A case highlighting how a nurse’s handling of the discharge of a patient – who later died at home from a haemorrhage – led to a Nursing and Midwifery Council fitness to practise hearing
you are the panel
That Nurse A:
1. Discharged Patient A without a plan, necessary equipment, documentation and appropriate consultation;
2. Failed to tell the family of Patient A information relevant to the use of a topical negative pressure unit (TNP);
3. Failed to effectively communicate to district nurses and/or tissue viability nurses the discharge of Patient A in that she:
3.1 Did not inform one/both services of the discharge in advance;
3.2 Did not submit a faxed referral until asked to do so by a tissue viability nurse;
4. Her actions at charges 1 to 3 above contributed to the death and/or to a material loss in the chance of survival for Patient A.
Patient A was an older female patient who died having been discharged from a hospital.
Patient A underwent surgery for the repair of an abdominal aortic aneurysm. The procedure was known as an endovascular aneurysm repair. Patient A remained in hospital after the surgery. A second procedure was later performed by a consultant vascular surgeon. As a result of the surgery, Patient A was left with a wound in her groin area. There were concerns that the wound area may have been infected. Patient A was recorded as having been ‘discharged home’. Patient A had not been seen by the consultant before she was recorded as having been discharged home. Patient A suffered bleeding at home and later died from a haemorrhage.
At the hearing
It is accepted that Nurse A was the nurse involved in the discharge of Patient A and was responsible. The discharge plan for Patient A appeared not to have been completed. Additionally, the discharge letter for Patient A had not been signed by a discharging doctor. There is no dispute that the canister required for the TNP machine should have been provided to Patient A upon discharge.
The panel had regard to the requirements of the trust’s admission and discharge policy. There is no record in Patient A’s notes that a copy of the district nursing referral was provided.
It is accepted that the consultant arrived on the ward after 5pm and did not see Patient A before her discharge. The panel found that neither Dr 5 nor Dr 6 authorised the discharge of Patient A and indeed told Nurse A not to discharge. Nurse A communicated to Patient A information relevant to the use of the TNP unit. The panel found charge 2 not proved. The panel accepted the evidence of Ms 7 and concluded that Nurse A did not inform her (the tissue viability nurse) of Patient A’s discharge in advance.
There was confusion about timings of the fax that Nurse A sent – when it had been received or sent or whether it displayed an accurate time at all. However, Ms 7’s account was consistent both in her oral evidence and her written statement, that Nurse A had not sent faxes prior to her being contacted. The panel accepted Ms 7’s account.
The panel concluded that, by allowing the discharge to proceed without a consultant review as stipulated by Dr 5 and Dr 6, Patient A ceased to be an inpatient, which meant that the haemorrhage occurred while Patient A was at home.
As stated by Mr 13, the fact that Patient A suffered a major bleed at home is associated with 100% mortality. If Patient A had remained an inpatient, action could have been taken to reduce this risk. The panel therefore agreed with Mr 13’s evidence that Nurse A’s actions contributed to Patient A’s death.
Results of the fitness-to-practise panel
The ftp panel can impose four different sanctions:
- Not impaired: the panel finds that the registrants’s fitness to practise is not impaired; therefore they can continue to practise
- 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