygen dropped but also his heart rate. He is described as “mottled” in appearance and, most significantly, a substantial amount of air was aspirated from his stomach via the NGT.


[Mr Johnson: "We say that Lucy Letby had sabotaged [Child Q] and had injected him with air and a clear fluid into his stomach via the NGT. She was trying to kill him."]

Mr Johnson tells the court the air had been put in there by Letby, as if the feeding chart had been followed correctly at 9am, the person feeding - Letby - would have aspirated Child Q's stomach to check there was nothing there before administering the 0.5ml milk feed.



Another nurse's medical note on an 'apnoea/brady/fit chart' notes: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++.

"O2 via neopuff given post suctioning. Dr... emergency called to attend.

"NGT used to aspirate stomach by Nurse L Letby”

The prosecution say given that Letby was Child Q's designated nurse and she performed the aspiration of air, it might be thought surprising that she did not make the note – yet she did make notes in records of other babies’ notes at about the same time.

Mr Johnson: "We question whether this is an attempt by her to create a documentary alibi."

Lucy Letby trial recap: Prosecution finishes outlining case, defence gives statement

THE prosecution in the trial of Lucy Letby, accused of murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to…

www.chesterstandard.co.uk

Thanks. I've updated Q's timeline, but I still can't make sense of her aspirating the stomach at 9.10 and appearing with the doctors at 9.17am.

New timeline for baby Q


22 Jun 2016, Wed

Child Q was born, premature but a good weight. He was on CPAP for the first 20 hours. He was admitted to the NU room 1 but was initially stable. He had an umbilical catheter but he was well enough to commence feeding via his NGT.


24 Jun 2016, Fri


8pm Night shift – Baby Q’s designated nurse monitored him through the night and was content with his condition but his blood gases deteriorated slightly so she referred the results to a doctor. The doctor was not concerned.

9.18pm to 10pm – LL was still in the unit, writing up retrospective notes for baby P for 8am that morning.


25 Jun 2016, Sat

3am – Child Q was fed 0.5ml of milk

5am – Child Q was fed 0.5ml of milk

7am – Child Q was fed 0.5ml of milk

8am – LL’s day shift – LL was Q’s designated nurse in room 2. Handover sheet for morning of 25 Jun 2016 for baby Q was found at LL’s home. LL made notes on Q’s fluid/feeding chart. He was receiving nutrition Babiven via his UVC.

9am – LL fed Q 0.5ml milk. Q’s heart and respiratory rates increased. LL left the feeding chart unfinished; prosecution say she left halfway through doing it. Numbers are noted for fluids but no record for feed or signature. Another nurse agreed to keep an eye on Q.

9.04am – LL signed for medication for another baby.

9.10am – Q’s monitor alarms went off and he vomited. His saturation levels were in the low 60s and his heart rate dropped. The nurse called for help and was joined by another nurse. Nurses used a suction catheter while respiratory support was given. Another nurse noted on baby Q's apnoea/brady/fit chart: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++. O2 via neopuff given post suctioning. Dr... emergency called to attend. NGT used to aspirate stomach by Nurse L Letby”. The prosecution say LL did the aspiration but made no note of doing it herself, yet she did make notes in other babies’ records at about that time. Prosecution query whether she was trying to create an alibi in the records. LL’s nursing notes recorded: “09:10hrs [Child Q] attended to by SN... – he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled ++. Neopuff and suction applied. Registrar attended. Air ++ aspirated from NG tube”.

9.17am - LL appeared with the doctors responding to the call. Q was mottled and a substantial amount of air was aspirated from his stomach via the NGT. There would not have been air if LL had aspirated his stomach before the 9am feed.

Air and fluid allegedly injected into stomach via NGT - attempted murder charge. The defence say "there was viral-drawn aspirates, indicating a bowel problem, supported by a diagnosis of NEC. A poorly functioning bowel had led to Child Q vomiting."

By 11.12am - Following the collapse, blood was taken to test for infection and other parameters. A venous blood gas test showed results suggesting that he was unwell but this had resolved by 11.12am. He was started on a course of antibiotics as a precaution. The doctor's view recorded at the time said Child Q's collapse was a result of “presumed sepsis with jaundice”. At that stage a chest x ray was taken which showed nothing untoward.

1.50pm - The more detailed blood tests were recorded at 1.50pm and showed slightly abnormal results which were treated. Child Q had made a reasonable recovery through the day.

7.20pm - at 7.20pm Q was "looking tired". Doctors took the decision to intubate him because his respiratory rate was down to 19 (low)and his heart rate was between 160-200 bpm (high). At that stage his blood gas readings were good.

8pm - end of LL’s shift.

10.46pm –
LL text to a doctor: do I need to be worried about what Dr G was asking?
Doctor replied that Dr G was only asking to make sure that the normal procedures were carried out.
LL replied that after Child Q had collapsed she (LL) had walked into the equipment room and Dr G was asking a nurse 'who was present when Child Q collapsed and how quickly someone had gone to him because LL had not been there'.
She continued her texts to the doctor, telling him that she had needed to go to her designated baby in room 1.

26 Jun 2016, Sun

The following day, Child Q's gases were unsatisfactory, but he had been extubated 4 hours earlier and was in air with high saturations. Medical staff noted a 'mildly dilated loop of bowel' on Child Q's left side and raised the possibility of NEC and surgery. Child Q was transferred to Alder Hey, where he quickly stabilised and no surgery was required. The prosecution say this was "another child who had suffered life-threatening problems and when out of the orbit of Lucy Letby, he made a rapid recovery."

 

[Legal]

It does seem, if the allegations are true, that she really doesn't like twins and triplets. Maybe she feels the parents are greedy having more than one child and it arouses some kind of envy in her (all MOO and guesswork). People are normally relaxed when they get back from holiday so perhaps seeing the triplets was a huge trigger that incited a mad killing spree. (if guilty and in my opinion).

 

[Sweeper2000]

It’s quite clear to see how in All of these cases especially the ones covered in the last two pages would raise concern. Truly remarkable occurrences, it does also give me confidence in the hospitals awareness. It’s quite difficult to interpret from my point of view though.

in regards to the notes though, I’m not sure complete accuracy can be expected and I’m led to believe note making is sometimes done ahead of time for A variety of reasons.

the Ncbi has actually done a study on it.


“Patients’ records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in order to effectively manage their patients. In hospitals, nurses have to record a wide range of information in the patient’s records and this leads to increased workload on the part of nurses that compromises accurate record-keeping.”

“Results​

Nurses working in public hospitals experience record-keeping as a challenging activity owing to a variety of challenges which include lack of time to complete the records, increased patients’ admission and shortage of recording material.

Conclusion​

Record-keeping is not done properly which is problematic, and it is recommended that there should be continuous training, monitoring and evaluation of nurses on record-keeping issues, supply of adequate recording materials and proper time management amongst nurses to improve record-keeping challenges. The need for comprehensive record-keeping remains fundamental in public hospitals in order to improve patient care.”

Record-keeping: Challenges experienced by nurses in selected public hospitals

Patients’ records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in ...

www.ncbi.nlm.nih.gov

 

[Tortoise]

It’s quite clear to see how in All of these cases especially the ones covered in the last two pages would raise concern. Truly remarkable occurrences, it does also give me confidence in the hospitals awareness. It’s quite difficult to interpret from my point of view though.

in regards to the notes though, I’m not sure complete accuracy can be expected and I’m led to believe note making is sometimes done ahead of time for A variety of reasons.

the Ncbi has actually done a study on it.


“Patients’ records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in order to effectively manage their patients. In hospitals, nurses have to record a wide range of information in the patient’s records and this leads to increased workload on the part of nurses that compromises accurate record-keeping.”

“Results​

Nurses working in public hospitals experience record-keeping as a challenging activity owing to a variety of challenges which include lack of time to complete the records, increased patients’ admission and shortage of recording material.

Conclusion​

Record-keeping is not done properly which is problematic, and it is recommended that there should be continuous training, monitoring and evaluation of nurses on record-keeping issues, supply of adequate recording materials and proper time management amongst nurses to improve record-keeping challenges. The need for comprehensive record-keeping remains fundamental in public hospitals in order to improve patient care.”

Record-keeping: Challenges experienced by nurses in selected public hospitals

Patients’ records provide a trace of care processes that have occurred and are further used as communication amongst nurses for continued management of patients. Nurses have the responsibility to ensure that records are accurate and complete in ...

www.ncbi.nlm.nih.gov

That study was done in a South African hospital and it doesn't mention anything about nurses completing notes ahead of time.

There is nothing in the nursing notes in this case that suggests they were made ahead of time, they are largely retrospective. They'd have had to predict the monitor readings and collapses.

 

[Sweeper2000]

That’s true but I wouldn’t assume the situation is much different here in the UK. It’s the well known and much complained about situation of bureaucracy although I understand the need. One explanation of why nurses might right notes down ahead of time or retrospectively is to free Up time for more clinically orientated practice. They could potentially write down what is scheduled care and then add the readings and treatment as they go. It’s a systemic issue so depending on certain factors will be present in any institution IMO regardless of location.

• “61 per cent of nursing staff say they are too busy to provide the level of care to patients that they would like, a significant increase from 43 per cent 10 years ago. 54 per cent say too much of their time is spent on non-nursing tasks such as paperwork“
• Nursing staff working in independent sector care homes consistently provided more negative responses to questions, indicating that this sector is under particular staffing pressure

Nursing staff stretched to breaking point over workloads, report reveals | Royal College of Nursing

employment survey

www.rcn.org.uk

its fitting with a hospital and unit that is considered to be understaffed.

“It found "significant gaps" in medical and nursing rotas, "poor decision-making" and "insufficient senior cover".

Staffing 'inadequate' at Chester baby death hospital

A review found "significant gaps" in rotas and "insufficient senior cover" at the Countess of Chester Hospital.

www.bbc.co.uk

“A study at a large acute trust in England, which was led by researchers in Nottingham, found nurses sometimes completed documentation retrospectively without full knowledge that care had actually been completed.

“Nurses working with older patients find current documentation time-consuming… resulting in gaps, mishaps and overlaps of information”
Study authors

One nurse in the study described a case in which a patient collapsed, but when their notes were consulted there was no information about why they had been admitted.

In other instances, documentation had been filled in before nurses had carried out procedures to ensure they did not forget ahead of any potential audits.”

'Inaccurate and incomplete’ nurse record keeping raises safety concerns, warn researchers

A study at a large acute trust in England, which was led by researchers in Nottingham, found nurses sometimes completed documentation retrospectively

www.nursingtimes.net

I just thought it might explain this query. Respectfully snipped.

“Thanks. I've updated Q's timeline, but I still can't make sense of her aspirating the stomach at 9.10 and appearing with the doctors at 9.17am.”

 

[Sundial]

What strikes me is the alleged reports and a bit of a pattern with most of these cases where she’s seemingly just “stood” or the first to call for help. When you really condense these cases and narrow down the points, it has a rather uncomfortable, uneasy feel IMO.


Baby A; Medication co-signed by colleague and LL- Witness- Nurse testified- later whilst at the computer; LL was stood by incubator

Baby B; Hospital records- LL and colleague administer liquid feed bag via IV line around midnight. At 12:16 (not the designated nurse) LL takes blood gases
At 12:30- alarm sounds and LL calls nurse to incubator
Handover sheet for baby B found in her home

Baby C; witness- nurse/shift leader- LL kept entering family room

Baby D; witness- Mother testified- LL hovering around with clipboard/watching

Baby E; witness- Mother testified-LL stood near incubator at work station
Baby F; Evidence agreed in court- TPN bag tampered with/insulin overdose

Baby G; witness- Mother testified- LL taking bloods, on return LL (and another)colleague stood over incubator

Baby I; witness- Nurse testified-
1. LL stood in darkened doorway (watching)
2. stood at incubator less than hour later
3.Mother testified- LL came into room (smiling) as they bathed their deceased baby

Baby J; Hospital records- LL co-signed medication, recorded notes at 3am and responding to alarm.
Text exchange earlier that day suggest babies needing feeding support (as with baby J) was not stimulating

Baby k; witness- dr J testified- LL stood over/next to incubator

Baby M; Hospital records; LL one of two to administer IV antibiotics.
Digital data shows colleague was at the computer 3:45pm. At 4pm when the monitor sounded, LL was first to the incubator.
*suddenly improved*
Hand-written drugs log during the collapse found at LL home
Baby N; Witness reports from colleagues:
1. designated nurse left for break- baby N described to be screaming
2. 12 days later, as nurses back is turned, LL claimed he desaturated (no alarm sounded)
3.Doctor reports swelling and fresh blood in the throat

Baby O; Door entry data; within minutes of entering the unit, baby O collapses, LL called for help.
Medical reports; trauma in and on the liver

Baby Q; Hospital records- incomplete feeding chart at 9:00am by LL and then signed for medication for different baby at 9:04am. Soon after this; baby Q deteriorated. Handover sheet with baby Qs name found at LL home

 

[ColourPurple]

Thanks. I've updated Q's timeline, but I still can't make sense of her aspirating the stomach at 9.10 and appearing with the doctors at 9.17am.

New timeline for baby Q




8am – LL’s day shift – LL was Q’s designated nurse in room 2. Handover sheet for morning of 25 Jun 2016 for baby Q was found at LL’s home. LL made notes on Q’s fluid/feeding chart. He was receiving nutrition Babiven via his UVC.

9am – LL fed Q 0.5ml milk. Q’s heart and respiratory rates increased. LL left the feeding chart unfinished; prosecution say she left halfway through doing it. Numbers are noted for fluids but no record for feed or signature. Another nurse agreed to keep an eye on Q.

9.04am – LL signed for medication for another baby.

9.10am – Q’s monitor alarms went off and he vomited. His saturation levels were in the low 60s and his heart rate dropped. The nurse called for help and was joined by another nurse. Nurses used a suction catheter while respiratory support was given. Another nurse noted on baby Q's apnoea/brady/fit chart: "09:10; brady 98; desat 68; fit ?; baby found to be very mucousy, clear mucous from nasopharynx oropharynx removed clear fluid +++. O2 via neopuff given post suctioning. Dr... emergency called to attend. NGT used to aspirate stomach by Nurse L Letby”. The prosecution say LL did the aspiration but made no note of doing it herself, yet she did make notes in other babies’ records at about that time. Prosecution query whether she was trying to create an alibi in the records. LL’s nursing notes recorded: “09:10hrs [Child Q] attended to by SN... – he had vomited clear fluid nasally and from mouth, desaturation and bradycardia, mottled ++. Neopuff and suction applied. Registrar attended. Air ++ aspirated from NG tube”.

9.17am - LL appeared with the doctors responding to the call. Q was mottled and a substantial amount of air was aspirated from his stomach via the NGT. There would not have been air if LL had aspirated his stomach before the 9am feed.

Air and fluid allegedly injected into stomach via NGT - attempted murder charge. The defence say "there was viral-drawn aspirates, indicating a bowel problem, supported by a diagnosis of NEC. A poorly functioning bowel had led to Child Q vomiting."

Are the prosecution trying to suggest that the clear fluid that Baby Q vomited could have been the medication that LL signed for for another baby around the same time? She's alleged to have injected "fluid" but without testing it presumably nobody would know what the fluid actually was.

 

[Tortoise]

That’s true but I wouldn’t assume the situation is much different here in the UK. It’s the well known and much complained about situation of bureaucracy although I understand the need. One explanation of why nurses might right notes down ahead of time or retrospectively is to free Up time for more clinically orientated practice. They could potentially write down what is scheduled care and then add the readings and treatment as they go. It’s a systemic issue so depending on certain factors will be present in any institution IMO regardless of location.

• “61 per cent of nursing staff say they are too busy to provide the level of care to patients that they would like, a significant increase from 43 per cent 10 years ago. 54 per cent say too much of their time is spent on non-nursing tasks such as paperwork“
• Nursing staff working in independent sector care homes consistently provided more negative responses to questions, indicating that this sector is under particular staffing pressure

Nursing staff stretched to breaking point over workloads, report reveals | Royal College of Nursing

employment survey

www.rcn.org.uk

its fitting with a hospital and unit that is considered to be understaffed.

“It found "significant gaps" in medical and nursing rotas, "poor decision-making" and "insufficient senior cover".

Staffing 'inadequate' at Chester baby death hospital

A review found "significant gaps" in rotas and "insufficient senior cover" at the Countess of Chester Hospital.

www.bbc.co.uk

“A study at a large acute trust in England, which was led by researchers in Nottingham, found nurses sometimes completed documentation retrospectively without full knowledge that care had actually been completed.



One nurse in the study described a case in which a patient collapsed, but when their notes were consulted there was no information about why they had been admitted.

In other instances, documentation had been filled in before nurses had carried out procedures to ensure they did not forget ahead of any potential audits.”

'Inaccurate and incomplete’ nurse record keeping raises safety concerns, warn researchers

A study at a large acute trust in England, which was led by researchers in Nottingham, found nurses sometimes completed documentation retrospectively

www.nursingtimes.net

I just thought it might explain this query. Respectfully snipped.

“Thanks. I've updated Q's timeline, but I still can't make sense of her aspirating the stomach at 9.10 and appearing with the doctors at 9.17am.”

I think that might be referring to routine tasks rather than emergencies.

I'm wondering why a nurse noted that LL did the aspirating when baby Q collapsed, when LL didn't arrive in the room until some minutes later. It's possible of course that the nursing note covered a longer period starting at 9.10 and ending much later after LL got there. But the prosecution seem to think LL was making entries in other babies' notes at that time to give herself an alibi, so who knows.

 

[Tortoise]

Are the prosecution trying to suggest that the clear fluid that Baby Q vomited could have been the medication that LL signed for for another baby around the same time? She's alleged to have injected "fluid" but without testing it presumably nobody would know what the fluid actually was.

The ITV link says possibly water or saline Who are the children alleged to have been murdered by Lucy Letby? | ITV News

"The neonatal nurse is claimed to have injected child Q with excess air and a clear fluid - possibly water or saline - into his stomach via a nasogastric tube.

The youngster was later transferred to another hospital, where he went on to make a "rapid recovery".

The defence say there is no evidence that Letby inflicted harm."