Name of registrant: NMC PIN: Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 11 April 2019 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Olayinka Salako 06L0220E Part(s) of the register: Registered nurse - sub part 1 Area of Registered Address: Type of Case: Adult Nurse March 2007 London Misconduct Panel Members: Legal Assessor: Panel Secretary: Registrant: Nursing and Midwifery Council: Order being reviewed: Fitness to Practise: Adrian Ward (Chair, lay member) Jane Fraser (Registrant member) Richard Bayly (Lay member) Cyrus Katrak Rob James Ms Salako in attendance and represented by Sam Oestreicher of Unison Represented by David Claydon, Case Presenter Conditions of Practice Order (12 months) Impaired Outcome: Conditions of Practice Order (6 months) to come into effect at the end of 2 May 2019 in accordance with Article 30 (1) 1
Decision and reasons on review of the current order: The panel decided to make a conditions of practice order for a period of 6 months. This order will come into effect at the end of 2 May 2019 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the second review of an order originally imposed by a Conduct and Competence Committee on 30 March 2017. At this time a suspension order was made for a period of 12 months. The order was reviewed by a panel of the Fitness to Practise committee on 23 March 2018 and was replaced with a conditions of practice order for a period of 12 months. The current order is due to expire at the end of 2 May 2019. The panel is reviewing the order pursuant to Article 30(1) of the Order. At the substantive meeting held in March 2017 the following charges were found proved: That you, whilst employed as a Registered Nurse between 29 July 2013 and 27 October 2014 at the King Edward VII Hospital, London ( the Hospital ): 1. At or around 22:00 on 23 November 2013, did not sign the medication administration record chart ( MAR chart ) for Patient A, to indicate that you had administered the following medication to Patient A: 1.1 25mg of Nortriptyline [proved by admission] 1.2 15mg of Mirtrazipine [proved by admission] 1.3 0.5mg of Clonazepam [proved by admission] 1.4 10mg of Esetemibe [proved by admission] 1.5 200mg of Iron Sulphate [proved by admission] 2
2. In respect of Patient B, who had been prescribed 1.5mg of Rivastigmine at 07:00 and 18:00 on 23 and 24 November 2013 incorrectly recorded that you had administered 1.5mg of Rivastigmine to Patient B at or around 22:00 on 2.1 23 November 2013 [proved by admission] 2.2 24 November 2013 [proved by admission] 3. In respect of Patient C: 3.1 On 29 January 2014, administered both an intravenous infusion containing Diclofenac and an oral dose of Voltarol to Patient C [proved by admission] 3.2 On 30 January 2014 at or around 08:00, did not administer 750mg of Cefuroxime to Patient C [proved by admission] 4. At or around 22:00 on 26 February 2014, administered 40mg of Enoxaparin to Patient D [proved by admission] 5. On 26 April 2014: 5.1 At or around 20:00, administered an unprescribed dose of 40mg of Clexane to Patient E [proved by admission] 5.2 Having acted as alleged at paragraph 5.1, at an unknown time on or around 26 April 2014, recorded on the MAR chart for Patient E that you had administered 40mg of Clexane to Patient E at 18:00 [proved by admission] 6. At or around 22:00 on 16 August 2014, prepared an unprescribed dose of Clexane for Patient F [proved by admission] 3
7. At or around 22:00 on 17 August 2014, prepared an unprescribed dose of Clexane for Patient H [proved by admission] 8. On or around 4 March 2015 attended a shift as an agency nurse at Guys and St Thomas NHS Trust without informing the nursing agency, namely Capital Staffing Services Ltd: i) that you were the subject of an interim conditions of practice order; [proved] ii) that you were dismissed from your previous employment at King Edward VII Hospital, London. [proved] 9. Your conduct at charge 8 above was dishonest, in that you knew that you were required to disclose the existence of the interim conditions of practice order and/or your dismissal, but did not do so; [proved] 10. On or around 4 March 2015, you practised as an agency nurse at Guys and St Thomas NHS Trust, without informing the person in charge and/or a person of authority within the Trust, prior to, or at the commencement of the shift, that you were subject to an interim conditions of practice order; [proved] 11. Your conduct at charge 10 above was dishonest, in that you knew that you were required to disclose the existence of the interim conditions of practice order, but did not do so [proved] And in light of the above, your fitness to practise is impaired by reason of your misconduct. The first reviewing panel determined the following with regard to impairment: 4
In reaching its decision on impairment, the panel took into account the need to protect the public, maintain public confidence in the profession, and the need to declare and uphold proper standards of conduct and behaviour. The panel noted that you have taken part in a significant number of training courses on various topics including medication since the substantive hearing. The panel noted in particular that you also completed a level 5 diploma in leadership and management in health and social care units. You told the panel that this qualification took 15 months to complete. You told the panel that you have assisted other nurses in the administration of medication in your role as a health care assistant. However, the panel concluded that as you have been suspended since the substantive hearing you have not had an opportunity to demonstrate remediation of the concerns relating to your administration of medication in the workplace. The panel considered that until you have demonstrated that you can administer and record medication safely, there remains a risk of repetition. The panel therefore concluded that your fitness to practise remains impaired on the grounds of public protection. The panel accepted your evidence, both oral and in your reflective piece, that you now realised your behaviour in not disclosing your conditions of practice order was dishonest and brought the profession into disrepute. The panel concluded that the public interest in relation to your dishonesty has been marked and satisfied by the twelve month period of suspension of your practice. The panel has therefore concluded that your fitness to practise is not currently impaired on the grounds of public interest. The first reviewing panel determined the following with regard to sanction: The panel next considered the imposition of a conditions of practice order. The panel took into account that there are identifiable areas of your practice in need of remediation. You have indicated a willingness to comply with such an order, and you did so in the past. Further, you have been proactive and discussed the 5
matter with your current employer who has indicated that it would able to employ you as a registered nurse with a conditions of practice order. In these circumstances the panel concluded that the following conditions of practice would provide sufficient public protection and would be workable, practical and measurable: 1. You must notify the NMC within 7 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. 2. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 7 days of you receiving notice of them. 3. a) You must within 7 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 7 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. 4. At any time that you are employed or otherwise providing nursing services you must not carry out administration of medicines except under the indirect observation of another registered nurse who has at least 12 months work experience since qualification and who is physically present in or on the same ward, unit, floor or home that you were working in or on the same ward, unit, floor or home that you were working in or on. 5. You must work with your line manager, mentor or supervisor (or their nominated deputy) to formulate a personal development plan focusing on medicines management, administration and recording. 6
6. You must prepare and submit a report one month before the review of this order detailing how you have applied your learning in practice. 7. You must send a report one month before the review of this order from any of your line managers, mentors or supervisors (or their nominated deputy) setting out the standard of your performance with particular reference to medicines management, administration and recording and your progress in fulfilling your Personal Development Plan. 8. 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 (7) above to them: Any organisation or person employing, contracting with, or using you to undertake nursing work Any agency you are registered with or apply to be registered with (at the time of application) Any prospective employer (at the time of application) 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). Decision on current fitness to practise This panel has considered carefully whether your 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 7
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. It has taken account of the submissions made by Mr Claydon, on behalf of the NMC, and those made by Mr Oestreicher, on your behalf. Mr Claydon outlined the background of the case including the findings of the substantive and first reviewing panels. He submitted that your fitness to practise remains impaired and that there was an agreement between parties that the conditions of practice should continue for a further period of six months to allow you to comply with conditions 5, 6 and 7. Mr Oestricher submitted that it is clear that you have not complied with conditions 5, 6 and 7 but that it is sometimes difficult to make the arrangements necessary when working in a care home. He further submitted that sometimes care homes do not have imbedded processes to support staff on a conditions of practice order. He noted, however, that this is not an excuse and that you accept the need to take action to ensure that your employer assists you in complying with your conditions of practice. Mr Oestreicher submitted that you are happy for the conditions of practice to continue for a further period of six months and that you will be more proactive in your compliance with them, with specific reference to conditions 5, 6 and 7. 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 your fitness to practise remains impaired. Regarding insight, the panel noted that you understand that you have not fully remediated your practice and that it is necessary to remain working under conditions 8
until you have undertaken all actions that are required. The panel, however, recognised that you are making progress. It took account of the comprehensive medication administration training records and was of the view that these demonstrated your progress but were also a bit aged. The panel noted that certain aspects of the medication administration training records will expire within the next six months. The panel noted that you had previously failed to comply with condition 1 of the conditions of practice order and the last panel determined that you remained liable to repeat matters of the kind found proved. This panel has taken into account the work you have undertaken to remediate but has also noted your failure in complying with conditions 5, 6 and 7 in that you have not completed a Personal Development Plan (PDP) or submitted a report from your line manager that specifically addresses remediation of your past failings. The panel was of the view that the completion of these conditions is of particular importance in completing full remediation and it is apparent that you need to take more responsibility in the undertaking of these matters. In light of this, the panel determined that there remains a risk of repeating your medication errors. The panel therefore decided that a finding of current impairment is necessary on the grounds of public protection. Determination on sanction Having found your 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 29 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 or impose a caution order but concluded that this would not protect the public and would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel next considered the imposition of a conditions of practice order. The panel was of the view that a conditions of practice order is sufficient to protect patients. Further, it was of the view that a further period of working under conditions would allow you to develop a Personal Development plan and work closely with your line manager 9
to produce a report that comments on your progress in your current role. The panel was also of the view that it was necessary that you demonstrate your ongoing capability in relation to medication administration and undertake mandatory training to confirm this. The panel determined that conditions could be formulated which would protect patients during the period they are in force. The panel went on to consider the imposition of a suspension order. Despite concerns, it was of the view that you should be given further opportunities to demonstrate your ability to comply with the conditions and show that you are fit to practise as a Registered Nurse without restriction. Accordingly, the panel determined, pursuant to Article 30(1) (c) of the Nursing and Midwifery Order 2001, to make a conditions of practice order for a period of 6 months, which will come into effect on the expiry of the current order. It decided to impose the following conditions which it considered are appropriate and proportionate in this case: 1. You must notify the NMC within 7 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. 2. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 7 days of you receiving notice of them. 3. a) You must within 7 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 7 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. 4. You must send to the NMC, at least 14 days before the next review hearing or meeting proof of completion of essential mandatory medicines training. 10
5. At any time that you are employed or otherwise providing nursing services you must not carry out administration of medicines except under the indirect observation of another registered nurse who has at least 12 months work experience since qualification and who is physically present in or on the same ward, unit, floor or home that you were working in or on the same ward, unit, floor or home that you were working in or on. 6. You must take responsibility to work with your line manager, mentor or supervisor (or their nominated deputy) to formulate a personal development plan focusing on medicines management, administration and recording. 7. You must take responsibility to prepare and submit a report one month before the review of this order detailing how you have applied your learning in practice. 8. You must take responsibility to send a report one month before the review of this order from any of your line managers, mentors or supervisors (or their nominated deputy) setting out the standard of your performance with particular reference to medicines management, administration and recording and your progress in fulfilling your Personal Development Plan. 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: Any organisation or person employing, contracting with, or using you to undertake nursing work Any agency you are registered with or apply to be registered with (at the time of application) Any prospective employer (at the time of application) 11
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). The order will be reviewed prior to expiry. This decision will be confirmed to you in writing. That concludes this determination. 12