A failure to understand the consequences of administering warfarin with cranberry juice to a patient resulted in the capabilities and knowledge of a care home nurse being brought into question
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Each month, Nursing Times will consider a real-life case that was heard by the Nursing and Midwifery Council’s Fitness to Practise case. We’ll give you the facts of the case, as presented to the panel, and you’ll get a chance to consider what decision you’d have made if you were on the panel. You can choose your response at the end of this article and then go to The Results to find out what really happened.
Nurse A, who worked in a care home, was charged with failing to demonstrate the standards of knowledge, skill and judgement required to practise as a registered nurse without supervision. It was alleged that her fitness to practise was impaired by her lack of competence and lack of knowledge of English, as she was unable to:
a. Order and store medicines properly;
b. Explain the purpose of the British National Formulary.
On her first day, Nurse A, who qualified in Romania in 2011, observed a medication round, wound care and general nursing duties. Her knowledge of medications was queried when she failed to understand that a resident was not to be given cranberry juice while taking warfarin. Nurse A did not know what warfarin was or that cranberry juice can interact with it and increase the risk of bleeding.
Due to initial concerns raised by the deputy manager, the manager asked Nurse A to complete an assessment of administration of medicine on 21 January 2016. Nurse A was asked “how she would order medication, what she would do once she got the prescription, how she would record it and how it would be stored.” She could not answer any of the questions, despite having worked as a nurse at a similar care institution.
The assessment also tested her knowledge of the administration of medicines and drug legislation such as Medicines Act 1968 and the Misuse of Drugs Act 1971, covert administration and the procedure to be observed. Nurse A again failed to meet the required standard.
Her manager picked 10 medicines used regularly in the care home and asked what they were used for and dosages as per guidelines from the National Institute for Health and Care Excellence. Nurse A could only answer three of the 10 questions. She was transferred to the position of healthcare assistant and referred to the Nursing and Midwifery Council for investigation.
As part of the investigation she took an International English Language Testing System (IELTS) assessment. She scored an overall band score of 5. As the minimum overall band score is 7, she showed she lacks the necessary knowledge of English to practise safely and effectively as a registered nurse.
At the hearing
The NMC expressed Nurse A’s wish for the hearing to proceed in her absence and referred the panel to her response, sent through on her behalf by her union.
Nurse A admits the above facts amount to her fitness to practise being impaired because of her: lack of competence; lack of knowledge of English; and inability to demonstrate basic knowledge requirement regarding the indication, side-effects and contraindications for a selection of common medications; and inability to demonstrate a basic understanding of the BNF.
Nurse A engaged in the NMC process and attended the IELTS assessments as requested. She also demonstrated insight into her failings by accepting that she currently lacks the skills, knowledge and judgement to practise safely as a nurse, and the requisite knowledge of English to allow her to practise safely and effectively
Results of the fitness-to-practise panel
The FTP panel can impose four different sanctions:
- 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
- Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
- 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
Find out what the NMC decided: Final panel decision and reasons
Which sanction, if any, would you impose of you were on the panel?