Nursing and Midwifery Council: Fitness to Practise Committee. Substantive Order Review Hearing. 12 January 2018

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1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 12 January 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: NMC PIN: Jessica Honner 08E0554E Part(s) of the register: RNA, Registered nurse (sub part 1) Adult (12 July 2008) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Ms Honner: Nursing and Midwifery Council: Order being reviewed: Outcome: England Lack of Competence Andrew Quested Harvey (Chair, Lay member) Dr Mooi Standing (Registrant member) Darren Shenton (Lay member) Richard Ferry-Swainson Gillian Cohen Not present and not represented in her absence Represented by Mr Ben Edwards, Case Presenter, Counsel, instructed by the NMC Suspension Order (12 months) An extension of the current Suspension Order (12 months) to come into effect at the end of 20 February 2018, in accordance with Article 30 (1) Page 1 of 13

2 Service of Notice of Hearing The panel was informed at the start of this hearing that Ms Honner was not in attendance, nor was she represented in her absence. The panel was informed that the notice of this hearing was sent to Ms Honner on 5 December 2017, by recorded delivery and first class post to her registered address. The panel noted that notice of this hearing was delivered to Ms Honner s registered address on 6 December Further, the panel noted that notice of this hearing was also sent to Ms Honner s representative at Richard Nelson LLP on 5 December The panel accepted the advice of the legal assessor. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11 and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). Proceeding in absence The panel then considered proceeding in the absence of Ms Honner. The panel was mindful that the discretion to proceed in absence is one which must be exercised with the utmost care and caution. The panel considered all of the information before it, together with the submissions made by Mr Edwards, on behalf of the Nursing and Midwifery Council (NMC). Mr Edwards submitted that it would be in the public interest to proceed in Ms Honner s absence. He submitted that the NMC had not received a response from either Ms Honner, or her representative, since the notice of hearing was sent on 5 December The panel noted that the Royal Mail track and trace service stated that the notice of hearing had been signed for at the registered address of Ms Honner by J. Honne. Page 2 of 13

3 Mr Edwards informed the panel that Ms Honner was no longer represented by Richard Nelson LLP. The panel was concerned that no attempts had been made by the NMC to contact Ms Honner, or her representative in relation to this fact or, to the fact that it had received no response in relation to the notice of hearing. The panel was mindful that Ms Honner had not engaged with the NMC since the substantive hearing in January The panel held a brief recess so that Mr Edwards could enquire with the NMC case officer to attempt to establish contact with Ms Honner to see if there was any reason for her non-attendance. The NMC case officer attempted to call Ms Honner on her landline, they received no answer. They then called her mobile phone and left a voic message. The case officer also called Ms Honner s previous representative who confirmed that they no longer represent her and have not done so since the completion of the substantive hearing. The panel waited for a brief period to see whether Ms Honner responded to the attempts made to contact her. The panel accepted the advice of the legal assessor. Ms Honner had been sent notice of today s hearing and the panel was satisfied that she was or should be aware of today s hearing and it is of the view that she had chosen to disengage from these proceedings. The panel, therefore, concluded that she had chosen voluntarily to absent herself. The panel had no reason to believe that an adjournment would result in Ms Honner s attendance. Having weighed the interests of Ms Honner with those of the NMC and the public interest in this statutory review taking place before the expiry of the current order, the panel therefore determined to proceed in Ms Honner s absence. The panel drew no adverse inference from her nonattendance. Page 3 of 13

4 Decision and reasons on application under Rule 19 Mr Edwards made a request that parts of the hearing of Ms Honner s case be held in private on the basis that proper exploration of her case involves her health conditions. The legal assessor reminded the panel that while Rule 19 (1) of The Nursing and Midwifery Council (Fitness to Practise) Rules 2004 (the Rules) provides, as a starting point, that hearings shall be conducted in public, Rule 19 (3) states that the panel may hold hearings partly or wholly in private if it is satisfied that this is justified by the interests of any party or by the public interest. Having heard that there will be reference to Ms Honner s health, the panel determined to hold such parts of the hearing in private. Decision and reasons on review of the current order: The panel decided to extend the current suspension order for a period of 12 months. This order will come into effect at the end of 20 February 2018, in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the first review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 19 January 2017 for 12 months. The current order is due to expire on 20 February The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved by way of admission which resulted in the imposition of the substantive order were as follows: That you failed to demonstrate the standards of knowledge, skill, and judgement required to practise without supervision as a band 5 nurse at Royal Devon and Exeter NHS Foundation Trust in that: Page 4 of 13

5 1. While subject to an informal performance management programme in 2010 you: 1.1. On 26 June 2010, administered flucaxacillin to an unknown patient: Intravenously instead of orally; Without a second checker; 1.2. On or around 3 September 2010 you inappropriately administered an enema to a patient per rectum when the patient had a stoma On 12 December 2010, incorrectly administered 4mcg of Desmopressin instead of the prescribed 0.4mcg; 1.4. On 16 December 2010, attempted to draw up IV Augmentin for an unknown patient: When it was contraindicated; Without a second checker 2. While subject to a formal three month performance management programme from 16 January 2011 to 23 September 2011 you: 2.1. On 21 January 2011: Attempted to administer Bendroflumethiazide to an unknown patient when the prescription had not been signed by a doctor; In relation to an unknown patient: a. Did not record on the MAR chart that Bimatoprost was not available; b. Did not order more Bimatoprost from the pharmacy; Page 5 of 13

6 Prepared 50mg of Phenytoin to administer to an unknown patient instead of the prescribed 100mg 3. On 6 August 2012: 3.1. Failed to escalate a deteriorating patient; 3.2. Did not focus on and/or prioritise patient care in that you were drawing pictures when there was clinical work outstanding 4. While subject to a formal performance management programme from 15 August 2012 to 27 February 2013 you: On 3 October 2012 during a medication round failed to sign each medicine chart; 4.3. On 19 October 2012: Did not communicate effectively with the Nursing Assistant on duty with you; 4.4. On or around 31 October 2012 were unable to: Appropriately deal with a patient who had a fit; Communicate adequately whilst under pressure; 4.5. Did not maintain a consistent standard of communication; 4.6. Did not demonstrate that you could remain focussed on your work; Page 6 of 13

7 5. In early December 2013: During a night shift commencing 15 December 2013 you: 6.1 Incorrectly wrote 16/13/13 in an unknown patient s records; 6.2 Failed to sign two sets of patient notes; 7. On 14 January 2014, in relation to an unknown patient: 7.1. Administered 7.5mg of Bisoprolol when: You had not checked the patient s blood pressure; The drug was contraindicated; 7.2. Miscalculated the patient s Early Warning Score as 3 when it should have been 5; 8. While subject to a supervised formal performance management programme between 30 March 2014 and 26 April 2014 you: 8.1. On 3 April 2014: Discharged an unknown patient without the correct medication; On 4 April 2014 you: Page 7 of 13

8 Attempted to administer Oramorph to a patient using a bottle specifically labelled for another patient instead of using ward stock Did not record that you had administered oral baclofen to an unknown patient Left an open drug cupboard unattended with your keys in the lock; Completed patient notes while making a personal telephone call; 8.3. On 7 April 2014 you miscalculated an unknown patient s Early Warning Score as 1 rather than 3; 8.4. On 8 April 2014 you: Left the drug cupboard keys unattended; Did not sign MDT signature sheets for one or more patients; 8.5. On 18 April 2014, documented that you had administered 30mg of codeine to an unknown patient when you had actually administered 60mg; 8.6. On 22 April 2014 you: Did not sign for the administration of Dalteparin and/or Warfain Did not recall all relevant aspects of patient care at handover AND in light of the above, your fitness to practise is impaired by reason of your lack of competence." The substantive panel on 19 January 2017 determined the following with regard to impairment: Page 8 of 13

9 The panel considers that your lack of competence as identified in these charges demonstrates that you put patients at risk of harm. Your failings fell below the fundamental standards expected of a registered nurse and your lack of competence brought the nursing profession into disrepute. The panel considered that you have demonstrated significant insight into your failings [PRIVATE]. The panel considered failing to escalate a deteriorating patient is a serious matter. Whilst the panel accepts that an AMU department is a busy area, it noted that on this particular occasion you were only in charge of two patients. The panel also noted that over the period of 4 years there was a pattern of your practice improving briefly but then regressing again. In its consideration of whether you have remedied your practice the panel took into account that you have taken steps to do so, by acknowledging your mistakes, undertaking a number of reflective pieces and by developing coping strategies. It was clear from your reflective piece and from your oral evidence that you are remorseful for your actions and you have insight into the fact that your fitness to practise remains impaired. It is clear that you aspire and wish to be a competent nurse. However the panel noted that you are not currently working as a registered nurse and that you are currently working as a Healthcare Assistant (HCA), band 2 in St Margaret s Hospice. The panel accepts that as an HCA you are demonstrating your commitment to remaining in the healthcare profession and that you have a genuine desire to care for and help patients. The panel took into account the positive testimonials from your current working colleagues and it also took into account the 3 and 6 month probationary reviews in your current role as an HCA. In summary the comments are in general positive, however, it is unclear as to the extent to which you are now functioning successfully as a band 2 HCA. The panel therefore concluded that based on the evidence before it that there remained a risk of repetition of the lack of competence identified as a Page 9 of 13

10 registered nurse. The panel therefore decided that a finding of impairment is necessary on the grounds of public protection. The panel determined that, in this case, a finding of impairment on public interest grounds was required. Over a period of 4 years you have repeatedly fallen below the standards expected of a nurse. Having regard to all of the above, the panel was satisfied that your fitness to practise is currently impaired. The original panel determined the following with regard to sanction: The panel determined that a suspension order for a period of 12 months was appropriate in this case. At the end of the period of suspension, another panel will review the order. At the review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order. Whilst this panel cannot bind any future reviewing panel, it may be assisted by: Evidence as to how your coping strategies have been implemented in healthcare practice. A testimonial from your employer, where relevant, commenting on skills that are transferable to a nursing environment, such as communication, recognising deteriorating patients and record keeping. Any other testimonials or references from colleagues who are registered nurses. Page 10 of 13

11 Decision on current fitness to practise The panel has considered carefully whether Ms Honner s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. The panel has had regard to all of the documentation before it in the NMC hearing bundle. However, there was no documentation provided by Ms Honner. It has taken account of the submissions made by Mr Edwards on behalf of the NMC. Mr Edwards submitted that there is no new evidence since the substantive hearing before the panel that Ms Honner has developed insight into her failings and lack of competence. He invited the panel to consider that Ms Honner s fitness to practise is currently impaired as there is nothing to suggest otherwise. Mr Edwards further submitted that Ms Honner has made no attempts to engage with today s hearing. He invited the panel to extend the current order that is in place but submitted that impairment and sanction are matters for the panel to decide. The panel heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether Ms Honner s fitness to practise remains impaired. Regarding Ms Honner s insight, the panel noted that the last panel found that she had insufficient insight. At this hearing the panel had not received any evidence of developing insight or remediation. The panel bore in mind that there had been no engagement by Ms Honner with the NMC in regard to today s hearing. Page 11 of 13

12 The last panel determined that Ms Honner was liable to repeat matters of the kind found proved. This panel has received no evidence to suggest that Ms Honner has taken any steps towards remediation since the substantive hearing. The panel was concerned that she has repeatedly fallen below the standards expected of a nurse. In light of this the panel determined that Ms Honner remains liable to repeat matters of the kind found proved. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is required because public interest in the profession and the NMC as regulator would be undermined if no finding of current impairment were made in these circumstances. For these reasons, the panel finds that Ms Honner s fitness to practise remains impaired. Determination on sanction Having found Ms Honner s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 30 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel then considered whether to impose a caution but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. Page 12 of 13

13 The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel has no information regarding Ms Honner s situation and notes that there has been no evidence of a willingness to comply with a conditions of practice order. It therefore determined that conditions of practice would not be appropriate or workable in this case. The panel then went on to consider the imposition of a further period of suspension. It was of the view that a suspension order would allow Ms Honner further time to fully reflect on her previous failings and to engage with her regulator. The panel concluded that a further 12 month suspension order would be the appropriate and proportionate response and would afford Ms Honner adequate time to further develop her insight and towards her remediation. At the end of the period of suspension, another panel will review the order. At the review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order. Whilst this panel cannot bind any future reviewing panel, it may be assisted by: Evidence as to how Ms Honner s coping strategies have been implemented in healthcare practice. A testimonial from her employer, where relevant, commenting on skills that are transferable to a nursing environment, such as communication, recognising deteriorating patients and record keeping. Any other testimonials or references from colleagues who are registered nurses. This order will be reviewed shortly before its expiry but can be reviewed earlier upon request by either Ms Honner, her representative, or the NMC, if any new information should become available. This decision will be confirmed to Ms Honner in writing. That concludes this determination. Page 13 of 13

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