Published by the ABC on 24 May 2022 was this article Bundaberg Hospital nurse administered medication to a patient without 'clinical need'
"Without a clinical need" - The medication was prescribed by a medical officer who assessed the patient.
The Team Leader assessed the patient to have a clinical need. The patient was agitated, climbing out of bed and assessed as being at a high falls risk from the bed with the potential for high impact trauma which could result in a brain haemorrhage, fracturing of bones, or death.
To not intervene would be negligence in the nurse’s duty of care for the patient and would also expose the Hospital (Bundaberg Hospital and QLD Health) to litigation.
As an Enrolled Nurse, Nancy Williams administered the prescribed medication on the professional advice of the Team Leader. Nancy adhered to the Scope of Practice requirements as set down by AHPRA.
The allegation made by an AIN who was approximately 3 metres away and monitoring two other roaming patients was not observing the administration of the medication.
The medication chart was left on the desk due to the patient’s disturbed behaviour. After administering the medication and once Nancy returned to the desk, the medication chart and patient's clinical file were missing, so she could not sign. It is a regular occurrence in QLD Health facilities that charts go missing.
Nancy Williams stated she broke the wafer in half with her fingernail through the tin foil cover, administered half of the wafer (2.5mg). She then disposed of the remaining wafer into the sharps bin so other patients could not pick it up and ingest it given that other patients were roaming in this vicinity. Nancy placed the empty foil wrapper into the waste bin.
It was noted that the AIN had not completed the behavioural chart at the time, nor for a substantial period of time prior. It was subsequently observed that this chart was completed retrospectively. It would have taken a period of time for the patient's behaviour to escalate.
The allocation of an AIN, a role with minimal skills, being allocated to patients with complex medical requirements needs to be investigated. NPAQ understand that Bundaberg Hospital closed the Dementia Ward (PARAS) to 'Save Money'. This action by management has placed significant stress on acute care bed stock. This has a knock-on effect to the Emergency Department with patients who require admission to an acute bed waiting excessive times. The result - Emergency Departments being overcrowded, exposing patients to a safety risk and causing ambulances to ramp.
An investigation is needed into Bundaberg Hospital Executive and the Acting Nursing Director regarding the under-resourcing of the unit/hospital to meet the care needs of this hospital's patients.
NPAQ was advised that staff have been coming in early for months in an attempt to provide timely nursing care and to assist their colleagues
Nancy Williams came onto the ward early and observed the patient's escalated behaviour which was distressing for the patient. She was not allocated this patient because she took up her designated allocation at 14.30 hrs.
Nancy Williams was crucified because she cared.
This could happen to any nurse in QLD Health currently working in extremely busy, chaotic wards that are short-staffed every day of the week.
Why were the Executive and Nursing Directors not doing their job and adequately resourcing the unit? This inaction puts the patient's health and safety at risk. It also puts the Nurse's Registration at risk which is creating significant stress.
Too often nurses work unpaid overtime, do not get their allocated meal breaks, and have no one assigned to relieve them for breaks. The Hospital is contravening the minimal patient ratios as set down by QLD Health.
Staff have extreme workloads and dedication to their patients ahead of their own needs.
There was indeed a clinical requirement as demonstrated by the patient’s impulsivity and attempting to climb out of bed. As Nancy Williams was not on duty as she arrived 30 minutes early for her shift, she could have just 'walked on by’ 'nothing to see here’ 'not my responsibility'. Instead, she intervened because she cared for the well-being of the patient.
Nancy William's shift was cut short at 5.30pm. She handed over that she had not signed for the medication or written in the patient's clinical file (chart), which had still not been located. The remaining team worked down a staff member for a further two hours, the Hospital in breach of the designated minimum patient ratios.
The AIN who made the allegation picked up the empty foil from the waste bin and took the foil home. They at no time reported to the team leader or any other nurse that they thought a potential medication error may have occurred. Instead, the AIN had a 'chat' with the next-door neighbour after she had left the hospital, who happened to be the HR Manager. A number of hours had gone by before the hospital was notified.
This behaviour breaches the code of conduct, breaking patient confidentiality. We question such behaviour and in our professional opinion, a duty of care for the patient’s wellbeing was not reported in a timely manner.
It is a routine procedure to shred the handover/work sheet after a shift. It is a breach of confidentiality to remove these sheets from the ward. These sheets contain highly sensitive patient information which has the potential to breach of the Privacy Act.
The statement that she had administered Olanzapine to a patient with the intent to ensure the patient remained calm during her shift was made by the AIN. Nancy Williams had no motive to do so as she was not allocated this patient.
Beryl Crosby – the Patient Advocate is renumerated by QH and was appointed in the days when Dr John Wakefield (previous DG) headed PSQ (Patient Safety QLD).
NPAQ is advocating that patients be represented by an independent body whereby patients and/or relatives can make a complaint without feeling under duress. Patients believe the current system is tokenistic.
The article states that 'attempts were made to contact Ms Williams but they were unsuccessful'. Nancy Williams advises that she was not contacted. There were no phone calls, emails or letters in the mail. She was unaware of the ABC article until a colleague contacted her.
A broken system creates an enormous risk to patients' health and safety, which can impact on their healthcare outcomes for the rest of their lives.
Nurse and Doctors believe the current system needs significant review and dismantling to provide a quality health service to the QLD taxpayer. It is not a free service. Each Queenslander pays tax for the Government to provide quality universal care.
In Queensland, we have a top-heavy health bureaucracy who do not have the skills to manage a healthcare system. The core business is patient care which Doctors and Nurses deliver 24/7. This must be adequately resourced immediately to ensure no harm comes to patients.
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