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Death of girl leads to call for better sepsis checks.

A mother and a coroner are demanding better checks for sepsis after the death of a five-year-old girl.

Their call comes after an inquest jury decided Ava Macfarlane’ life might have been saved if she had been admitted to Queen's Medical Centre (QMC), Nottingham earlier.

The 11-member jury at the three-day inquest heard that the child, who had Down Syndrome, was taken to QMC on December 13, 2017 because she was vomiting, struggling to breath and had a high temperature. Tests also showed she also had a high heart rate.

Even so, one doctor said her condition would improve with medicine, suggesting she probably had "a viral illness". The child was given Calpol and ibuprofen but a second doctor failed to examine her before sending her home to Sherwood, Nottingham, where her condition worsened. She was then admitted to the children's intensive care unit and died within two days.

Emergency doctor, Dr David Shearn, admitted to the inquest that Ava had been showing at least two "red flags" of sepsis and, if he had followed guidelines from the National Institute for Health Care and Excellence and the Sepsis Trust, then the infection would have been identified earlier.

When asked by assistant coroner, Laurinda Bower, whether the "failure to follow the Sepsis 6 Pathway contributed to her death", he replied: "it probably did.”

He added: "I think earlier treatment of the infection may have improved her chances of survival."

According to Dr Shearn, there has since been an education drive and mandatory training about sepsis for staff. However, he admitted he had colleagues who would still adopt a "watch and wait" approach to a child who came in with a high temperature and a raised heartbeat rather than immediately start treating them for sepsis, despite best practice guidelines, because they did not want to "over treat" every child who arrived with the symptoms.

In its narrative conclusion, the jury said: "Ava was inappropriately discharged. There was a failure to take account of her history, to brief her family comprehensively, to review observation trends or do a full examination.

"It is probable Ava's chances of survival would have been increased by earlier intervention. Guidelines should have been followed. Failures in Ava's hospital care on December 13 probably more than minimally contributed to her death."

A post mortem gave the cause of death as toxic shock syndrome, caused by a streptococcus pyogenes infection with Down Syndrome as a factor.

The jury said there was "a failure of the initial assessment" to consider following national guidelines for sepsis, although she showed symptoms of it.

Under her powers for the prevention of further deaths, Laurinda Bower, said she had "significant concerns" that national guidance is still not being followed.

She said: "Doctors appear to be deciding whether to apply it or not." She said that she would invite the hospital's medical director to the court to discuss the issue.

After the inquest, Ava's mother, Lesley Gearing, said: "I had to do it for her and we have the right outcome. They should be following those guidelines and it looks as if they are still not doing that.”

Medical director for Nottingham University Hospitals NHS Trust, Dr Keith Girling, said later: "On behalf of the trust, I offer my deepest sympathy to Ava's family and apologise for the significant shortcomings in our care, including our failure to admit Ava to hospital on December 13 and start her on treatment for sepsis.

“We have made a number of changes since this case, including strengthening mandatory screening for all patients who access our emergency services with the introduction of e-screening.

"We have also further raised awareness of sepsis, particularly in relation to children with complex medical conditions such as Down Syndrome, who are more vulnerable to serious infection."