Unprofessional conduct resulting from inadequate monitoring of patients
In February 2016, the Nursing and Midwifery Board of Australia (Board) received a referral concerning Mr Glenn Scott, a registered nurse, and the suicide on 25 April 2009 of Mr Matthew Spalding, a patient of the Ballarat Health Service.
It was alleged Mr Scott acted in a manner constituting unprofessional conduct because Mr Scott:
- failed to ensure that the patient, Mr Spalding, was adequately monitored; and/or
- signed the observation chart for Mr Spalding, for observations done at 1.30am and 2.00am, when Mr Spalding did not conduct the observations; and/or
- made an incorrect entry on Mr Spalding's observation chart based on a brief conversation with Mr Butler, another registered nurse, that Mr Spalding had been checked at 2.00am.
Mr Spalding was admitted to hospital on 23 April 2009, following a marked deterioration in his mental health the previous day. He was commenced on a treatment plan for visual observations to occur at 30 minute intervals, with a plan to monitor risks and behaviour. Mr Scott was carrying out shift supervision duties on the night of 23 April 2009, and was covering the ward along with two other nurses.
There were three patients in the high dependency area of the hospital, including Mr Spalding. One of these patients had required seclusion, was unsettled and was considered to be a risk to herself. The last visual observation of Mr Spalding occurred at 1.20am, before Mr Scott and Mr Butler were distracted by the other patient, who had to be re-secluded. After attending to the other patient at approximately 2.00am, Mr Butler noticed Mr Spalding's door was closed and asked Mr Scott if everything was 'all quiet down there' to which Mr Scott replied 'yes'. Unknown to Mr Butler, this conversation formed the basis of Mr Scott's entry into Mr Spalding's chart, that visual observations were carried out at 2.00am.
It was not until 2.20am that the third nurse on the ward, Ms Thomas, carried out a visual observation of Mr Spalding and discovered he had hung himself. Attempts to revive Mr Spalding were unsuccessful.
Initially, Mr Scott contended that half hourly checks were not standard procedure upon admission and that Mr Spalding was adequately monitored. It was only later in proceedings that Mr Scott conceded he had failed to ensure Mr Spalding was adequately monitored.
Findings
Mr Scott's conduct was found to fall well below the standards expected of him and registered nurses in the community. The recording and carrying out of accurate and timely patient observations is the cornerstone of patient care.
Mr Scott's registration was already suspended at the time of hearing, pending the outcome of a further tribunal decision. No determination of the tribunal in this matter was to affect this suspension.
The tribunal placed a number of restrictions upon Mr Scott's registration, should he return to practice as a nurse.
Mr Scott's registration is subject to supervision from a supervisor who is to always be physically present in the workplace and available to observe and discuss Mr Scott's management of patients and performance.
Mr Scott is to attend mentoring with another registered nurse in relation to the importance of reflective nursing practice and adhering to the Board's code of professional conduct for nurses, code of ethics for nurses and his professional obligations in respect of standards of nursing care, applicable to the practice of nursing (in particular mental health nursing).
Mr Scott is limited to only working in places approved by the Board and may not be the only registered nurse on duty at any place of practice. Mr Scott is also required to notify APHRA within seven days of commencing practice in a place and provide AHPRA with the contact details of the Director of Nursing at such a place.
Mr Scott was reprimanded.
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