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When medication administration goes against professional standards

The NSW Civil and Administrative Tribunal (‘Tribunal’) found Mr Brian McLean (EN) guilty of unsatisfactory professional conduct and professional misconduct for inappropriate administration of a Schedule 4D drug to nursing home patients. 

The Tribunal ordered that the EN be publicly reprimanded. The EN had been registered as an enrolled nurse but was no longer registered at the time of the Tribunal hearing. The Tribunal noted that had the EN still been registered, the Tribunal would also have cancelled his registration. During the hearing, the EN admitted to serious breaches of his duties in administering medication to three patients over a lengthy period of time.

Specifically, the EN removed Risperidone tablets from a resident’s Webster pack (Patient A) and administered them to three other residents (Patients B, C and D) over a 6-month period. 

During the hearing, the EN accepted that he:

  • was aware that Patient B had not been prescribed Risperidone but thought such medication may help the patient
  • made no assessment of Patients B, C and D
  • did not check the relevant medication charts and took it on himself to dispense medication against policy and good clinical and medical practice
  • made no record of the medication administration
  • did not seek approval from the medical officer.
  • was not acting in accordance with workplace protocols 

Unsatisfactory professional conduct is:

conduct that demonstrates

  • the knowledge, skill or judgement possessed; or
  • care exercised, by the practitioner in the practice of the practitioner’s profession

is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience.

Professional misconduct is:

  • unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner’s registration; or
  • more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner’s registration.
 The EN also agreed that his conduct was dangerous, particularly in situations where patients could not communicate.

Practice point

If you disagree with a patient’s medication regime or believe it needs to be revised:
discuss any concerns with the medical officer
follow workplace protocols to obtain written orders before any change in administration
document the administration accurately.

Medication administration references

Guide to Handling Medication in Nursing Homes in NSW, NSW Health; (File No 03/6937)
Policy Directive: Medication Handling in NSW Public Health Faciliti
es, NSW Health (PD2013_043) 

 

CASE STUDY 1 : REFLECTIVE PRACTICE ACTIVITY

The following professional standards could have guided the EN on good clinical practice:

Enrolled Nurse standards for practice

  • Professional and collaborative practice: reflects the responsibilities of the EN to maintain currency and to demonstrate best practice, including the provision of nursing care according to the agreed plan of care.
  • Provision of care: encompasses all aspects of care from assessment to engaging in care, including health education and evaluation of outcomes. This covers collecting data, reviewing and documenting the health and functional status of the person receiving care accurately and clearly.
  • Reflective and analytical practice: relates to the ability of the EN to reflect on evidence-based practice and ensure currency of essential knowledge and skills to care for the personal, physical and psychological need of themselves and others. This includes practising safely within legislative requirements, safety policies, protocols and guidelines.

Code of Ethics for Nurses in Australia

  • Nurses value informed decision-making
  • Nurses value a culture of safety in nursing and health care.
  • Nurses value ethical management of information.

Code of Professional Conduct for Nurses in Australia

  • Nurses practise in a safe and competent manner
  • Nurses practise in accordance with the standards of the profession and broader health system
  • Nurses practise reflectively and ethically

Professional boundaries

  • Therapeutic and care relationships: the community trusts that nurses will act in the best interest of those in their care and that the nurse will base that care on an assessment of the individual’s specific needs.

To read more about the professional standards for nurses and midwives in Australia and to access the Code of Conduct, Code of Ethics and Competency Standards, visit the NMBA website.

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