Download Conduct and Competence Committee Substantive hearing

Conduct and Competence Committee
Substantive hearing
7 to 8 May 2013
Nursing and Midwifery Council, Hilton Belfast, 4 Lanyon Place, Belfast, BT1 3LP
Name of registrant:
Binu Manuel
NMC Pin:
04Y0175O
Part(s) of the register:
Registered Nurse – sub-part 1
Adult Nursing – August 2004
Area of registered address:
Northern Ireland
Type of case:
Misconduct
Panel members:
James Daniell (Chair - lay member)
Caroline Williams (Registrant member)
Joseph Magee (Lay member)
Legal Assessor:
Conor Heaney
Panel Secretary:
Vicky Connick
Shorthand Writer:
Ubiqus
Nursing and Midwifery Council:
Represented by Jamie Hunt,
Case Presenter,
NMC Regulatory Legal Team
Nurse:
Registrant present and represented by John
Guerin, Campbell Fitzpatrick Solicitors
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Facts proved:
1(a), 1(b), 2(a), 2(b) 3, 4, 5, 6(a), 6(b), 6(c), 6(d)
by admission
Facts not proved:
n/a
Fitness to practise:
Impaired
Sanction:
Caution order – 5 years
Details of charge as read
That you while a registered nurse by Belfast Health and Social Care Trust between 10
May 2010 and 12 January 2011:
1. During the night shift of 10/ 11 May 2010, did not perform observations for:
a. Patient A;
b. Patient B;
2. During the night shift of 10/ 11 May 2010, did not take any action to ensure that
the observations at charge 1(a) and/ or 1(b) above were performed, in that you:
a. Did not ask nursing colleagues to perform the observations;
b. Did not report the failure to perform observations to the night co-ordinator
or a doctor;
3. During the handover on 11 May 2010, did not inform staff that you had failed to
carry out observations on Patient A and/ or Patient B during the course of the
nightshift;
4. Administered medication to Patient C when you had not properly checked the
medication;
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5. Administered medication to Patient C via a naso-gastric tube without initially
taking and testing the aspirate;
6. On 12 January 11 in respect of Patient D:
a. Did not ensure that Patient D received medication at the prescribed time;
b. Incorrectly placed an infusion pump on an IV line of normal saline;
c. Incorrectly recorded that you had administered 250ml of volplex IV to
Patient D when you had not;
d. Did not clearly record on Patient D’s fluid balance chart the IV fluids
administered.
And in light of the above, your fitness to practise is impaired by reason of your
misconduct.
Decision on facts
Mr Manuel,
You were employed by Belfast Health and Social Care Trust (“the Trust”) as a
registered nurse working on Ward 4C (“the Ward”) of the Royal Victoria Hospital. The
Ward is a 32 bedded unit which includes spinal patients and fracture trauma patients.
The allegations in this case concern three discrete incidents involving four patients,
between 10 May 2010 and 12 January 2011.
On 11 May 2010, Ms 4, Ward Manager, received a report from a member of staff on the
Ward. She was informed that the member of staff had noticed that post operative
observations were not carried out as required on the previous shift. The patients
concerned were Patient A and Patient B. The failure to conduct these post operative
observations was not communicated with the night coordinator or a doctor.
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Patient A was 93 years of age, had undergone hip surgery and she was described as
being confused. The observations on Patient A should have been undertaken as a
minimum at four hourly intervals as recorded on the patient’s observation chart. The
observation chart showed that Patient A was checked at 18:00 hours on 10 May 2010
and was not subsequently checked until 10:35 hours on 11 May 2010 by the day staff
who took over from you. You documented in an entry in Patient A’s nursing notes on 10
May 2010 that Patient A would not allow you to perform observations. You did not return
at a later stage in the shift to attempt observations and nor did you ask nursing
colleagues to attempt to carry them out.
Patient B was 91 years old and was suffering from a pubic fracture. The observations
on Patient B should have been performed at 06:00 on 11 May 2010. There was no
indication in Patient B’s nursing notes as to why you did not perform the observations as
required.
At the end of your shift on the morning of 11 May 2010, during the handover, you did
not report to your nursing colleagues, that you had failed to perform Patient A and
Patient B’s observations during the handover.
A disciplinary hearing was held on 3 February 2011 which was chaired by Ms 3. The
disciplinary panel heard evidence at this meeting from Ms 5, Investigating Officer. Ms 5
stated that you had confirmed that you had taken two medicine glasses containing
medication to Patient C from the medicine trolley and that you had administered the
medication to Patient C without checking it. Ms 3 states in her witness statement that
during the disciplinary hearing you stated that you had done this as Ms 6, Staff Nurse,
had asked you to administer the medication and you had assumed that the medication
contained in the two medicine glasses within the medicine trolley had been dispensed
by Ms 6.
During the course of the disciplinary hearing, a further incident became apparent. Ms 5
gave evidence that you had confirmed that you had administered medication to Patient
C via a naso-gastric tube without initially testing the aspirate. Ms 3 states in her witness
statement that you confirmed during the disciplinary hearing that you had assumed that
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the pH of the aspirate had been checked by Ms 6 to ensure that it was correctly
positioned.
On 12 January 2011 you worked with Ms 2 and cared for Patient D. Ms 2 states in her
witness statement that Patient D had been unwell all morning with low blood pressure
and low urinary output. Patient D had an Early Warning Score of 3 – 6 early in the
morning, which is a deviation from the normal. The Junior Doctor had prescribed
Volplex 250mgs to be administered over 30 minutes through an IV. You documented
that you had given this medication as prescribed. Ms 2 was informed by Ms 7, Staff
Nurse, that a different medication was being administered to Patient D, namely
Dextrose 5% plus 20mmls of KCL via Baxter Pump at 125mls per hour over four hours.
Ms 2 instructed Ms 7 to stop the infusion and administer the infusion of Volplex that was
due via the Baxter Pump.
Ms 2 then reviewed Patient D’s fluid balance chart and found it difficult to know what
had been administered or not as the recordings were not clear. She states in her
witness statement that there was a column for IV fluids and a column for oral intake and
that you had recorded the IV fluids in the oral intake column and vice versa. Ms 2 stated
that the fluid balance chart was very difficult to understand and that you were not able to
explain it to her.
Ms 3 states in her witness statement that during the disciplinary hearing you confirmed
that you had failed to ensure that Patient D had received the prescribed medication at
the prescribed time as you had failed to open the clamp on the infusion. You also
confirmed that you had placed the infusion pump on an IV line of normal saline in error.
You met with Ms 4 and Ms 2 on 12 January 2011. At this meeting the incident regarding
Patient D was discussed. Ms 4 states in her witness statement that it was unclear from
Patient D’s fluid balance chart what the exact status of the treatment and management
activity had been since 08:00 hours on 12 January 2011. During this meeting you
admitted that you had made a mistake.
You were subsequently dismissed from the Trust on 22 February 2011.
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The panel noted the submissions of Mr Guerin, on your behalf, and acknowledged that
you have admitted the facts in their entirety.
Accordingly, the panel found the facts proved in their entirely, by reason of your
admissions.
Determination on Misconduct and Impairment
The panel next considered, on the basis of the matters found proved, whether your
actions amount to misconduct, and if so, whether your fitness to practise is currently
impaired. The NMC defines fitness to practise as a registrant’s suitability to remain on
the register without restriction. The panel had regard to all the information put before it,
and to the submissions made by Mr Hunt, on behalf of the NMC, and Mr Guerin, on
your behalf. The panel heard and accepted the advice of the legal assessor.
The panel exercised its own independent judgment in determining whether the facts
found proved amount to misconduct and if so, whether your fitness to practise is
currently impaired. In this context, the panel kept in mind the need to protect the public,
to maintain public confidence in the nursing profession, and to uphold proper standards
of conduct and behaviour.
The panel had regard to the written statements from the following witnesses from the
Trust:
i.
Mr 1, Eyes and ENT Services Manager;
ii.
Ms 2, Deputy Ward Sister, the Ward;
iii.
Ms 3, General Manager for Orthopaedics;
iv.
Ms 4, Ward Manager, the Ward.
Mr Hunt submitted that the panel, in exercising its professional judgment, must consider
public protection and the need to protect individual patients from the risks posed by you
continuing in your current role, and the wider public interest, including the need to
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maintain confidence in the profession and the need to declare and uphold proper
standards of conduct.
Mr Hunt submitted that misconduct amounts to conduct which falls short of what one
would expect from a reasonably competent nurse. He referred the panel to the case of
Roylance v. GMC (No.2) [2000] 1 AC 311, in which Lord Clyde concluded that
“misconduct is a word of general effect, involving some act or omission which falls short
of what would be proper in the circumstances.”
Mr Hunt reminded the panel that the NMC Code of Professional Conduct, the Code,
Standards of conduct, performance and ethics for nurses and midwives (May 2008)
(“the Code”) sets standards to which registrants are expected to adhere. He invited the
panel to consider the Code in its entirety, and submitted that specifically numbered
standards 35, 42 and 61 are of relevance in this case.
Mr Hunt submitted that the allegations in this case are not isolated events and are
serious in nature. He submitted that the gravity of the allegations is clear and that they
amount to sufficiently serious misconduct to call into question your fitness to practise.
Mr Guerin, on your behalf, stated that you admit that your fitness to practise is impaired
by reason of your misconduct.
The panel reminded itself of the facts admitted and found proved. It noted that you have
admitted that your actions amounted to misconduct. The panel considered this matter
carefully and was of the view that your misconduct amounted to serious breaches of
nursing standards.
In considering whether the facts admitted and found proved amounted to misconduct,
the panel referred to the Code.
Preamble
The people in your care must be able to trust you with their health and wellbeing
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To justify that trust, you must:
 work with others to protect and promote the health and wellbeing of those in your
care, their families and carers, and the wider community
 provide a high standard of practice and care at all times
As a professional, you are personally accountable for actions and omissions in your
practice, and must always be able to justify your decisions.
And in particular,
Numbered standards
35. You must deliver care based on the best available evidence or best practice.
42. You must keep clear and accurate records of the discussions you have, the
assessments you make, the treatment and medicines you give, and how effective these
have been.
61. You must uphold the reputation of your profession at all times.
The panel concluded that, by reason of the facts found proved in this case, your actions
demonstrated serious breaches of the Code as outlined above. The panel considered
that your behaviour fell below the standard of what would be reasonably expected of a
registered nurse in both your acts and omissions.
The panel was of the view that you did not follow best practice in providing care to the
patients which led to the events of the charges as admitted and found proved. It
acknowledged that these patients were vulnerable and was of the view that you had
failed to provide basic elements of care and complete your professional responsibilities
as a nurse. The panel further noted your fundamental failings in relation to record
keeping. It determined that you had put patients at risk of harm and had breached the
Code in this respect.
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The panel concluded that the facts as admitted and found proved amounted to
misconduct.
In addressing impairment, Mr Hunt invited the panel to consider your fitness to practise
as of today. He submitted that the panel should look forward and not back. He stated
that the panel was entitled to take into account the way in which you acted in the past
and the extent to which you have remedied your past misconduct. Mr Hunt invited the
panel to subject any claim of remedy to careful scrutiny, particularly where past conduct
suggests ongoing susceptibility or entrenched attitudinal problems. He reminded the
panel of the seriousness of the allegations. Mr Hunt stated that you had showed lapses
in clinical judgment and that four patients were affected. He reminded the panel that the
incidents which led to the charges as admitted and found proved were not isolated.
Mr Hunt submitted that an aggravating factor in this case was that the four patients
involved in the incidents were vulnerable. In particular, he reminded the panel that
Patient A and Patient B required observations to be undertaken and that you had not
completed these. He stated that you had not asked your nursing colleagues to perform
the observations and that you had not reported your failure to perform the observations
to the night coordinator or the doctor. Mr Hunt submitted that this amounted to a failure
to carry out your professional responsibilities. He stated that the best practice in such
circumstances would be to seek help from colleagues or continue to try to carry out the
observations. Mr Hunt submitted that at the time of the incidents, you were practising
within the realms of your expertise and that it was expected that you would provide the
best care to patients. He stated that you had not informed members of staff during the
handover that you had not carried out the necessary observations and that there was
the potential for further direct harm to patients.
Mr Hunt reminded the panel of the medication administration errors you had made in
relation to Patient C as admitted and found proved. He reminded the panel that you had
administered medication when you had not performed the proper checks. He stated that
there were guidelines and procedures in place to ensure that patients were protected.
He submitted that medications must be checked, the dose clarified and checked with
colleagues to ensure that no harm was caused to patients. He reminded the panel that
nurses are accountable for their own practice. Mr Hunt stated that you should have
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tested the aspirate and engaged your colleague’s assistance. Mr Hunt submitted that
your errors in relation to Patient D were a further aggravating factor. He further
submitted that patient records should be clear and accurate and reflect the care
provided and that there was a general and clear purpose to provide an accurate
reflection of the fluids provided. He stated that there was the potential for direct harm.
Mr Hunt invited the panel to consider the following factors when assessing whether you
have remedied your failings:
i.
whether the misconduct was ‘easily remediable’;
ii.
whether the misconduct had ‘been remedied’;
iii.
whether the misconduct is likely to be repeated.
Mr Hunt submitted that the incidents which led to the charges as admitted and found
proved were serious and that there was a risk of direct harm. He submitted that your
misconduct involved four separate patients which took place between May 2010 and
January 2011, and that your errors had occurred despite you undergoing further training
at the Trust. He submitted that your misconduct was not easily remediable. He further
submitted that the panel must assess your insight, and that your admission of the
charges was not necessarily indicative of full insight.
Mr Hunt invited the panel to consider the case of Council for Healthcare Regulatory
Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin)
(“Grant”) and to the approach of Dame Janet Smith in the Fifth report to the Shipman
Inquiry 2004, for determining impairment. Mr Hunt submitted that your misconduct
amounted to flagrant breaches of basic clinical skills, which put patients at unwarranted
risk of harm. He submitted that you had brought the profession into disrepute and that
there were issues surrounding public protection in your case. He further submitted that
there was a need to protect the public, maintain public confidence in the profession and
uphold confidence in the profession.
Mr Guerin, on your behalf, informed the panel that he had advised you of the case of
Grant and that you had agreed that your fitness to practise is impaired.
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Mr Guerin informed the panel that you accepted the charges but wished to inform the
panel of the mitigating circumstances at the time of the incidents.
In relation to Patient A, Mr Guerin referred the panel to an observation sheet entitled
“Spiral Recording”. He informed the panel that you had made some reference to
observations on this sheet, although you accept that you did not record observations on
the standard observation chart. He submitted that you accept that your record keeping
was not as complete as it should have been. In relation to Patient B, Mr Guerin informed
the panel that Patient B had been asleep during the course of the night shift and that
there were no issues or concerns with Patient B. He submitted that you accept that you
should have properly recorded this. Mr Guerin submitted that you accept that you
should have kept proper records in relation to Patient A and Patient B and that you
should have kept others informed during the course of the evening.
In relation to Patient C, Mr Guerin submitted that you have accepted these charges. He
stated that this boils down to a simple breakdown in communication between you and
Ms 6, who was assisting with the administration of medication. Mr Guerin submitted that
you had thought Ms 6 had carried out the aspirate testing and that when she had
handed you the medication you had wrongly thought that she had checked it. He stated
that this was a simple breakdown in communication between two members of staff and
that you appreciated your error and accepted responsibility.
In relation to Patient D, Mr Guerin submitted that there was a three way adaptor in place
and that you had thought that the adaptor was turned in a certain way, but had
subsequently discovered that you were wrong. He submitted that you had thought you
had administered the medication and then recorded it. He stated that you should not
have recorded Patient D had Volplex when this had not been administered.
Mr Guerin informed the panel that the fluid balance chart in relation to Patient D was
confused and that this was not a reflection on you, but on your colleagues who
completed the chart when they took over and administered the medication.
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The panel carefully considered whether your fitness to practise is currently impaired by
reason of your misconduct. The panel heard and accepted the advice of the legal
assessor.
In assessing the issue of impairment, the panel referred to the case of Council for
Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011]
EWHC 927 (Admin) and to the approach of Dame Janet Smith in the Fifth report to the
Shipman enquiry 2004, Paragraph 25.50, and applied the test therein.
“Do our findings of fact in respect of the doctor’s misconduct, show that his/ her fitness
to practise is impaired in the sense that s/he;
(a) has in the past acted and/or is liable in the future to act so as to put a patient or
patients at unwarranted risk of harm; and/or
(b) has in the past brought and/or is liable in the future to bring the medical
profession into disrepute; and/or
(c) has in the past breached and/or is liable in the future to breach one of the
fundamental tenets of the medical profession.
The panel reminded itself that your misconduct was not in relation to an isolated
incident and that four patients had been affected. It noted that you had received further
training and support after the first incident, including clinical supervision from the Trust,
but that further incidents had taken place. The panel noted that you were an
experienced nurse at the time of the incidents and that you had not adopted best
practice in the care you provided. In particular, the panel had regard to your lack of
communication with colleagues in the handing over of care, medication errors and
failure to follow guidelines and procedures for the administration of medication and poor
record keeping.
The panel considered that your actions demonstrated a failure to understand your
personal responsibility and accountability for your acts and omissions. The panel was of
the view that responsibility to properly hand over care to colleagues, responsibility to
check equipment and medication before administration, and accurate record keeping
are fundamental principles of nursing care. The panel considered that your failures in
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these areas amounted to a breach of the fundamental tenets of the profession. The
panel concluded that your misconduct had put patients at risk of harm and that your
actions would bring the profession into disrepute.
The panel further considered the case of Cohen v GMC [2008] All ER 307. It noted that
you have not tendered any information in relation to your current practice or anything
you have done to remedy your failings. The panel was of the view that whilst you have
shown a degree of insight in your acceptance of the charges, you have not shown that
you appreciate the gravity of the incidents which led to the charges. Nor, by seeking to
shift some responsibility for your actions to others, have you demonstrated a full
appreciation of the importance of personal responsibility and accountability within your
practice. Consequently, the panel considered that there was a risk of repetition of your
misconduct.
The panel considered that your conduct breached the Code and that public confidence
in the profession, the upholding of proper professional standards, and public confidence
in the NMC as a regulator would be undermined if the panel did not find your fitness to
practise to be impaired.
Consequently, the panel determined that your fitness to practise is currently impaired.
Determination on Sanction
In reaching its decision on sanction, the panel considered all the evidence before it, the
submissions of Mr Hunt, on behalf of the NMC, and the submissions of Mr Guerin, on
your behalf.
Mr Hunt, on behalf of the NMC, referred the panel to the NMC’s Indicative Sanctions
Guidance (May 2012) (“ISG”) and invited the panel to have regard to this document
when reaching its determination on sanction. He submitted that the panel should have
regard to the principle of proportionality and that it should balance the aggravating
features in this case with the mitigating features. Mr Hunt submitted that the aggravating
features in this case are that there was the potential for direct harm to patients, that your
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errors were not an isolated incident and concerned four patients on a specialist ward.
He submitted that it was necessary that observations are performed on patients to
provide care and ensure checks in relation to whether a patient has deteriorated. Mr
Hunt submitted that your record keeping errors highlight your failures in relation to basic
nursing skills. He further submitted that your medication errors illustrate your failures in
relation to basic nursing care and lapses in clinical care. He reminded the panel that the
Trust was supportive in providing you with training and support after the first incidents,
but that further incidents had taken place.
Mr Guerin, on your behalf, provided the panel with a background of your nursing training
and employment history. He informed the panel that prior to the events which led to the
charges you had started your employment at the Trust as a Band 5 Staff Nurse in 2006
and had worked at the Fracture Clinic until November 2007, when you moved to the
Ward. He stated that there had been no issues with regard to your capabilities as a
nurse until May 2010.
Mr Guerin submitted that you fully appreciate that your failings which led to the charges
had the potential to harm patients. He invited the panel to note that no actual harm did
come to the patients. Mr Guerin submitted that whilst you have admitted your
observations of Patient A and Patient B were not as fulsome as they should have been,
you had undertaken some observations, and that this is not a case of a nurse
disregarding their duties. He invited the panel to take this into account when considering
the mitigating circumstances of this case.
Mr Guerin asked the panel to note that the NMC did not adduce a statement from Ms 6
in relation to the incident concerning Patient C. He further submitted that the witness
statement submitted from Ms 3 contains a considerable amount of hearsay evidence.
He invited the panel to attach the appropriate weight to this hearsay evidence.
Mr Guerin referred the panel to the witness statement of Ms 4 and submitted this
illustrates that you had admitted your mistakes at an early stage to the Trust. He further
submitted that there is clear evidence of your insight and that there is evidence that you
have learned from your mistakes. Mr Guerin submitted that you had accepted your
errors throughout the NMC proceedings. He informed the panel that you have engaged
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with the NMC throughout the investigative process and that you have cooperated fully
with the interim conditions of practice order imposed by an interim order panel for nearly
18 months. He stated that you admitted the charges at the outset and that you have not
‘buried your head in the sand’.
Mr Guerin referred the panel to training certificates which evidence that you have
attended training courses recently. In particular, he drew the panel’s attention to a
certificate detailing that you had attended an external medicine update course with The
Beeches Management Centre on 12 January 2012. He informed the panel that this
organisation was one of the pre eminent providers of courses in relation to the
administration of medication in the locality.
Mr Guerin informed the panel that your current employer, Staff Nursing Ltd, had
supported you in your adherence to the interim conditions of practice order currently in
place. He informed the panel that you had undergone a period of staff training last week
in relation to the safe administration of medication and record keeping. Mr Guerin
referred the panel to a supportive reference provided by your employer dated 2 May
2013. He further referred the panel to documents completed by your employer after you
had undergone periods of supervision. He stated that the form completed after your
supervision on 28 April 2013 detailed “Binu was very competent in the entire medication
round. He concentrated 100% on the round and was not disturbed by the
surroundings…” Mr Guerin informed the panel that the form completed after your
supervision on 29 April 2013 detailed that you continued to maintain safe practice. He
further informed the panel that the form completed after your supervision on 5 May 2013
stated “Again, Binu was completely competent in all aspects of administration of
medications”. Mr Guerin submitted that you had demonstrated your awareness of
guidelines and procedures.
Mr Guerin submitted that when determining sanction, the panel should consider the
least restrictive sanction first and referred the panel to the ISG. He further submitted
that a caution order would be the most appropriate sanction in this case. He reminded
the panel that you had made early admission from the outset of NMC proceedings and
at the time of your mistakes. He submitted that you had demonstrated insight and regret
regarding your failings. He reminded the panel of your previous good history. He stated
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that you had been the subject of an interim conditions of practice order for nearly 18
months and that this must be taken into consideration by the panel when reaching its
determination on sanction. Mr Guerin informed the panel that you had encountered
some financial difficulties as a result of the interim conditions of practice order in place.
He submitted that a caution order is now appropriate and sufficient to protect the public
and maintain public confidence in the profession and in the NMC as a regulator.
The panel took account of the aggravating and mitigating factors, exercised its own
independent judgment on this issue, and has heard and accepted the advice of the legal
assessor. It has taken into account the ISG. The panel has had regard to the need to
protect the public as well as the wider public interest. It has applied the principle of
proportionality and weighed the interests of the public against your own interests. The
panel reminded itself that the purpose of any sanction is not to punish a registrant for
any past misconduct, but is to protect the public and/ or maintain confidence in the
profession and its regulatory process.
The panel first considered taking no action. Although the panel accepted that you have
learned from your failings, it was of the view that your misconduct demands that a
sanction be imposed to mark the departure from the professional standards set out in
the Code and to maintain the reputation of the profession. Accordingly, the panel has
concluded that the facts found proved in this case are too serious for it to take no action.
The panel next considered a caution order. Paragraph 64 of the ISG states:
”… a caution order may be appropriate where the case is at the lower end of the
spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour
was unacceptable and must not happen again”.
The panel reminded itself of its determination on misconduct and impairment, “The
panel further considered the case of Cohen v GMC [2008] All ER 307. It noted that you
have not tendered any information in relation to your current practice or anything you
have done to remedy your failings. The panel was of the view that whilst you have
shown a degree of insight in your acceptance of the charges, you have not shown that
you appreciate the gravity of the incidents which led to the charges. Nor, by seeking to
shift some responsibility for your actions to other, have you demonstrated a full
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appreciation of the importance of personal responsibility and accountability within your
practice. Consequently, the panel considered that there was a risk of repetition of your
misconduct.”
The panel noted the information you have provided today in relation to training courses
which you have undertaken since the events which led to the charges. This information
was not available to it at the impairment stage. It further noted that you have been
working for your current employer Staff Nursing Ltd, without any repetition of the sort of
errors which led to the charges, and that you have provided the panel with a positive
reference from your employer dated 2 May 2013 which states “Binu Manuel has been
supervised on three occasions during Administration of Medication and has
demonstrated safety and accountability during and following the procedures. Further to
this there have been no concerns raised by out Clients or the supervising nurse. I am
further satisfied that he demonstrated awareness of the guidelines for medicine
administration as laid down by the NMC.” The panel further noted the documentation
completed after your supervised medication rounds on 28 and 29 April and 5 May 2013
and the positive comments therein.
The panel was of the view that you have worked well within your current working
environment and that the information provided by you today illustrates the degree of
insight you now have and your commitment to address your failings. Consequently, the
panel considered that a caution order would afford adequate protection to the public. It
was of the view that this sanction would mark the departure from the professional
standards set out in the Code and would maintain the reputation of the profession and
public confidence in the NMC as a regulator.
The panel decided to impose a caution order for the period of five years. This period is
intended to mark the seriousness with which the panel views your misconduct. Further,
the panel took into account that if you were to be considered for a post with another
employer at any time over the next five years, that employer would be alerted to the fact
that the order had been imposed.
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The panel noted your compliance with the interim conditions of practice order currently
in place. It considered that a conditions of practice order, or any other sanction more
restrictive than a caution order, would not be appropriate or proportionate in this case.
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