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A nurse on an elderly care unit administered excessive amounts of insulin to a patient then, having realised the mistake, subsequently tried to hide the error by altering the patient’s prescription chart
Nurse A worked as a band 5 staff nurse in an elderly care unit between January 2000 and August 2013. Her fitness to practise was alleged to be impaired due to misconduct, because:
1. While responsible for the administration of insulin to Patient A on a night shift, Nurse A: failed to identify that 50 units was the incorrect dose; administered the incorrect dose; failed to monitor or record Patient A’s blood sugar levels before, immediately after and at regular intervals after administering the drug; and, at a later point in time, altered Patient A’s chart so it noted the correct dose instead of what was administered.
2. Nurse A’s changing of the chart data was dishonest.
During a night shift, Nurse A administered insulin to Patient A; Colleague 1 signed the prescription chart as the second checker, but did not actually check Patient A had been given the correct dose.
Later that night, finding Patient A making noises and appearing visibly unwell, Colleague 2 asked Nurse A to take Patient A’s vital signs. Patient A was unresponsive and hypoglycaemic. Colleague 2 checked the patient’s chart and identified that the dose administered was incorrect. Colleague 2 asked Nurse A for the syringe so the dose could be checked; it could not be found. She also asked what Patient A’s blood sugar levels were but Nurse A could not say.
Patient A was moved to the medical unit and the overdose reported to the trust, which launched a serious critical incident investigation.
The trust found Nurse A had not recorded Patient A’s blood sugar levels at any point and noted that the dose on the prescription chart appeared to have been altered – the ‘5’ in ‘50’ looked like it had been changed from a ‘1’. The prescribing doctor confirmed the prescription was for 10 units. Nurse A denied altering the chart in an investigation meeting but, before the trust’s disciplinary hearing, she told Colleague 1 she had altered it to cover up her mistake. Colleague 1 did not report this when interviewed. Nurse A later admitted altering the chart to read ‘50’, not ‘10’, units. Nurse A admitted all charges and showed remorse and that she was developing insight into her clinical failure and dishonesty. She attended training regarding the relevant areas of concern. No other concerns had been noted in her 25-year career.
At the hearing
All charges admitted by Nurse A were found proved by admission. The panel then considered whether they amounted to misconduct and Nurse A’s fitness to practise was currently impaired.
It found Nurse A’s actions fell far short of the standards expected of a registered nurse and breached the Code in terms of cooperative working, information sharing, record keeping, candour, rectifying harm, patient safety and harm reduction. This amounted to misconduct and showed that, when faced with a deteriorating patient, Nurse A put her own interests ahead of theirs and did not take responsibility for her actions.
Nurse A wrote in an email that her fitness to practise was impaired. The panel felt the public has a right to expect nurses to be honest and that honesty is a fundamental tenet of nursing. As such, to maintain public confidence in the standards of the profession and the Nursing and Midwifery Council as regulator, impairment was found to mark Nurse A’s conduct in respect of her dishonesty. This, the panel noted, was required on the grounds of public interest and public protection.
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