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Professional Accountability and Patient Safety
Name of the writer
Name of the institution
Health Care Complaints Commission v Akhurst 2016 NSWCATOD 70
Introduction
Patient A and Patient B are addicted to the drug. They have been under the examination and care of the respondent (Dammen Alan Akhurst) who worked as a registered nurse in the Intensive Care Unit at the Royal North Shore Hospital (RHSH). The registered nurse acted inappropriately for the treatment and care of Patient A when he diverted and replaced the fentanyl with saline. He also altered with the medication of Patient B when he took a drug of addiction for his own use, without the permission of authorities (Caselaw.nsw.gov.au). That drug was supposed to be used for Patient B who was under his observation and care. Dammen Alan Akhurst was guilty of unsatisfactory professional misconduct due to which his registration was cancelled. The Tribunal had decided that the respondent would pay the commissions costs of the application. Moreover, the respondent would not be able to apply for a review of the Tribunal decision for a minimum period of two years. Here, the focus is to determine various actions and omissions along with system-based errors and responsibilities of the nurse in the given case.
File number 1520129
Case link HYPERLINK https//www.caselaw.nsw.gov.au/decision/57478fb1e4b05f2c4f04e75c https//www.caselaw.nsw.gov.au/decision/57478fb1e4b05f2c4f04e75c
Registered Nurse and adverse outcomes for the Patient
It is notable to mention that five complaints were made against the respondent in accordance with s 39(2) and 90B(3) of the Health Care Complaints Act 1993 and s 145 of the National Law. The registered nurse was engaged in the unsatisfactory professional conduct as the care exercised by him was considerably below the standard level.
Actions
Administer the wrong medication
He tempered with the infusion of Patient A and Patient B as he knowingly replaced the fentanyl drug with saline. It is evident that he was engaged in unethical conduct relating to the purported practice of nursing as he took a drug of addiction for himself instead of using it for the patient. Instead of giving these infusions to the patients, the respondent knowingly administers the wrong medication which leads towards the crucial condition of the patients. The respondent self-administered a drug of addiction with the permission of the authorities. Furthermore, the respondent breaches the Code of Professional Conduct for Nurses in Australia in 2010 when he failed to dispose of the fentanyl in his possession.
Misleading information to Hospital Staff
It is noteworthy to mention that the respondent was guilty of unsatisfactory professional conduct as he engaged in unethical and improper conduct regarding his practice of nursing. The respondent misleads the hospital administration over the use of the prescribed drug for patients. He provided false information that he is not involved in the usage of fentanyl for his own use. He was given a letter from the council based on his inappropriate and misconduct of professional practice as a nurse. When he was taken in front of the council, he provided them with false statement and misleading information. He even told the council that he was taking fentanyl for possible self-administration. The proceeding was conducted on 19 May where the respondent provides a false statement in order to delegate the member of the council.
Sufficiently Serious Nature to Justify
According to the section 139E of the National Law, the respondent was found guilty of professional misconduct. It is notable to mention that the respondent tried to justify the cancellation or suspension of his registration by engaging in inadequate professional conduct of satisfactorily serious nature. He was trying to convince the council that he was not taking fentanyl for personal use.
Impairment within the meaning of s 5 of the National Law
By conducting the whole proceeding and listening to the false concerns of the respondent, the council reported that he has an impairment within the meaning of section 5 of the National Law. They state that the respondent is not suitable to work as a registered nurse due to his mental impairment, disability, substance abuse. The council accused the respondent that he was suffering from substance abuse due to which he was unable to perform his duties as a nurse in an effective way. Moreover, the council concluded that the respondent does not have sufficient mental capacity to practice this profession.
Omission
It is the responsibility of the nurse to carry out the requisite treatments and medications. He/she is responsible to monitor the changes in the conditions of patients and maintaining reports of the patients. It is notable to mention that in the given case, the respondent was deteriorating the condition of patients by tampering with their infusion and medications. He was replacing the prescribed drug fentanyl with saline without even telling the authorities which adverse the events. Instead of giving this infusion to the patient, the respondent showed unethical and non-professional behaviour in managing the patients treatment. It is notable to mention that the respondent was required to provide appropriate and true information regarding the use of prescribed for patients. Instead, he misleads the administration and authorities about the whole event. The respondent failed to provide adequate professional conduct of sufficiently serious nature to justify the deferment of his registration. The entire events suggested that the respondent is suffering from detrimental effects due to substance abuse and mental disorder. It was the responsibility of the registered nurse to tell the authorities about his current medical condition in order to justify his role as a registered nurse. However, the respondent failed to provide authorities about his medical conditions and continued to work as a registered nurse. Hiding such circumstances and conditions from the hospital authorities lead towards the worst circumstance of this case. The respondent did not provide the patient with an alternative of fentanyl infusion to keep him safe from adverse health effects. First of all, he should not tamper with the prescribed infusion, but still he alter the infusion, he was supposed to change it any potential alternative that might not damage the patients condition. The respondent did not even bother to note down the medical conditions of patients after refilling their infusion with saline. Due to his negligence in monitoring the condition of patients after altering their solution, the patient had to suffer from adverse side effects.
System-based factors
It is notable to mention that error management is essential for all the medical facilities to manage unsafe acts by medical staff. According to the World Health Organisation, it is the responsibility of the hospitals administration to monitor the acts of their staff in order to enhance their performance. Error management is helpful to limit the incidence of dangerous occurrence by monitoring the behaviour, activities, and attitudes of medical staff and healthcare practitioners (OGrady, 2008). However, in the past few years, researchers are debating the efficiency of tools for managing unsafe acts. The major role of error management is to establish that system that is better to tolerate the occurrence of errors (Throckmorton Etchegaray, 2007). Human is always prone to errors, but machines have the ability to provide appropriate outcomes. In the given case, the unsafe acts of Akhurst were not monitored by the authorities due to the lack of effective systems. There was no monitoring system in the patients ward to check the activities of Akhurst. It is evident that human conditions are difficult to change, but the system and environment can be changed in which humans are working (Johnstone, 2012). It is the failure of hospital management to let a registered nurse tampered with the infusions of patients. The hospital management should need to have CCTV cameras placed in the patients ward as well. By doing so, the management will have the chance to monitor the activities of the patient and medical practitioners along with registered nurses (Russell, 2012). Another system based error in that particular hospital is not checking any medical staff when they left the hospital. The medical staff is well aware of the fact that there is no potential system of checking in the hospital, so they tend to take whatever they need. The Swiss cheese model of system accidents two main factors that are involved in all adverse events (Flook, 2003). One of them is active failures and other is latent conditions. The active failures are unsafe acts that are committed by the registered nurse in this case. The unsafe acts, in this case, include tampering with the medication and infusion of patients and misleading hospital management and administration about the actual information. The latent condition, in this case, is the strategic procedure of the hospitals top management to monitor their medical staff.
Evidence-Based Literature
There is a need for a proper and prior understanding of relevant NSW policies to ensure better outcomes in the end when it comes to the idea of the provision of suitable healthcare services for patients (Fowler, 2008). It is essential for the registered nurses to have the necessary knowledge about all the relevant NSW policies to avoid any complication in future. The domain of evidence-based action is critical to ensure proper prevention from the adverse outcomes that also appeared in the particular case of Health Care Complaints Commission v Akhurst (Gould et al., 2010). The entire background of the considered case indicates that there is a need for offering effective ethical obligations to provide better healthcare services to the patients (Shadbolt, 2002). Different forms of ethical concerns prevail in case of the issue of Akhurst. Ethical concerns are greatly ignored by the registered nurse which eventually appeared as the adverse results in the end (Beaupert et al., 2014).
Exploration and execution of a proper code of ethics are essential to meet the actual standards of healthcare services for all the patients. The role of NSW policies is essential which is considered as the initial guideline for the registered nurses in the country to follow a proper plan of action (Hughes, 2008). Ethical perspective is recognised as the one major focus of the Institute of NSW to apprehend the better form of ethical practices involves in the whole scenario of the provision of healthcare prospects to the patients (Stiggelbout et al., 2012). Professional conduct is one mandatory aspect relevant to the main idea of the role of nurses in the entire process of healthcare services for the patients. The existing evidence and the overall approach of policies established by NSW indicate that it is one of the core duties for the nurses to give only those medicines to the patients which are prescribed by the doctors (Agarwal et al., 2016). This particular concern is reflecting as the main obligation for the registered nurses to attain an effective form of healthcare services for the patients. Detailed understanding of the specific case of Health Care Complaints Commission v Akhurst reveals that medicine was changed by the nurse which is established as the one of the critical ethical concern linked with the approach of the code of ethics.
The entire structure of ethical paradigm in the process of healthcare services demands from nurses to provide authentic information at all different forums. It is mandatory for the nurses to deliver true information in all different spectrums (Buchan et al., 2015). This obligation is also immensely violated by Akhurst when he attempts to fabricate information for his own benefit. It is established as the immense offence to mislead concerned shareholders (Cashin et al., 2015). He provides wrong information to the hospital staff that eventually makes it impossible to draw effective outcomes in the end. Codes of ethics delivered in the form of NSW which are characterised as the guidelines for the registered nurses. Proper development of moral, ethical, and professional attitudes for nurses is essential to meet the standards of healthcare services (Kangasniemi et al., 2013). Registered nurses should adopt their responsible role considering ethical, legal, and professional obligations.
Adoption of established NSW policies is recognised as the solution to avoid the ethical concerns in the healthcare setting (Browne Tarlier, 2008). Registered nurses need to reconsider the current role and align it according to the requirements set by the NSW for the nurses. NSW health policies, local protocols, and the healthcare guidelines established as the fundamental platforms to avoid an unethical form of actions in the healthcare setting (Dixon, 2013). Code of ethics is clearly defined for the nurses to ensure the desired form of healthcare services for the patients (Halcomb, Patterson Davidson, 2006). Professional misconduct must be handled according to the established guidelines set by the healthcare institutes of the country.
Conclusion
By keeping in view the above discussion, it is concluded that registered nurses need to provide quality care by following the policies. In order to improve the quality of care, nurses need to maintain professional boundaries at all time. The progression of nurses practices set to continue as healthcare continues to evolve with the passage of time. Every nurse is accountable for his/her actions, hence he/she need to guard himself/herself against litigations. Nurses must be aware of the legal implications of their practice and should notify every little detail to hospital management and administration.
References
Agarwal, R., Green, R., Agarwal, N., Randhawa, K. (2016). Management practices in Australian healthcare can NSW public hospitals do better Journal of health organization and management, 30(3), 331-353.
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursesbooks.org.
Beaupert, F., Carney, T., Chiarella, M., Satchell, C., Walton, M., Bennett, B., Kelly, P. (2014). Regulating healthcare complaints a literature review. International journal of health care quality assurance, 27(6), 505-518.
Browne, A. J., Tarlier, D. S. (2008). Examining the potential of nurse practitioners from a critical social justice perspective. Nursing Inquiry, 15(2), 83-93.
Buchan, J., Twigg, D., Dussault, G., Duffield, C., Stone, P. W. (2015). Policies to sustain the nursing workforce an international perspective. International nursing review, 62(2), 162-170.
Cashin, A., Buckley, T., Donoghue, J., Heartfield, M., Bryce, J., Cox, D., Dunn, S. V. (2015). Development of the nurse practitioner standards for practice Australia. Policy, Politics, Nursing Practice, 16(1-2), 27-37.
Dixon, K. A. (2013). Unethical conduct by the nurse A critical discourse analysis of Nurses Tribunal inquiries. Nursing ethics, 20(5), 578-588.
Flook, D. M. (2003). The professional nurse and regulation. Journal of PeriAnesthesia Nursing, 18(3), 160-167.
Fowler, M. D. M. (2008). Guide to the code of ethics for nurses Interpretation and application. Nursesbooks. org.
Gould, G., Viney, K., Greenwood, M., Kramer, J., Corben, P. (2010). A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW model of service delivery and summary of preliminary findings. Australian and New Zealand journal of public health, 34(3), 326-329.
Halcomb, E. J., Patterson, E., Davidson, P. M. (2006). Evolution of practice nursing in Australia. Journal of Advanced Nursing, 55(3), 376-388.
Health Care Complaints Commission v Akhurst - NSW Caselaw. (2019).Caselaw.nsw.gov.au. Retrieved 5 April 2019, from HYPERLINK https//www.caselaw.nsw.gov.au/decision/57478fb1e4b05f2c4f04e75c https//www.caselaw.nsw.gov.au/decision/57478fb1e4b05f2c4f04e75c
Hughes, I. (2008). Action research in healthcare. The Sage handbook of action research Participative inquiry and practice, 2.
Johnstone, M. J. (2012). Unethical professional conduct. Australian Nursing Journal ANJ, The, 19(11), 34.
Kangasniemi, M., Vaismoradi, M., Jasper, M., Turunen, H. (2013). Ethical issues in patient safety implications for nursing management. Nursing ethics, 20(8), 904-916.
OGrady, E. T. (2008). Advanced practice registered nurses The impact on patient safety and quality.
Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing Regulation, 3(3), 36-42.
Shadbolt, N. E. (2002). Attitudes to healthcare and self-care among junior medical officers a preliminary report. The Medical Journal of Australia, 177(1), 19.
Stiggelbout, A. M., Van der Weijden, T., De Wit, M. P., Frosch, D., Lgar, F., Montori, V. M., Elwyn, G. (2012). Shared decision making really putting patients at the centre of healthcare. Bmj, 344, e256.
Throckmorton, T., Etchegaray, J. (2007). Factors affecting incident reporting by registered nurses the relationship of perceptions of the environment for reporting errors, knowledge of the nursing practice act, and demographics on intent to report errors. Journal of PeriAnesthesia Nursing, 22(6), 400-412.
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