A case study showing an example of how falsifying the recording of administering controlled drugs led to a nurse being the subject of a Nursing and Midwifery Council fitness to practise hearing
Charges facing Nurse A
In June 2017, while working a night shift at a mental health nursing home:
- Nurse A recorded that she had given Patient A two doses of 30mg/5ml solution Oramorph, a controlled drug (CD), when she had administered doses of 10mg/5ml solution on two occasions;
- On one of those occasions she administered the doses without another qualified person present and signed the initials of a colleague, Mr 1, in the ‘witnessed by’ column of the CD record;
- She went back to the records and wrote over the ‘3’ in each of the entries with a ‘1’. She signed the amendment herself and did not obtain any counter-signatory.
Nurse A’s actions were dishonest in that Mr 1 had not been present during the administration of drugs.
Background to charges
Nurse A came onto the register as a mental health nurse in 2001 and in February 2017, began a contract placement at Cornerstone House operated by Vision Mental Health. On the night shift in 2017, Nurse A was working with another registered nurse, Mr 1, and two healthcare support workers. During that shift Nurse A recorded in the CD register that she had given Patient A two doses of 30mg/5ml of Oramorph solution. She had in fact administered prescribed doses of 10mg/5ml solution.
The CD register and Patient A’s drug chart appeared to show that Mr 1 countersigned the above mentioned drug administrations. Mr 1 denied that he was present during the drug administrations and stated that he did not sign these documents.
It was alleged that Nurse A administered the doses without another qualified person present and falsified Mr 1’s signature in the records. When informed of the erroneous entry, Nurse A altered the entry by writing over the ‘3’ with a ‘1’, which was not in accordance with the appropriate procedure for corrections of record errors. In addition, the amendment was not countersigned by a colleague as required.
At the hearing
Nurse A admitted all the charges in their entirety.
The panel felt that Nurse A’s actions fell significantly short of the standards expected of a registered nurse, and that her actions amounted to a breach of the Code. The panel found that Nurse A’s fitness to practise was impaired. Although no patients had come to harm, her actions put patients at an unwarranted risk of harm. The panel was of the view that Nurse A’s actions breached fundamental tenets of the profession.
The panel considered that Nurse A was genuinely remorseful. It considered her oral evidence and written reflective piece, and found that she had demonstrated significant understanding of where her actions fell short of the standards expected of a registered nurse, the consequences of those actions, and how she would act differently in the future.
The panel considered Nurse A’s unblemished 17-year career as an able nurse, and felt there was a minimal risk of repetition. Impairment could not be found on public protection grounds. However, Nurse A’s dishonesty in this case compounded matters. The overarching objectives of the NMC are to protect, promote and maintain the health, safety and wellbeing of the public and patients, and to uphold and protect the wider public interest. Despite her level of insight, the panel determined that a finding of impairment was necessary on public interest grounds.
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