Nursing and Midwifery Council Fitness to Practise Committee. Substantive Order Review Meeting

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1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Meeting 30 August 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Lorraine Christine Stuart 86Y0163S Part(s) of the register: Registered Nurse Sub Part 1 Adult Nursing (November 1989) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Scotland Misconduct Julia Thompson (Chair, Registrant member) Noreen Kent (Registrant member) Tim Mann (Lay member) Ian Ashford-Thom Edmund Wylde Order being reviewed: Outcome: Conditions of Practice Order (12 months) Striking Off Order 1

2 Service of Notice of Meeting The panel was informed that the notice of this meeting was sent to Ms Stuart on 18 July 2018 by recorded delivery and first class post to her registered address. The panel noted that notice of this meeting was delivered to Ms Stuart s registered address on 24 July 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 11A and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). 2

3 Decision and reasons on review of the current order The panel decided to make a striking off order This order will come into effect at the end of 11 October 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the second review of a conditions of practice order, originally imposed by a panel of the Conduct and Competence Committee on 8 September 2016 for 12 months. The current order is due to expire at the end of 11 October 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, whilst working as a registered nurse at the Crofthead Nursing Home, on 9 January 2015: 1. Did not administer prescribed medication to one or more residents, as set out in Schedule 1; 2. Recorded that you had administered medication at 21:00 to one or more residents, as set out in Schedule 1, when you had not; 3. Your conduct in charge 2 above was dishonest, in that you signed the medication administration record to indicate that the medication had been given, when you knew that it had not; 4. Did not ensure that a witness was present when administering: 4.1. Morphine sulphate to Resident F; and/or 4.2. Temazepam to Resident G; 5. Did not ensure that a complete entry was made in the controlled drug register in relation to: 5.1. The administration of morphine sulphate to Resident F; and/or 5.2. The administration of temazepam to Resident G; 3

4 And, in light of the above, your fitness to practise is impaired by reason of your misconduct. Schedule 1 A. Resident A s prescribed 21:00 medications: i. Amitriptyline 25mg ii. Atenolol solution 25mg iii. Trazodone 50mg iv. Tramadol oral drops 100mg v. E45 cream B. Resident B s prescribed 21:00 medications: i. Oxytetracycline 250mg tablet ii. Simvastatin 20mg tablet C. Resident prescribed C s 21:00 medications: i. Donepezil ii. E45 cream D. Resident D s prescribed 21:00 carbamazepine 200mg tablets. E. Resident E s prescribed 21:00 medications: i. Codeine phosphate syrup 25mg ii. Paracetamol suspension The first reviewing panel determined the following with regard to impairment: The panel first considered whether Ms Stuart s fitness to practise remains impaired. The panel accepted the seriousness of Ms Stuart s conduct which related to medication administration errors and dishonesty as regards record keeping. This panel agrees with the original panel that Ms Stuart s dishonesty was at the lower end of the scale and is capable of remediation. The panel noted 4

5 the from Ms Stuart on 12 July 2017 where she indicated she had no objection to a meeting taking place for the substantive order review and that she did not wish to attend. There has been no further communication from Ms Stuart and no evidence has been provided to indicate whether any remediation has taken place. Therefore the panel considers the risk of repetition remains. There was also no evidence available to indicate Ms Stuart s compliance with the conditions of practice order. The panel considered that as there is a lack of any information from the registrant, there could be no evidence of any substantive or material change in her circumstances and as such confirmed the original panel s position 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. For these reasons, the panel finds that Ms Stuart s fitness to practise remains impaired. The first reviewing panel determined the following with regard to sanction: 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 order 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 impose a caution order. 5

6 The panel next considered the imposition of a conditions of practice order. The panel was of the view that the conditions of practice order in place is sufficient to protect patients and the wider public interest, noting as the original panel did, that there was no evidence of general incompetence and no deep seated attitudinal problems, and that conditions could be formulated which would protect patients during the period they are in force. Accordingly, the panel determined, pursuant to Article 30(1) (c) of the Nursing and Midwifery Order 2001, to extend the conditions of practice order for a period of 12 months, which will come into effect on the expiry of the current order. The panel stated that 12 months would be sufficient time to allow Ms Stuart further opportunity to find employment, if she is not currently employed, and complete the supervision and training required. It decided to impose the following conditions which it considered are appropriate and proportionate in this case: 1. You must work with your line manager, mentor or supervisor (or their nominated deputy) to create a personal development plan designed to address the concerns about the following areas of your practice: (a) administration of medicines; (b) record keeping; 2. You must provide evidence for appropriate training in relation to the administration of medicines including controlled drugs. 3. At any time that you are administering medicines, you must place yourself and remain under the direct supervision of a registered nurse nominated by your employer, until such time that you are deemed competent by a registered nurse. 4. You must meet with your line manager, mentor or supervisor (or their nominated deputy) at least monthly to discuss the standard of your 6

7 performance and your progress towards achieving the aims set out in your personal development plan. 5. You must provide a reflective on the impact of your actions on the Home, the residents, your colleagues and the reputation of the nursing profession. 6. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance and your progress towards achieving the aims set out in your personal development plan to the NMC prior to any NMC review hearing or meeting. 7. You must tell the NMC within 30 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 8. You must tell the NMC about any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them. (a) You must within 14 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. (b) You must within 14 days of entering into any arrangements required by these conditions of practice provide the NMC with the name and contact details of the individual/organisation with whom you have entered into the arrangement. 7

8 9. You must immediately inform the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures, and disclose the conditions listed at 1 to 8 above, to them: (a) Any organisation or person employing, contracting with, or using you to undertake nursing work. (b) Any agency you are registered with or apply to be registered with (at the time of application) to provide nursing services. (c) Any prospective employer (at the time of application) where you are applying for any nursing appointment. (d) Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take such a course (at the time of application). Before the end of the period of the order, a panel will hold a review hearing to see how well Ms Stuart has complied with the order. At the review hearing the panel may revoke the order or any condition of it, it may confirm the order or vary any condition of it, or it may replace the order with another order. Any future panel reviewing this case would be assisted by Ms Stuart s full engagement with the NMC, with her providing up to date information regarding her continuing commitment to pursuing her nursing career, along with references and testimonials from any employer and clinical colleagues. Decision on current fitness to practise This panel has considered carefully whether Ms Stuart 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 8

9 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. 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 Stuart s fitness to practise remains impaired. It considered that it had no new information from Ms Stuart to indicate a material change in the circumstances of this case, or to speak to whether her fitness to practise is currently impaired. The panel noted that Ms Stuart was not present at the original substantive hearing and has not engaged significantly since. As the panel had no information before it to suggest that Ms Stuart has made attempts to remediate her practice, it concluded that there remains a risk of repetition of her misconduct. 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 also required. For these reasons, the panel finds that Ms Stuart s fitness to practise remains impaired. Determination on sanction Having found Ms Stuart 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 9

10 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 order 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 impose a caution order. The panel considered continuing the current conditions of practice order. It bore in mind that Ms Stuart s failings are remediable, and that Ms Stuart initially stated that she was prepared to take any remedial actions, whatever necessary, to prove my practice and ensure clients safety. However, this panel had no evidence to demonstrate that Ms Stuart has backed up that initial willingness to engage. Although not bound by the decisions of previous panels, this panel took into account the determination of the last panel, namely that: The panel stated that 12 months would be sufficient time to allow Ms Stuart further opportunity to find employment, if she is not currently employed, and complete the supervision and training required. Any future panel reviewing this case would be assisted by Ms Stuart s full engagement with the NMC, with her providing up to date information regarding her continuing commitment to pursuing her nursing career, along with references and testimonials from any employer and clinical colleagues. 10

11 This panel noted that the previous panel had thereby attempted to direct and encourage Ms Stuart to take measures to demonstrate commitment to continue her nursing career. It considered that there was no information before this panel to indicate that Ms Stuart has engaged with her current conditions of practice order or the recommendations of previous panels. It further noted the relatively undemanding nature of Ms Stuart s current conditions of practice order. Further, the panel had regard to the fact that the original incidents happened three-and-a-half years ago, and that the registration fee expiry date was 30 November In light of the circumstances of the case, the panel considered that to impose a further conditions of practice order would be inappropriate, due to Ms Stuart s lack of engagement, or even any indication of attempts to gain employment with those conditions. The panel was of the view that there was no value in imposing further conditions of practice, with no evidence of Ms Stuart s willingness to engage with them. The panel next considered imposing a suspension order. It noted the lack of engagement on Ms Stuart s part and considered that there was no value in extending these proceedings when Ms Stuart was not engaging appropriately. In these circumstances the panel determined that a period of suspension would not serve any useful purpose and that there was a public interest in bringing these matters to a conclusion. The panel noted the seriousness of the charges found proven, the fact that Ms Stuart had engaged only minimally, and that it had no evidence of remediation, insight or progress before it. The panel also noted that the letter sent to Ms Stuart by the NMC date 18 July 2018, about this meeting, included a warning about this panel s power to make a striking-off order; there has been no response from Ms Stuart. The panel therefore concluded that the only sanction that would adequately protect the public and serve the public interest was a striking-off order. The panel therefore directs the registrar to strike Ms Stuart s name off the register. In accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 this striking off order will come into effect upon the expiry of the existing suspension order, namely at the end of 11 October

12 This decision will be confirmed to Ms Stuart in writing. That concludes this determination. 12

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