A recent case from Eardisland, Herefordshire, demonstrates the impact of institutions like the Nursing & Midwifery Council in the UK that considers allegations of misconduct of nurses. A nurse was given a three-year caution for not adhering to the Council's professional code of conduct which led to serious consequences for the patient.
Inaccurate documentation is a major misconduction of nurses.
Karyn Probert will probably never forget May 2005. It was the month when the nurse who was employed at the Station Drive Surgery, Ludlow, made a momentous mistake. She forgot to ask a woman for the date of her last menstrual period before administering the contraceptive drug Depo-Provera, an injection that can stop periods completely.
The mother-of-four recognised only four month later that she was pregnant and demanded an abortion. During the procedure a heartbeat was noted which is considered a live birth but the baby died of extreme prematurity. The post-mortem showed that the women had been four weeks pregnant when she was given the contraceptive drug.
The moment Karyn Probert became aware of her mistake, she “got panic” as she said and falsified her previous entry by adding the words “last menstrual period – first day 11.5.2005” and two weeks later made a further entry – “remembered conversation with patient”. What the nurse did not seem to know: new information and documentation systems of hospitals and surgeries track all entries by date.
Due to this reporting inaccuracy the independent panel of the Conduct and Competence Committee of the Nursing & Midwifery Council (NMC), the UK regulator for nursing and midwifery, decided to issue Karyn Probert with a three-year caution.
To be eligible to work in the UK, every nurse or midwife must be registered with the NMC. The primary purpose is to safeguard the health and wellbeing of the public. The NMC maintains a register of all nurses and midwives practising within the UK and it establishes standards for their education, training, conduct and performance.
The institution makes a lot of sense: it provides a framework for the nurses and at the same time protects them from mistakes. The situation in other countries is not as clearly regulated and leaves nurses and hospital waiting for court decisions. In Germany the courts have to decide about the impact of a mistake in hospitals. And due to the federals structure every court might come to a different conclusion. The Robert-Koch-Institute in Germany estimates that on average 80.000 patients per year die of incorrectly administered drugs. Three years ago a nurse mixed up the heart catheter infusion of a newborn child – causing the death of the baby. But in countries without standards, misconduct is often only detected when the patient suffers damages or when the therapy fails.
In the case of Karyn Probert, the panel took into account that her actions did not result in direct or indirect harm to the patient and that the subsequent outcome for the patient was not a result of her actions. However, according to the panel inaccurate record-keeping and falsifying records violated the standard required of a registered nurse and in totality amounted to misconduct.
"Nurses are required to adhere to their code of conduct which says that they should act in a way to uphold the reputation of the profession. The panel considered her behaviour to be unprofessional and dishonest and outside of the NMC's guidelines on record keeping which say that "records should be written in such a manner that any alterations or submissions are dated, timed and signed in such a way that the original entry can still be read clearly".
In their decision the panel took into account the fact that Ms Probert had a good nursing record, that there had not been any repeat incidents as well as the very positive testimonials regarding the nurse’s dedication to her profession and her contribution to academic teaching and nurse training.
Accurate record keeping is a fundamental part of a nurse's practice and last year nearly 10% of the cases that went to a full hearing were to do with poor record keeping.
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