Staff caring for an 80 years old woman failed to hear a warning alarm alerting them to the fact that she had become disconnected from a breathing ventilator, an Inquest into her death heard.
On account of this being the second such incident in the critical care units of UHG, Coroner for West Galway, Dr Ciaran MacLoughlin, recommended that the HSE would issue a statement to assure members of the public that a review had taken place following this incident, and that ICU/HDU were safer places to be as a result.
Neither the nursing staff, nor the doctors doing their rounds at the time, heard the beeping noise to indicate that the life of Ann Downes, of 12 Bayview Heights, Ballybane, was in danger.
“This is the second occasion that this has happened (March 2012),” the Coroner pointed out to witnesses and family members.
“I was given to understand that corrective measure were put in place to ensure that this would never happen again. It is in the general public’s interest what happened, and why measures don’t seem to be in place.
“When it comes to the equipment, it doesn’t matter how ill the patient is, all must be treated the same. I know Mrs Downes was a very ill person, and that death was expected, but it is not reasonable to say that when the respirator malfunctioned no one knew.”
William Downes assumed his mother was asleep when he visited her on the afternoon of November 18 last year. He said that for about 30 minutes, no one came near her, until a male staff member called out her name. When he got no response from her, he became concerned, and Mr Downes was ushered out.
His mother, who had been admitted nearly a month earlier with hip and knee pain, was pronounced dead at 2.35pm.
An infection in her prosthetic knee had caused multi-organ failure, and she was unexpected to make a full recovery, but her medical team had hoped that she would be able to go home.
When her ability to breathe independently improved, she was moved from ICU (Intensive Care Unit) to HDU (High Dependency Unit), where the ratio of staff-patients is 1 to 2. There she was receiving a small level of ventilation support.
Consultant anesthetist, Mr Patrick Nelligan, saw her several times on the morning of November 18, and again at 1.30pm. He said that a team of doctors were doing their medical rounds at 2.15pm, but avoided Mrs Downes as she was being dealt with by the infectious diseases team, and the curtains were pulled around her bed space.
Nobody heard the alarm going off, until the nurse in charge, Sean O’Shaughnessy, was returning to the nurses station and noticed the beep – a recording of the same alarm was played for the Coroner, after which he noted: “It doesn’t seem to inspire any degree of urgency … you would be oblivious to it.”
When asked by the Coroner if Mr Downes – who was not present at the hearing – had heard the alarm, the nurse said: “he brought no attention to us at that time… there was nothing significant that said to me ‘stop what you’re doing, someone is in critical difficulty.’”
Assistant Director of Nursing, Catherine Lee, said the HDU unit was a very busy and often noisy ward, with telephones, equipment, and talking, combining to create “a cacophony of noise.”
When asked what measures had been implemented since Mrs Downes’ death, she said that the alarm settings were changed from default to being set according to the needs of the patient.
She said that the hospital’s response was to reduce unnecessary alarms, in order to make staff more aware of the important ones.
“We have reduced the alarms from 30,000 to 8,000 per week between ICU and HDU,” she said.
“There could often be nuisance alarms, such as if a patient coughs.”
However, Dr MacLoughlin was not satisfied. “You can make all the excuses – but why didn’t you see it or hear it,” the Coroner responded.
“This is in the public interest… I know you say that it’s a safe place to be, but was it safe on that day?
“It took 23 minutes before attention was drawn to this patient’s condition, by which time she was dead… The patient was in serious danger, and her condition should have been made known to staff immediately, irrespective of what was being done on the ward. There was a ward round going on at the time, there were numerous doctors around – there is something not right with that.”
Dr MacLoughlin returned a verdict in accordance with the medical evidence, that death was caused by respiratory failure due to bilateral bronchopneumonia.
“While I am aware that an internal review took place, this is the second occasion in which a ventilator was disconnected, and an internal review took place then also,” he said.
Bikers do their bit to mark anniversary of blood service
This year marks the tenth anniversary of Blood Bike West, and the big birthday was marked in style with a sun-drenched afternoon at Galway Plaza’s Bike Fest West.
Galway stuntman Mattie Griffin was the headline attraction; there was face painting, games, plenty of ice-cream – and hundreds of motorcycle enthusiasts and families.
The birthday celebrations kicked off with a 160-strong motorcycle spin around the Galway countryside, raising well-needed funds for the volunteering efforts of Blood Bike West.
As a 100% volunteer-run and funded organisation, donations are vitally important for Blood Bike West to continue operating their medical transport in the West of Ireland.
Since its inception in 2012, demand for their volunteers’ services continues to grow: collecting and delivering all manner of urgent medical items regionally and nationally, such as bloods, breast milk, medicines, scans, and equipment.
In 2021 alone, Blood Bike West delivered 983 urgent medical deliveries throughout the country.
As part of Galway City Councils Community, Blood Bike West undertook to operate a 24/7 service, including 165 medication deliveries from pharmacies to the self-isolating and vulnerable during the COVID-19 lockdowns.
Since Blood Bike West’s inception in 2012, this increase sees the ongoing need to replace and renew their fleet of motorcycles.
Their motorbikes, Madison, Heather, Margaret, and newly inaugurated bike Cara, are regularly seen on Galway roads, delivering consignments to and from local and regional hospitals.
Park fun to mark Africa Day
On Saturday next (May 28) in Salthill Park, Galway’s African community invites people to join them in a celebration of culture as part of the national Africa Day celebrations.
Africa United Galway, emerging from lockdown and having hosted online festivals for the past two years, will be delivering a family fun day event.
Africa Day 2022 will reinforce a collaboration between Africa United Galway and Galway Africa Diaspora, Shining Light Galway and GoCom Radio (broadcasting live), who have worked to create a festival that will showcase Galway as a city of culture.
Among the performances on the day will be Afrobeat dancer Lapree Lala of Southside Moves, who will show how to dance in African style; Elikya Band will be bringing indigenous African Congolese music; The Youth Performances will be displaying their talent in rap, singing, speaking, and dancing and for the young at heart.
Galway Afrobeat performer Dave Kody will get the crowd moving and there will be poetry through spoken word and cultural displays. There will be a photo booth and face painting and everyone will get to have a taste of African cuisines.
In the spirit of inclusion and integration, The St Nicholas Collegiate Church Parish Choir will be presenting a special African performance as well as a feature presentation by the Hession School of Irish Dance, who will be presenting the famous Riverdance.
Also organised is a football friendly between the African community and An Garda Siochana.
The Mayor, Colette Connolly, will officially be opening the event with a keynote speech and several African Ambassadors are expected to be present on the day to reinforce the culture, beauty and strength of Africa and support for its people.
Africa Day is sponsored by Irish Aid and supported by Galway City Council.
Domestic Violence Response recorded highest number of clients in 24 years under Covid ‘shadow’
BY TIFFANY GREENWALDT-SIMON
A domestic violence support charity in Galway has recorded its highest number of clients in 24 years – “under the shadow” of Covid-19.
Domestic Violence Response (DVR), which is based in Moycullen, also reported its highest level of counselling support sessions in its 2021 annual report published last week.
The charity saw 136 new clients in 2021, and a total of 266 people utilised its services. It also saw a significant increase of return service users.
The support service also provided 51 nights of emergency accommodation through a partnership between Airbnb, Safe Ireland, and Women’s Aid.
Elizabeth Power, Coordinator of DVR Galway, said: “Our 2021 annual report highlights the stark reality of the level of domestic violence in Galway. Under the shadow of Covid-19, DVR recorded the highest number of clients in our 24-year history and delivered the highest number of support services.
“Our staff noted increases in the level of worrying and harrowing experiences of control and abuse. The trauma of these experiences will live with our service users long after Covid-19 fades into memory.
“While Covid-19 restrictions are behind us, domestic violence continues to be present in hundreds of homes throughout Galway.
“As we move through 2022, we will continue to provide our much-needed services to women and men throughout Galway, with an extensive counselling support and advocacy service and a number of new initiatives including a partnership with the HSE which will be launched in the coming months.”
For more, read this week’s Connacht Tribune.
Connacht Tribune Digital Edition App
Download the Connacht Tribune Digital Edition App to access to Galway’s best-selling newspaper.
Or purchase the Digital Edition for PC, Mac or Laptop from Pagesuite HERE.
Get the Connacht Tribune Live app
The Connacht Tribune Live app is the home of everything that is happening in Galway City and county. It’s completely FREE and features all the latest news, sport and information on what’s on in your area. Click HERE to download it for iPhone and iPad from Apple’s App Store, or HERE to get the Android Version from Google Play.