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| Hyponatraemia inquiry: Royal patient care 'lacked structure' | Hyponatraemia inquiry: Royal patient care 'lacked structure' |
| (40 minutes later) | |
| A public inquiry into the death of a four-year-old boy at the Royal in Belfast has heard that his care lacked structure which resulted in serious and numerous omissions. | A public inquiry into the death of a four-year-old boy at the Royal in Belfast has heard that his care lacked structure which resulted in serious and numerous omissions. |
| Adam Strain died following a kidney transplant in 1995. | Adam Strain died following a kidney transplant in 1995. |
| The hyponatraemia inquiry is investigating the deaths of five children in Northern Ireland. | The hyponatraemia inquiry is investigating the deaths of five children in Northern Ireland. |
| The inquiry also heard on Tuesday that Adam's mother requested a surgeon not take part in her son's procedure. | The inquiry also heard on Tuesday that Adam's mother requested a surgeon not take part in her son's procedure. |
| The inquiry is examining the deaths of three children - Adam, Claire Roberts and Raychel Ferguson. | The inquiry is examining the deaths of three children - Adam, Claire Roberts and Raychel Ferguson. |
| But it is also investigating the events following the deaths of Lucy Crawford and Conor Mitchell. All of the children died in hospital. | But it is also investigating the events following the deaths of Lucy Crawford and Conor Mitchell. All of the children died in hospital. |
| In relation to four of the deaths hyponatraemia is said to be a contributing factor. | In relation to four of the deaths hyponatraemia is said to be a contributing factor. |
| Hyponatraemia describes an abnormally low level of sodium in the blood which occurs when fluid is not administered properly. | Hyponatraemia describes an abnormally low level of sodium in the blood which occurs when fluid is not administered properly. |
| A nursing expert appointed by the inquiry team raised very serious concerns about how staff at the Royal Belfast Hospital for Sick Children cared for Adam. | A nursing expert appointed by the inquiry team raised very serious concerns about how staff at the Royal Belfast Hospital for Sick Children cared for Adam. |
| The nursing expert, Sally Ramsey, said that record keeping fell below the expected standards. There was also no nursing care or dialysis plan. | The nursing expert, Sally Ramsey, said that record keeping fell below the expected standards. There was also no nursing care or dialysis plan. |
| She said: "As a child in chronic renal failure about to undergo major surgery - the care given to Adam pre-operatively lacked structure which resulted in omissions in his care. " | She said: "As a child in chronic renal failure about to undergo major surgery - the care given to Adam pre-operatively lacked structure which resulted in omissions in his care. " |
| It has been revealed that prior to Adam's operation his mother requested that one of the surgeons should not be involved in his surgery as she had no faith in him. | It has been revealed that prior to Adam's operation his mother requested that one of the surgeons should not be involved in his surgery as she had no faith in him. |
| As there was no plan in place that instruction was ignored. | As there was no plan in place that instruction was ignored. |
| The inquiry has also heard that handwriting was misread which could mean that Adam received the wrong amount of fluids. | The inquiry has also heard that handwriting was misread which could mean that Adam received the wrong amount of fluids. |
| Counsel for the family, David McBrien, said the family still had many questions. | |
| This included why a leading doctor did not play a more active role in the operating theatre, why it took a different doctor 16 years to recognise he had made so many mistakes and why there was such poor communication between clinicians? | This included why a leading doctor did not play a more active role in the operating theatre, why it took a different doctor 16 years to recognise he had made so many mistakes and why there was such poor communication between clinicians? |
| In summing up, an expert witness said: "Adam's death was an avoidable tragedy - it's a shame it has taken so many years for the lessons to be learned in this case." | In summing up, an expert witness said: "Adam's death was an avoidable tragedy - it's a shame it has taken so many years for the lessons to be learned in this case." |
| The inquiry will resume on 16 April and is expected to last until November. | The inquiry will resume on 16 April and is expected to last until November. |