A Bundaberg Hospital nurse who administered medication to a patient "without a clinical need" and then failed to document it in medical records could have caused "serious or even fatal consequences", a Queensland industrial commissioner has ruled.
Enrolled nurse Nancy Williams is alleged to have given a patient a 5mg wafer tablet of the anti-psychotic drug Olanzapine on June 20, 2021, despite the medication order only being for 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 on that shift.
Ms Williams remains registered although the hospital said she was no longer able to administer medications.
She disputed some of the allegations against her and cited mitigating factors in an appeal before the Queensland Industrial Relations Commission (QIRC), including that the patient's chart was missing immediately after she had administered the medication.
'No trivial breach of policy'
But industrial commissioner John Dwyer said in his ruling: "Nothing offered in mitigation by Ms Williams amounts to a reasonable excuse."
"This is no trivial breach of policy. A failure to record what medication has been administered to a patient, either immediately or without unreasonable delay, creates an enormous risk to the health and safety of a patient.
"The risk is exacerbated by circumstances, for example, such as a patient having a communication deficit for whatever reason or the access of other nursing staff to that patient who are subsequently attending to that patient and exercising their own discretion to administer medication as well."
Mr Dwyer said he was satisfied 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 medication of this type".
"There was no clinical history or need to administer 5mg of this particular medication," he wrote.
'Handover sheet' shredded, nurse says
Ms Williams submitted that she had administered 2.5mg of the drug to the patient, insisting she had broken a 5mg tablet in half and disposed of the unused portion into a sharps bin.
The medication was administered sometime between 2:10pm and 2:30pm but when her shift was terminated at 5pm, she had still not updated the patient's chart.
"There is a contention that Ms Williams entered the intervention into her 'handover sheet' but Ms Williams placed this document in a shredder as she was being escorted from the premises thereby eliminating any evidence that might corroborate her assertion," a footnote to Mr Dwyer's decision said.
Ms Williams was the subject of four allegations as part of a show cause process instigated by the Wide Bay Hospital and Health Service.
Three were substantiated but the fourth – that she had administered Olanzapine to a patient with an intent to ensure the patient remained calm throughout her shift – was not.
Attempts were made to contact Ms Williams but they were unsuccessful.
Minister requests review of drug management at hospital
In a statement, the Wide Bay Hospital and Health Service (WBHHS) said an internal review into the issue found "appropriate practice had not been undertaken in regards to a single incident with a standard prescription drug".
WBHHS said it had implemented a "number of remedial actions" and as a result the nurse involved was no longer able to administer medications.
The health service said its remedial actions had been supported by the QIRC in its review of the matter.
Bundaberg patient advocate Beryl Crosby has written to Health Minister Yvette D'Ath detailing the case and concerns about other allegations involving drug management at Bundaberg Hospital.
Ms D'Ath replied to Ms Crosby that she took the allegations "extremely seriously" and had referred the concerns to Queensland Health's acting director-general Shaun Drummond for review.
"I am advised that Clinical Excellence Queensland is currently examining the allegations, and that other relevant authorities have also had this matter referred to them," Ms D'Ath wrote.
The Australian Health Practitioner Regulation Agency cites no conditions on Ms Williams's registration to her practise as a nurse.
