A junior nurse who failed to realise Aishwarya Aswath was dying of sepsis was repeatedly called away from monitoring the Perth hospital's waiting room.
Tahnee Vining on Friday gave emotional evidence to an inquest into Aishwarya's death, conceding she should have considered whether the seven-year-old had sepsis given she had symptoms consistent with the condition.
Aishwarya had been experiencing vomiting and diarrhoea for about 36 hours when brought to Perth Children's Hospital at 5.30pm on Easter Saturday last year.
She was left waiting for more than 90 minutes, despite her parents pleading with staff to escalate her care.
Ms Vining told the inquest she had observed Aishwarya to be pale and grunting in pain when she assessed her around 6pm as the designated waiting room nurse.
She recorded Aishwarya as having an elevated heart rate and breathing rate, cold hands and a temperature of 38.8C, above the threshold for considering sepsis protocols.
Ms Vining said she hadn't been aware of that threshold because the chart it was listed on was new.
She believed Aishwarya was suffering from gastro which could be treated with fluids and ibuprofen, a plan she did not document but relayed verbally to another nurse.
Immediately after the assessment, Ms Vining was called to help with blood collection for a patient going into surgery.
She was then summoned to help the resuscitation team which further delayed her return.
When she finally wrote up Aishwarya's notes almost an hour later, Ms Vining recorded parental concern as "zero", believing the family had been reassured by the assessment.
Aishwarya, who was by then described as floppy and barely able to lift her head, was moved into a resuscitation area just after 7pm.
She went into cardiac arrest and was pronounced dead two hours later, having succumbed to an infection related to group A streptococcus.
Ms Vining told the inquest she had at least 20 waiting room patients under her care and her workload had compromised her ability to deliver the highest standard of care.
She was also a designated runner for the resuscitation team, had to attend to patients in treatment pods for medication checks and was overseeing a student nurse.
"I think if I had have been present in the waiting room after my assessment ... I would have been able to recognise her deterioration and recognise the severity of her illness," she said.
Ms Vining, who at the time had just over a year's emergency department experience, said she had felt unable to push back against the demands.
"As a junior nurse when I first started, I wouldn't say no to anything," she said.
"I felt there was a lot of pressure to just do as much as you can and keep going and going."
Ms Vining, who later assisted the resuscitation team in their attempts to save Aishwarya, was in tears as she described the "traumatic" experience and expressed condolences to the girl's family.
"The fact of the matter was we were short-staffed," she said.
"There was no one to escalate to, no senior staff and I did the best I could with what I had."
The inquest continues.
