A NURSE who contributed to the deteriorating health of a Stockton Centre resident who died the next day has been struck from the register and banned for two years.
The ban comes nine years after the 49-year-old Stockton resident's death on September 11, 2015.
The nurse, Melinda Farley, resigned in March, 2017, after being removed from face-to-face nursing duties and before being sacked.
Ms Farley started working at the Stockton Centre in 1995 where the patient, who had a severe intellectual disability, had lived since she was a child.
She lived in Unit 17 with about 20 other people with disabilities.
Patient well-known
Ms Farley had worked with the patient "on and off" for many years and knew her well, but had not seen her for a few months when she started a shift at 3pm on September 10, 2015.
Evidence contained in a judgement published this week (September 17) included statements from Ms Farley and two other members of staff who worked that shift.
In the months leading up to her death, the patient had a number of health issues including recurring constipation and episodes of abdominal distension.
A health care plan was written for her in July, detailing what to watch for in terms of clinical signs of her condition worsening, which included mood changes.
Staff were directed to conduct regular reviews and assessments including measuring her stomach, recording her food and fluid intake and activity levels, and to be on the look out for signs of obstructions. Her health care plan was reviewed on September 4.
Warning signs
The day before she died, the patient had been on an outing and Ms Farley noticed she looked tired, with dark bags under her eyes, and that her fingers were cyanosed (had a blueish tone).
There were no nursing client progress notes for the patient for the five days leading up to September 10, but that did not concern her, Ms Farley told the tribunal.
Ms Farley said she was handed a receipt for the patient's lunch and on that basis assumed the patient had eaten. She said she read the medical progress notes but the need to aim for fluid intake of more than three litres did not "stand out to her".
The patient refused her favourite food and drink, ate very little over the shift and was rocking back and forth for some time, all potential indicators that she may be unwell, the tribunal found.
But Ms Farley failed to monitor or address the patient's fluid intake, and failed to recognise she needed a medical review.
She denied that another nurse suggested an ambulance be called, but the tribunal rejected that evidence. It also rejected Ms Farley's evidence that she was told the patient's measurements had been taken and were in 'normal range'.
Substandard
The tribunal found Ms Farley guilty of "extremely serious misconduct", saying that while the lack of clinical progress notes leading up to the 10th suggested that other staff may well also have failed in their care of the patient, it was clear that Ms Farley's care was "wholly inadequate".
"Ms Farley was a registered nurse with approximately 20 years' experience," the judgement said.
She was experienced at caring for patients with challenging behaviors, and the officer in charge of the unit, and the patient a was a vulnerable patient who showed clear signs she may be in pain "and yet Ms Farley did not undertake a comprehensive assessment of her".
The procedure was to contact a medical officer if a patient was unwell, and that was clearly stated in the health plan which she had read.
Her attitude towards the woman's care on that day was "completely slap dash", the tribunal found.
She was dismissive of her colleagues' concerns about the patient, and remained dismissive, even after the patient's death, saying she did nothing wrong.
"While she says she feels terrible about (the patient's) death, she says she has no regrets about what happened on her shift," the judgement says.
"She says there is nothing about her conduct on that shift that she would do differently".
That demonstrated a very disturbing lack of insight, into the "very significant shortcomings" in her care for that patient on that day.
Ms Farley, whose registration had lapsed, would have had her registration cancelled and was banned for applying to be re-registered for two years.
