A staff nurse working in a nursing home was referred to the Nursing and Midwifery Council’s fitness-to-practise panel after they performed illegal actions to administer medication to a resident
The charges
That Nurse A:
1. Administered phenytoin sodium capsules to Resident A subcutaneously instead of orally as had been prescribed;.
2. Upon realising their error at charge 1:
a. Did not conduct proper clinical observations on Resident A;
b. Did not complete an incident report;
c. Did not escalate the error to a clinical practitioner.
The background
Nurse A was employed as a staff nurse at a nursing home.
An incident occurred with Resident A for whom Nurse A was providing end-of-life care. It was alleged that Nurse A went into their bedroom and attempted to administer an oral anti-seizure capsule medication. However, although Nurse A put the capsule into Resident A’s mouth, they were drowsy and unable to swallow. Nurse A allegedly removed the capsule and emptied its contents into a medication pot, added water and then injected the solution via a sub-cut line into the upper thigh area.
This administration was not compliant with the prescription, infection control procedures or medicines administration policy.
Resident A had a syringe driver in place and a prescription for levetiracetam, which was to be administered if they were unable to swallow, but Nurse A did not set this up for the patient.
It was further alleged that Nurse A realised that they should not have administered medication in this manner. They allegedly completed ‘visual’ observations, but did not take any clinical observations, nor contact the home’s on-call nurse.
Resident A developed a haematoma as a result of their actions. Nurse A was dismissed following an investigation and a disciplinary hearing. Nurse A admitted both allegations at the disciplinary hearing.
At the hearing
The panel heard from Nurse A’s representative, who informed the panel that Nurse A made full admissions to all charges. The panel, therefore, found all charges proved.
Having reached its determination on the facts, the panel then moved on to consider, whether the facts amounted to misconduct and, if so, whether Nurse A’s fitness to practise was impaired.
The panel was of the view that their actions fell significantly short of the standards expected of a registered nurse, and amounted to a breach of the Code. This was a very serious error involving a vulnerable resident receiving palliative care, unable to communicate or complain. The panel noted that their error caused actual harm and that their actions after the error could have led to significant harm.
The panel found that Nurse A took an unreasonable risk with the health and safety of Resident A. It considered that while Nurse A’s reflective piece showed some insight, it was centred on reporting errors in the future rather than how they would prevent errors from happening in the first instance. The panel felt they had a lack of insight into their actions.
The panel was satisfied that the misconduct in this case was capable of remediation but that there was a high risk of repetition, and decided that a finding of impairment was necessary.
The panel concluded that any informed member of the public would be shocked by Nurse A’s illegal actions in taking an oral medication, crushing its contents, mixing it with a liquid and using it as an injectable medicine when there was an alternative subcutaneous form of medication prescribed.
The panel was satisfied that Nurse A’s fitness to practise was impaired.
Results of the fitness-to-practise panel
The FtP panel can impose four different sanctions:
- Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
- Conditions of practice: this will prevent a registrant from carrying out certain types of work or working in a particular setting, it may require them to attend occupational health or do retraining. The order can be applied for up to three years and must be reviewed by an FTP panel again before expiry
- Suspension: the nurse or midwife will be suspended from practice for a period of initially not longer than one year, but this can be extended after review by an FTP panel
- Striking off: a nurse or midwife is removed from the register and not allowed to practise in the UK. The nurse or midwife must apply to be readmitted to the register
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