Coronial
VICmental health

Finding into death of Allison Naomi Eagle

Deceased

Allison Naomi Eagle

Demographics

44y, female

Date of death

2021-04-26

Finding date

2024-04-19

Cause of death

Unascertained, presumed sudden cardiac death

AI-generated summary

44-year-old woman with schizophrenia and bipolar affective disorder died unexpectedly in a psychiatric inpatient unit. She had obstructive sleep apnoea and was on multiple antipsychotic medications. On the night before her planned discharge, she received PRN sedative medications (lorazepam and olanzapam) for agitation. She was found unresponsive the following morning despite overnight observations. Autopsy revealed no structural cardiac abnormality, but toxicology showed therapeutic levels of antipsychotic drugs known to prolong QT interval. The cause of death remained unascertained, likely sudden cardiac death. The coroner found medications were appropriate and within accepted dosages. Barwon Health's review identified process improvements regarding PRN medication review, ECG protocols, observation procedures, and medical handover processes, though these were not causative of death.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Contributing factors

  • obstructive sleep apnoea
  • obesity (WHO Class II)
  • antipsychotic medications with QT-prolonging potential
  • schizophrenia with associated increased risk of sudden cardiac death
  • use of benzodiazepines and antipsychotics in setting of sleep apnoea

Coroner's recommendations

  1. More regular review of PRN sedative medications with clarity of the difference between acute sedation and ongoing PRN medications
  2. Guidelines surrounding medication dose escalation including depots
  3. Clear policy surrounding routine ECGs for consumers on psychotropic medications and guidelines on appropriate use of investigations in inpatient units
  4. Articulation of nursing observations overnight and after sedation in procedures
  5. Articulation of the medical handover process in the Swanston Centre
  6. Improved documentation of non-medical strategies employed to reduce agitation
  7. Articulation of how nursing visual observations are to be undertaken in procedures
  8. Update to night-time observation procedures to require close observation and recording of breathing via chest rise and fall, audible breathing and movement, with rousing and vital signs if unarousable
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