Medical staff caring for a student being treated in hospital after she suffered a dislocated hip in a rugby accident did not initially test her for sepsis even after a system designed to pick up early warning signs suggested this should have been done, an inquest has heard.
Staff at Southmead hospital in Bristol also apparently failed to carry out all the observations needed to keep 20-year-old Maddy Lawrence safe, the hearing was told.
Lawrence sustained a dislocated hip when she was tackled during a game for UWE Bristol on 9 March 2022. She was taken to hospital, developed sepsis, had a series of operations including a leg amputation and died of multiple organ failure 16 days later.
The inquest has heard that Lawrence lay on the pitch for more than five hours while she waited for an ambulance. It has also been told that a bomb hoax delayed a CT scan being done.
Yvonne Bushell, a former nurse, told the inquest on Friday she was concerned about the degree of pain Lawrence was in when she was involved in her care over three days from 11 March 2022.
She confirmed that she told a patient safety review investigation she felt doctors “weren’t listening” to how much pain Lawrence was in.
Jonathan Jones KC, who is representing the family at Avon coroner’s court, suggested it was “very unusual” for a fit young woman who had suffered a dislocated hip to still be “crying out in pain” so long after it had been manipulated back into place.
Jones questioned Bushell over why regular observations had apparently not been carried out on Lawrence when her News (national early warning score), which is designed to pick up deterioration and sepsis, indicated this should have been done.
Bushell said she had been “let down” by trainee colleagues whom she had expected to carry out the observations, adding: “I wasn’t aware of the lack of observation being taken.” She said she was “really shocked” when she found out.
The inquest was also told that at this point in her care, no screening for sepsis was ordered though, again, scores in News could have triggered this.
Jones asked: “Do you think you should have screened for sepsis?” Bushell replied: “Potentially yes.”
Bushell, who has retired from nursing, said she had reflected on Lawrence’s care. “I don’t know … why I didn’t do what I should have done,” she said. “I apologise.” Bushell said she had been trained in News but did not remember being trained in sepsis six, a care pathway created to reduce the chance of a patient dying of the condition.
Lydia Jenner, an orthopaedic registrar who saw Lawrence in Southmead the day after the injury, said she was in pain but “looked well” and she expected her to be home by the weekend.
She said she was unaware of her News scores. If she had known it, she said she would have asked nurses and junior doctors to monitor her for deterioration. “I was surprised to learn they [the News scores] were high.
Jenner said she had changed her practice and looked at News scores. She said the hospital had been “hindered” by the bomb hoax but disagreed with Bushell’s claim that doctors had not listened to concerns about the pain Lawrence was in.
The inquest continues and is expected to last two weeks.
