Nurse’s death sparks call for better tuberculosis education
A coroner has called for better protection for healthcare workers following the death of a nurse who contracted tuberculosis (TB) while volunteering at a London hospital.
Carrianne Franks, a flight sergeant nurse for the Royal Air Force, found out just 24 hours before she died that she had contracted TB.
“She gave care to everybody when she was alive, and she didn’t get the care back”
Chris Franks
An inquest found that a delay in diagnosing the infectious disease contributed to her death.
Carrianne, from Nottinghamshire, had volunteered through the RAF to undertake a nurse placement at Chelsea and Westminster Hospital NHS Foundation Trust to assist through the Covid-19 pandemic.
It was on this placement where she was exposed to a “very aggressive” form of TB from an infected patient on the ward she was working on between 23 and 24 November 2020.
According to Nottinghamshire coroner, Laurinda Bower, Carrianne was not classed by the hospital as a ‘close contact’ of the infected patient, meaning she was ineligible for contact tracing to inform her she had been around someone with TB.
Her GP and the RAF’s occupational health department were also not informed that she had worked on a ward where a patient had tested positive for the infection.
Carrianne became seriously ill with respiratory symptoms in June 2021 and was initially diagnosed with Covid-19 and then pneumonia.
She spent almost nine weeks on a respiratory ward and later died on an intensive care ward at the Bassetlaw District General Hospital in Worksop on 27 August 2021.
Carrianne only found out she had contracted TB the day before she died aged 30.
In the prevention of future deaths report, Ms Bower said doctors would have benefitted from knowing about Carrianne’s proximity to a patient with TB from months before, as they could have run tests to rule out whether she had contracted the illness.
The report said that doctors “would have arrived at a diagnosis far sooner and in time to start treatment that would have prevented her death”.
It added: “The lack of knowledge of her heightened risk of TB because of occupational exposure to a smear positive case, significantly delayed her diagnosis and treatment, which in turn contributed to her death.”
Carrianne Franks was a nurse for the RAF
The coroner outlined three areas of concern for consideration of NHS England, the National Institute for Health and Care Excellence (NICE) and the UK Health and Security Agency (UKHSA) going forwards.
Firstly, Ms Bower said that current clinical and public health guidelines “do not identify healthcare professionals as a group at heightened risk of TB exposure”.
She also warned that the current threshold by NICE for contact tracing “sets the bar too high”.
NICE TB guidelines currently recommend that inform and advise letters are issued to ‘close contacts’, who are people who have had prolonged, frequent or intense contact with the person, or ‘social contacts’, who are people that have had contact with the person that has not been prolonged, frequent or intense.
Ms Bower said: “I cannot see a good reason for restricting the warn and inform letter process, rather than applying the same broadly to all staff who worked on the unit at the relevant time.”
Lastly, she raised concern that there were “inefficient education measures” in place to make sure NHS staff knew about the symptoms of TB and the need to raise alarm of possible exposure to the condition.
According to the NHS, common TB symptoms include:
- a cough that lasts more than 3 weeks – you may cough up mucus (phlegm) or mucus with blood in it
- feeling tired or exhausted
- a high temperature or night sweats
- loss of appetite
- weight loss
- feeling generally unwell
Carrianne’s parents, Bev and Chris Franks, are also among those calling for better education for healthcare staff around TB, so that deaths such as Carrianne’s can be prevented in the future.
Mr Franks told Nursing Times that the family was sad “every day” about the loss of their daughter, and that they felt let down by the services which were supposed to keep her safe.
He said: “To me, they hadn’t given her the care that she warranted.
“She gave care to everybody when she was alive, and she didn’t get the care back.”
Mr Franks welcomed the announcement this week from NHS England that Martha’s Rule will be rolled out from April 2024.
The rule, named after a teenager who died of sepsis after her family’s pleas for an escalation of her care were ignored in 2021, will give patients and their families more power if they think their care team is not listening to their concerns.
During his own daughter’s hospital stay, Mr Franks said at times he felt he wanted to “scream the ward down” because of how much Carrianne was deteriorating.
He said: “Martha’s Rule is brilliant, because what we witnessed with Carrianne was exactly the same – she struggled all the way through.
“At one time, we rang the RAF and asked them if they knew any doctors that could help us.”
Similarly, Carrianne’s mother Ms Franks urged healthcare professionals to listen when patients and their families raise concerns.
She said: “I know doctors and nurses have got a horrible job…but they’ve got to build the relationships with their patients to understand how poorly they actually are and have an honest conversation.”
In addition, Ms Franks said healthcare professionals should challenge assumptions that TB “is not a thing anymore” and therefore not a risk for nurses and other staff.
She said: “Those signs and symptoms should have been in the forefront of their thinking [with Carrianne].
“It’s systematic, healthcare professionals are not being contacted.”
Carrianne’s family have been fundraising in her name to raise awareness of TB.
Earlier this month, they did a 33km walk to mark what would have been Carrianne’s 33rd birthday.
Responding to the prevent of future deaths report, a NICE spokesperson said: “We will consider the issues raised by the report and respond to the coroner directly.
“We follow an established process when making sure our published guidelines are current and accurate and take a proactive approach to responding to events (with an assessment of priority) that may impact on our recommendations.”
Meanwhile, an NHS England spokesperson said: “NHS England extends its deepest sympathies to the family and friends of Carrianne Franks.
“We are carefully considering the prevention of future deaths report sent to us by HM Coroner and will respond in due course.”
The UKHSA was contacted for comment.
