Charge Detail Summary

Return
File Number: Nur19/440P
Practitioner: Ms H
Hearing Start Date:

Hearing End Date:

Hearing Town/City:
Hearing Location:
Charge Characteristics:

Practising outside conditions or outside scope of practising certificate (Not Established)


Procedure - inappropriate

Failed to follow appropriate procedure

(Not Established)


Safety of patient put at risk
(Not Established)


Failure to record
(Established)


Title or scope - misrepresentation of
(Not Established)


Additional Orders:

Name Suppression to Practitioner

Interim order for suppression of practitioner's name and any identifying details.

Permanent order for suppression of practitioner's name and any identifying details.

1008Nur19440P.pdf1051Nur19440P.pdf


Other Suppression Orders

Permanent suppression of the name and identifying details of  the names of the various organisations who have supported the application for name suppression, the location of the practitioner's current employer and the name of the previous employer.

1051Nur19440P.pdf


Appeal Order:


Decision:

Full Decision 1051Nur19440P.pdf


Appeal Decision:


Precis of Decision:

Charge

The Tribunal considered a charge of professional misconduct laid by a Professional Conduct Committee against Ms H, registered nurse (the Nurse).

The charge consisted of 10 particulars relating to two separate patients A and B on two separate occasions.  The charge concerned the administration of Propofol, Fentanyl and Ketamine to Patient A, Particulars 1 to 5 and administration of Propofol and Ketamine to Patient B, Particulars 7 to 10.  Particular 6 concerned false representation relating to Patient A.

The charge alleged that the Nurse’s conduct amounted to professional misconduct.

Patient A

Particular 1, 3 and 4

  • Practised outside her scope of practice in administering intravenous Propofol (Particular 1), Fentanyl (Particular 3) and Ketamine (Particular 4) without a prescription or having obtained a verbal order and failed to follow the appropriate Policy relating to verbal orders for medications.

Particular 2

  • Compromised the safety of Patient A by administering Propofol without supervision and failed to document the name of the person who supervised her administering Propofol.

Particular 5

  • Compromised the safety of Patient A by failing to complete full and accurate documentation in the patient’s clinical notes relating to the administration of Propofol, Fentanyl and Ketamine.

Particular 6

  • Falsely represented herself as a Clinical Nurse Specialist (CNS) by signing patient A’s Clinical Assessment form as ‘The practitioner (CNS)’ when she knew or ought to have known she was a Clinical Nurse Specialist Intern.

Patient B

Particular 7 and 9

  • Compromised the safety of Patient B in that she either administered intravenous Propofol (Particular 7) and Ketamine (Particular 9) without a prescription or having obtained a verbal order, failed to follow the appropriate policy relating to verbal orders for medications.

Particular 8

  • Compromised the safety of Patient B in either administering Propofol to the patient without appropriate supervision or failed to document the name of the person who supervised her administration.

Particular 10

  • Compromised the safety of patient B by failing to complete full and accurate documentation in Patient B’s clinical notes of the administration of Propofol and Ketamine.

Background

At the time of the alleged events the Nurse was employed on a training programme at a DHB for nurses wanting to become a CNS in Paediatrics.  The Nurse was working in the Emergency Department (ED) of a DHB at the time of the incidents.  Both Patient A and Patient B were under the age of 16 and attended at the ED on different days with factures sustained from accidents.

Finding

The Tribunal found that:

Patient A

Particular 1, 3 and 4. The Nurse did have a verbal order to administer Propofol and that part of the Particulars was not established.  However, the Nurse’s failure to follow all of the documentation procedures under the policy for verbal orders for medications was established.

Particular 2. Was not established.  Supervision can be direct or indirect and while it would have been prudent to document the name of the person supervising, at the time of the event this is not a strict requirement under the Guidelines for Propofol.

Particular 5. Was established in that the Nurse failed to document the administration of Propofol and Fentanyl on the Acute Assessment page of the patient’s notes but all other alleged failures to document set out in this Particular were not established.

Particular 6. Was not established.  The signing as a Clinical Nurse Specialist (CNS) rather than CNS intern was due to the computer self-populating the clinician’s name and title and cannot be amended.

Patient B

Particular 7 and 9. The Nurse did have a verbal order to administer Propofol (Particular 7) and Ketamine (Particular 9) and that part of the Particulars was not established.  However, the Nurse’s failure to follow all of the documentation procedures under the policy for verbal orders for medications was established.

Particular 8. Was not established.  The reasoning was the same as for Particular 2.

Particular 10. Was not established.  The Nurse did document the use of Propofol and Ketamine.  While the Nurse did not complete the Emergency Care Assessment form, she was not assigned as the Registered Nurse and the Tribunal accepted that it was not her role at that point in time to complete the post-procedural notes.

Overall finding

The Tribunal found that the established particulars and sub-particulars cumulatively amounted to a falling short of the conduct expected of a reasonably competent nurse.  However, the Tribunal was not satisfied that the gravity of the conduct in the circumstances of this case warranted disciplinary sanction and no penalty was imposed.

Tribunal Orders

The Tribunal granted permanent name suppression to the Nurse and suppression of any details that might identify her.

The Tribunal directed publication of the decision and a summary.