Regarding temp of babies - they cannot regulate their body temperature.especially such prem babies. My little girl wasn’t able to go into a cot untill she was around 4 months, and before that (but after an incubator) she went into a hot cot. So I presume it would need to be recorded whatever their temp is.
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I'm so glad you've wrote this. It is as if you're in my head, as today I've read the wiki and had similar questions.
I just wanted to add. I'm 70% guilty, 30% NG so intrigued to see what the defence come up with. The only thing that is making me think guilty is sheer coincidence and the fb searching. The handover notes found at home but be a genuine mistake. You take them home after a busy shift but don't dispose of them at home because of confidential information. She may have forgotten to take them back.
Another couple of questions
1. If they had suspicions about her, and changed her from night to day shift, why did they still continue to give her high risk babies and not allocate a support worker to work alongside her? It was stated in some of the evidence that there were 7 nurses but only 5 babies so surely that's able to do at times.
2. Why is communication between nursing and doctors being done on fb messenger? Surely the doctor should also be reprimanded for this as unprofessional?! Especially when off shift?
3. What if the other nurses in a couple of the cases were the same nurse....? But they can't link them to all cases as they have LL, which again, some of them could be coincidental deaths.
4. You can't always document what you're doing at an exact time, if you're doing the thing you're meant to document! How is a nurse meant to do 2 things at once?
Anyway. I'm sure I'll have more questions as it goes on, but it'll be interesting to see what the defence come back with.
Exactly this! It’s insulting just to put it down to their prematurity! Feels like the easy way out to me.
It seems quite a big oversight for several people to make on a newborn who can't regulate their own body temp.
as someone who had a poorly baby in NICU your point is absolutely lovely to read. I’d have hated him to be written off because he was ill. If them being ill and in the NICU meant a death sentence then they’d have all died but the fact is so many babies will come home from NICU and will get better so it absolutely deserves to be thoroughly investigated.My comprehension of the reporting is that LL didn’t do the temp at 8pm as part of the hourly observations, but that temp was not checked hourly throughout the day either.Yes, it sounds like babies were very poorly and there was lax procedures across the board. Low temp can cause mottling - so were babies deteriorating beforehand already?
Prem babies need as much rest as possible so I personally wouldn’t (and therefore don’t) do hourly temps on a stable baby. At 8pm the baby was stable so if the temp was done at 7pm then personally I wouldn’t check it and so I can only guess thats probably what LL decided as well (obviously unless shes guilty). We like to do “group cares” on stable premature babies so we do everything at once and the aim is then to leave them for up to 6hrs without any non-essential intervention if possible (nappy changes etc)
Seeing as I wrote something almost identical (without the 'anyway', which is very insulting), then I'll explain - I would in no way write a baby off 'just' because they were sick and premature.
I think there's a real miscommunication in the way the babies are being described in my opinion - they are said to be doing 'well' and stable etc, but to someone who hasn't had any preemie experience, the picture they may have in their head is of a chunky newborn baby, and so a dramatic downturn would sound really surprising. A tiny tiny 1lb baby can go downhill so incredibly quickly for a number of reasons even if they were previously 'doing well'.
Therefore, a baby who was seen to be 'stable' and 'doing well' on an extremely busy unit with low staffing, who hadn't had its temperature taken or recorded for hours, could theoretically crash 'unexpectedly'.
Edited to add: I am very sorry if anyone did think any comment of mine was dismissive of a baby. Pregnancy/childbirth/babies are such a bloody miracle and to have something come along to threaten that is the scariest thing in the world.
Yes my baby wasn’t premature but when she was in NICU they would do everything together - so temperature, nappy change and a feed at once. So it would have been logged every 3 hours or so (when she was due a feed), not hourly
In the incubators, (well in ours anyway) the baby is lay on a temperature probe so they don't have to be disturbed. The temp is then displayed on the screen with Heart Rate, Sat's, Resp Rate, that way the incubators internal temperature can be controlled to suit the current temperature of a baby. I'd expect a Level 2 NICU such as this to have that in the incubators? Especially for a new born
I've had less competent nurses moved to my shift pattern so I could 'supervise' them but ultimately they're a qualified nurse without restrictions on practice and they're not my priority so if the tit hits the fan on shift, I'm going to look after my patients and not them. The management who swapped her shifts when they noticed a pattern should be held accountable for some of this.
We've used fb messenger at times to communicate, especially after a hard day, asking how they are or for an update but not using patient names. No policy or rule about it in my trust.
The documentation is frustrating, I often document the following day if I need to, if she's busy with a poorly baby of course she needs to document later and some details may not be perfect including timings. It's so hard to accurately recall how long each thing takes when you're in a highs stress environment cos sometimes the time flies over yet some minutes feel like hours!
I see what you mean and agree they deserve to have every possible cause looked at thoroughly so this can never happen again but I’ve perceived those kind of posts a different way - are these babies dying because they were really unwell and received substandard care or are these babies dying because someone murdered them - both these things are preventable. It’s been established these deaths are higher than normal so it seems unlikely they died solely because of their prematurity. Whatever was the cause of these babies dying I think everyone will agree it’s absolutely devastating and shouldn’t happen. It’s just so cruel whether it’s naturally occurring or by human cause.
Quoting myself just to say I hope nobody thinks I am writing them off just because of these facts. I just think they could be contributing factors.
Yes, I feel it's just really insensitive. Really sick babies get better all the time survive.
100%.
I have a question about the babies temperature. As monitors continuously record heart rate, respiratory rate, oxygen saturation etc would this be the same for temperature? Would there be a probe attached?
If so, would you be able to look back on the machines internal log as you can with other recordings? Genuine question.
That's interesting. Just out of curiosity as they haven't specifically stated in the reporting how many of the hourly checks weren't recorded...I get you not checking if it was fine an hour before and baby was stable and sleeping etc,but what sort of time gap between the last check done and the one due now would make you think 'hang on, I'd better check'?
Also, does the age of prematurity come into it, as at 28 weeks, baby A and B were both really tiny
Sorry if silly questions
Yeah exactly so on a stable term baby this is what nursing staff would do. But stable for a term baby is completely different to stable on a prem baby. So at 28 weeks the baby would definitely need hourly observations, but as a neonatal nurse if the temp had been stable all day and the baby had been in the same incubator set at the same temperature all day I wouldn’t be doing hourly temperature checks as part of those hourly obs. Its just unnecessary intervention for a baby that should still be in the mothers womb all nice and cosy and left alone for another 12+ weeks.
Nope. Well the incubators have heating monitors but in general no, temps are still checked by armpit typically hourly.
You beat me to it, I was going to say adults have temperature probes, why don't babies?
I hope there was a probe. Unrecorded temperature on new born very prem babies is a massive concern to me. Perhaps I'm old school but for at least 24 hrs post op/post trauma or in this case post very early birth I'm not considering that patient stable. I want to see stability in the figures and with my own eyes.
but if they died from poor care alone then surely other nurses will have had their babies die too?
I had 1lb odd twins at 30 weeks. Twin 2 needed resuscitated and ventilated, twin 1 needed cpap. Both didn't get any actual milk til day 2 but they were still 'well' and 'stable' despite the very real potential risk due to their immaturity.
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