A nurse at Bundaberg hospital administered medication to a patient with no ‘clinical need’

A Bundaberg hospital nurse who administered medication to a patient with ‘no clinical need’ and then failed to document it in medical records could have had ‘serious or even life-threatening consequences’, an industry commissioner has said from Queensland.

Registered nurse Nancy Williams allegedly gave a patient a 5mg tablet of the antipsychotic drug Olanzapine on June 20, 2021, despite the drug order being only 2.5mg.

She allegedly administered the drug without making “adequate observations of the patient”, who was not among those Ms Williams was supposed to be treating during that shift.

Ms Williams remains registered despite the hospital saying she was no longer able to administer medication.

She disputed some of the allegations made against her and cited mitigating circumstances in an appeal to the Queensland Industrial Relations Commission (QIRC), including that the patient’s record disappeared immediately after she administered the drug.

“No trivial violation of policy”

But Industrial Commissioner John Dwyer said in his decision: ‘None of the mitigation offered by Ms Williams constitutes a reasonable excuse.

“This is no trivial breach of policy. Failure to record medications that have been administered to a patient, immediately or without unreasonable delay, creates a huge risk to a patient’s health and safety.

“The risk is exacerbated by circumstances, for example, a patient having a communication deficit for any reason or the access of other nursing staff to that patient who then care for that patient and exercise their own discretion to administer drugs as well.”

Mr. Dwyer said he was satisfied, based on the evidence presented, that neither Ms. Williams nor the supervising registered nurse had adequately conducted observations of the patient “that could safely inform them of the need to administer drugs of this type”.

“There was no clinical history or need to administer 5mg of this particular drug,” he wrote.

Shredded ‘remittance sheet’, nurse says

Ms Williams said she administered 2.5mg of the drug to the patient, insisting she broke a 5mg tablet in half and threw the unused part in a sharps bin.

The medication was administered between 2:10 and 2:30 p.m., but when her shift ended at 5 p.m., she still had not updated the patient’s chart.

‘There is a claim that Ms Williams wrote down the intervention on her ‘transfer sheet’ but Ms Williams placed that document in a paper shredder as she was being escorted off the premises thus eliminating any evidence that might support her assertion,” a footnote to Mr. Dwyer’s ruling said.

Ms Williams was the subject of four allegations as part of a show cause process initiated by the Wide Bay Hospital and Health Service.

Three were substantiated, but the fourth – that she administered olanzapine to a patient in an attempt to ensure the patient remained calm throughout his shift – was not.

Attempts were made to contact Ms Williams but were unsuccessful.

Minister calls for review of medication management at hospital

In a statement, the Wide Bay Hospital and Health Service (WBHHS) said an internal review of the matter found “proper practice was not undertaken with respect to a single incident with a prescription drug. standard”.

WBHHS said it had implemented a “number of corrective measures” and as a result the nurse involved was no longer able to administer medication.

The health service said its corrective action was supported by the QIRC in its review of the matter.

Bundaberg Patients’ Advocate Beryl Crosby has written to Health Minister Yvette D’Ath detailing the case and concerns about other allegations regarding the management of medication at Bundaberg Hospital.

Ms D’Ath told Ms Crosby that she takes the allegations “extremely seriously” and has forwarded the concerns to Queensland Health’s acting chief executive, Shaun Drummond, for consideration.

‘I am advised that Clinical Excellence Queensland is currently reviewing the allegations and that other relevant authorities have also taken up the matter,’ Ms D’Ath wrote.

The Australian Health Practitioners Regulatory Agency cites no conditions for Ms Williams registering to practice as a nurse.

Ms D’Ath took her concerns to Queensland Health Acting Chief Executive Shaun Drummond for consideration.(AAP Image: Dan Peled)

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