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Mid Staffs nurses avoid being struck off after failing to act when patient deteriorated

Two nurses who admitted failing to act when a patient died at Stafford Hospital can remain on the nursing register, a fitness to practise hearing has ruled.

More than 50 cases relating to the scandal at Mid Staffordshire Foundation Trust were originally referred to the Nursing and Midwifery Council, but it found no case to answer in 37 of them.

The conclusion of the two cases last week means six of the 15 referrals where the NMC found there was a case to answer have now been closed. Only one registrant who worked at the West Midlands trust has so far been struck off the register.

Therisia Van der Knapp and Evelyn Agbeko both admitted misconduct in relation to their care of a patient on ward 11 of Stafford Hospital in April 2010. Both were staff nurses at the time but Ms Agbeko was in charge during the night shift when the incident occurred.

Ms Agbeko admitted that at 4am and 6am she had recorded the patient was asleep when she “knew or ought to have known” the patient had died. The NMC panel also found she failed to ensure adequate observations were carried out or ensure that the resuscitation team was called when the patient was found unresponsive.

She has been made subject to a 12-month conditions of practice order, which bans her from taking charge of a shift and requires her to complete training courses in basic life support.

The panel decided not to impose any restrictions on Ms Van der Knapp’s practice due to the level of insight she demonstrated into her actions and that she had no previous blemishes on her 35 year nursing career.

She admitted that on finding the patient unresponsive she failed to press the emergency alarm, ensure that the resuscitation team was called or commence basic life support.

In her defence, Ms Van der Knapp said the CPR protocol was different in her home country of Holland. But the NMC ruled as a nurse practising in the UK she had a duty to follow the required standards in this country.

The panel decided to impose a caution on Ms Van der Knapp, which will be visible on her registration for two years.

In Ms Agbeko’s case the panel ruled that sanctions were necessary because she was the nurse in charge and had shown “limited” insight during the NMC proceedings.

Mid Staffordshire Foundation Trust said in a statement that both women no longer worked for the trust.

Trust director of nursing and midwifery Colin Ovington said: “The trust does not tolerate poor care and we have a robust internal disciplinary process for dealing with staff who do not reflect our trust values in their practice.

“Appropriate action, including suspension and dismissal is taken against those who fall short of the standards we expect from our nurses. Referrals are also made to the NMC where necessary.”

 

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Readers' comments (24)

  • Does this mean that by not being allowed to be 'in charge' of a shift she will now always have the support of another trained nurse who will have to take all the responsibility for that shift?
    Aren't both nurses supposed to know how to deal with a resus?

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  • How can this be?
    NHS staff are paid good money to lead and manage patient care but no one accepts accountability for these deaths!

    - No wonder people are losing confidence in the staff of the NHS & the state regulator CQC
    This is bad news for the people who put patients first

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  • Wow.
    What the hell are we paying the NMC for exactly.
    These numpties should NOT be allowed near patients ever again.

    Has anyone ever researched what percentage of members of NMC panels are still clinically credible???

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  • I attended a networking event yesterday and heard Julie Bailey talk about her awful experiences when her mother was on ward 11 for 8 weeks and the suffering that was going on. It is hard to understand how anyone, particularly in the healthcare sector, could subject patients to such maltreatment or standby and watch it happen. It is up to everyone of us, staff, patients and visitors to highlight both good and bad experiences for the sole purpose of making improvements

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  • they no longer work for the trust - so have they been quietly shunted off somewhere else?

    'the trust does not tolerate poor care' - so why was the poor care allowed to continue.

    did they both already have BLS training before being let loose on the wards? if not, why not.

    not being allowed to be in charge of the shift anymore is hardly a punishment is it, most nurses would welcome that opportunity wouldn't they.

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  • michael stone

    It seems you need to cock-it-up in a really big way, to get the boot: or, do something trivial and upset your boss a lot.

    This, as I've said before, is something of a joke:

    'In her defence, Ms Van der Knapp said the CPR protocol was different in her home country of Holland. But the NMC ruled as a nurse practising in the UK she had a duty to follow the required standards in this country.'

    'Follow the required standards' - around CPR ! Has the NMC not read the 'stuff' around CPR - oh, probably not as it happens.

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  • Who cares what they do in Holland, this is not Holland. They did not help a patient in need and one told fibbies. What exactly do nurses have to do before they are booted out?
    Why give either of them a second chance.

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  • tinkerbell

    what about the strain it will place the other RN nurse under who has to work alongside this liability.

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  • For a nurse to practice in the UK there is a requirement to be registered with the NMC so surely this means they are bound by UK law and hospital policy on CPR.

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  • michael stone

    Anonymous | 21-Jun-2013 11:22 pm

    Nurses are bound by the law, the NMC tells nurses to both obey the law and also to follow 'local policies': a couple of years ago I pointed out that some local guidance around things like CPR/ADRTs didn't actually fit the law, and that by telling nurses to follow dodgy guidance, the NMC was itslef 'apparently vicariously liable'.

    I supplied the explanation of the problem with various 'local policies' and the NMC guy said 'I'll ask our legal dept, and get back to you'. About 2 weeks later, he sent 'I have to get permission to ask out legal experts questions, and I've been refused permission to ask our legal department about this'.

    Law is law, and guidance isn't law: court cases will tend to make decisions based on the law, tribunals and internal inquiries tend to make decisions based on their own guidance/policies - hugely messy, when guidance and policy drifts away from the actual law !

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  • michael stone | 22-Jun-2013 9:34 am

    Michael, you have been heard. we know your views on the subject. you keep dragging up the same old arguments!

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  • michael stone

    Anonymous | 22-Jun-2013 11:02 am

    Well, yes - but that was prompted by Anonymous | 21-Jun-2013 11:22 pm
    who seems to not realise that the law and hospital guidance need not automatically be aligned, and that checking whether law and guidance do fit properly, is necessary: so presumably, there are still some people who have not heard (and others who do not believe).

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  • michael stone | 22-Jun-2013 1:16 pm

    from Anonymous | 22-Jun-2013 11:02 am

    and

    Anonymous | 21-Jun-2013 11:22 pm

    "...who seems to not realise that the law and hospital guidance need not automatically be aligned,..."

    who suggested they were? I most certainly did not!

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  • michael stone

    Anonymous | 21-Jun-2013 11:22 pm

    For a nurse to practice in the UK there is a requirement to be registered with the NMC so surely this means they are bound by UK law and hospital policy on CPR.

    How can one be 'bound by' BOTH UK law and hospital policy on CPR, if they are not aligned and they conflict with each other ? And as it happens, there isn't a single law covering CPR for the UK: England and Wales have got the same legislation (sadly misrepresented in a lot of clinically-authored guidance), but not the UK as a whole. It is all very messy indeed.

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  • "The Trust does not tolerate poor care" are they having a laugh??? At the time these nurses were practising in Stafford that Trust was tolerating poor care on a daily basis!!

    I suspect the Nurse who did not start CPR probably hadn't even been on BLS training, because I can't imagine there was a whole lot of Nurse training going on in Stafford at the time.

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  • tinkerbell

    Sarah Brooklyn | 23-Jun-2013 4:51 pm

    they gotta be havin a laugh haven't they, because they say the exact opposite to what actually was happening - everytime, think it's called bullshit but sadly some people outside of nursing and some inside will actually fall for it.

    Pull the other one, it's got a ruddy great bell on it eh.

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  • Michael Stone

    Scotland has been a separate entity as far as ' the Law' is concerned since the Act of Union.

    What are these 'UK laws' on CPR, and how do they differ so completely from what 'policy' is in Mid-Staffs? Does everywhere bar Mid-Staffs use the BeeGees "Stayin' Alive" to time CPR, as written in Magna Carta, whilst Mid-Staffs uses their other hit " Massachusetts". Do Nurses there press on the buttocks instead of the chest and blow into the patients rear end at a ratio of 100,000:1? Or are you just spouting crap from your fountain of percieved knowledge about EoL care again, or segway this into a DNAR debate?


    A body that has been dead for hours is already rigorous. She wouldn't need the crash team, she would need an undertaker. As none of us were there, especially you Mike, we have absolutely no idea what position this patient died in, but they would have been stiff as a board and LIVID ( and I don't mean angry)

    If you read the UK Resuscitation Council guidelines it states very early on in the book NOT to commence CPR on patients that have rigor mortis or a noticably traumatic death, e.g decapitation, because you will be wasting your time, and they are based on INTERNATIONAL guidelines.

    Now, if the Trusts policy was that CPR must be undertaken and the MET team called, then all well and good, but there is a difference in a fresh collapse and an already decaying corpse, about 4 hours in this case.

    Still, good to get rid of Johnny Foreigner whilst the real culprits pretend they knew nothing about the poor numbers in this hospital.

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  • michael stone

    redpaddys12 | 24-Jul-2013 3:57 am

    'If you read the UK Resuscitation Council guidelines it states very early on in the book NOT to commence CPR on patients that have rigor mortis or a noticably traumatic death, e.g decapitation, because you will be wasting your time, and they are based on INTERNATIONAL guidelines.'

    Clinical factors cross national boundaries, legal requirements however often do not - so the methodology of attempting CPR is in principle universal, but the legal issues around 'should potentially clinically-possible CPR be attempted' can vary in different countries.

    Although the Neuberger Review of the Liverpool Care Pathway was very clear that the LCP and CPR are separate issues in principle, it did discuss problems with CPR at some length (it also got some things wrong - but it was tight about the following):

    1.77 The professional guidance for clinicians on attempting cardiopulmonary resuscitation (CPR) is not clear.


    The sections 1.78 and 1.79 are correct (but don't format properly when I've tried to copy them in here), but section 1.80 is misleading:

    1.80 In order to make the right decision for the patient, the clinical team should first explain the reasons for a particular course of action, and allow time for the patient and their relative or carer to
    question, understand and assimilate. Given the low chance of a success, many patients with a terminal diagnosis decide that, should their heart stop, they would prefer not to undergo a resuscitation
    attempt.52

    Patients in any state of health, have got a clear legal right to refuse future CPR, irrespective of how probable it is that they will arrest, or why they might arrest - that isn't 'prefer not to undergo resuscitation' it is 'I'm forbidding attempted resucitation - if you try, you are legally assaulting me, and I want you to be prosecuted'. It isn't a decision for the clinical team to make - as 1.80 implies - it is legally the patient's decision and then DNACPR is a simple matter of it being an instruction from the patient to his clinicians.

    I get very pissed off, that clinicians cannot understand the law !

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  • michael stone

    The Neuberger review of the LCP can be downloaded from:

    https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients

    I'm starting to get irritated by red implying that I don't know what I'm discussing - as Mr Ustinov once put it, 'but I do not ascribe this to malice - I put it down to ignorance'.

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  • It blows my mind that people like this dont get struck off the register by the same NMC who,if I dont manage to get a job with the NHS by 2015 will automatically not let me re-register.
    This despite the fact that I have been working as a nurse for 30 years but just recently moved back to the UK and have completed a Return To Practice at Uni.

    My chances of getting a job with the NHS?? Slim to none

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