Location Coroner for Manchester West, Alan Walsh, identified her death by a cerebral thrombosis arose from a blend of her condition and an oral contraceptive she was taking, which mixed can increase the danger of blood clotting.
Miss Davies was admitted to hospital after complaining of significant headaches and vomiting and the thrombosis was identified by scans, with staff advising treatment method by means of anti-coagulation medication and observation.
However, her condition deteriorated and she died in the early hours of Boxing Day.
Professor David Sanders, from the Royal Hallamshire Hospital in Sheffield, informed the inquest there was an improved chance of clotting from the blend of Crohn’s illness and the medication she was taking, but for the clots to develop in the brain from such circumstances was extremely rare.
The inquest heard five wards at the hospital with up to thirty sufferers on every single were in the hands of just three physicians on Christmas Day.
Dr Zinnarah Zainodin told the court she visited Katie twice in the course of the day to carry out a full neurological examination, becoming unable to do so the 1st time due to the quantity of pain she was in.
Even so, Dr Zainodin also admitted not totally checking which medication she was becoming provided.
The court heard how subsequent evaluations led to the identification of failings in care, despite the fact that these did not contribute immediately to Katie’s death.
The troubles identified in treating Katie incorporated the quality of the two health-related and nursing care and staff information of the seriousness of her situation.
Mr Walsh said he would compose to the Wellness Sectretary about tips for treating thrombosis sufferers and the bleeper technique utilised to call medical professionals, as this repeatedly failed to deliver assist to the Miss Davies.
The inquest heard sufferers struggling from such conditions are no longer taken care of at Wigan but right transferred for professional care.
The coroner explained: “Katie’s death was this kind of a shock to the hospitals that actions have been taken and Wigan’s modifications are ongoing. I’m grateful to Salford Royal, as physicians there have devised new guidance for the treatment method of patients with this sort of thrombosis. I am really concerned these are not becoming followed in some locations, and I will request a evaluation of the policy nationwide.”
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