In a recent and concerning case, a registered nurse practicing as a band 5 community nurse, referred to as Nurse X, faced severe consequences as they were struck off the Nursing and Midwifery Council (NMC) register due to a series of medication administration errors and professional misconduct.
Nurse X faced a a multitude of charges, including documenting that medication had been administered when it hadn’t, failing to complete patient records after visits and attempting to administer medication when they had not been signed off as competent to do so. It was also revealed that Nurse X had taken clinical items for personal use, had demonstrated intimidating and aggressive behaviour towards colleagues and had asked for payments from patients and their families, exhibiting a serious breach of trust. The charges against Nurse X, which we will explore in more detail in this article, shed light on the importance of proper training, accurate record-keeping, and maintaining high standards in the healthcare profession.
Vitamin B12 Medication Administration Errors
One specific charge that Nurse X faced was in relation to a medication administration error of a Vitamin B12 injection. Nurse X had documented in a patients notes that they had administered a Hydroxocobalamin injection into a patient’s abdomen, rather than into their arm. This was discovered when another nurse attended to give a subsequent injection and noted the incorrect administration route, meaning that the B12 injection had been administered subcutaneously rather than intramuscularly.
This error not only breached procedures and was outside of the medication licencing, but it also called into question Nurse X’s training in administering Vitamin B12 injections. The investigation revealed conflicting statements from Nurse X, who insisted that their notes were incorrect however a witness reports that Nurse X admitted the error weeks later. Unfortunately, the patient involved passed away before further investigation could take place, leaving room for uncertainties. The panel in the end determined there was inadequate evidence to prove the charge as there was no direct witness evidence, however Nurse X was found guilty of incorrectly documenting that they had given it via the wrong route.
These charges highlight the need for adequate training in injection administration and emphasise the crucial role of accurate documentation to ensure patient safety and accountability.
The Need for Proper Training and Documentation
The importance of accurate documentation is also highlighted in the charges made about to Nurse X in relation to inaccurately recording the administration date of a loading dose of a Vitamin B12 injection, falsely stating it was given when, in reality, it took place the following day.
According to the National Institute for Health and Care Excellence (NICE) guidelines on Anaemia – B12 and folate deficiency, the administration of loading doses for individuals deficient in Vitamin B12 varies based on neurological involvement. Loading doses are usually given on alternative days for those with neurological involvement and three times a week for those without neurological involvement.
In Nurse X’s case, they documented administering the B12 injection on the 27th February. However, discrepancies arose when a different nurse attended on the 1st March for a follow up injection. The patient’s husband contested that the injection was given on the 28th, contradicting Nurse X’s documentation. Further complicating matters, Nurse X was found to have fabricated reasons for not administering the dose on the right day, claiming difficulty accessing the property which was countered by the patient’s husband report. Nurse X later claimed that this was a mistake, insisting they incorrectly wrote the wrong date. This charge was proven, emphasising the importance of precise documentation and accurate and truthful medical records, especially when dealing with critical medications and patient care plans.
Competency Issues and Lack of Training Evidence
Nurse X also faced charges related to the improper administration of medication via a Peripherally inserted central catheter (PICC) line, including failing to flush the line and inadequate documentation. Additionally, they attempted to administer medication through a patient’s PICC line without being officially recognised as competent by their employer, a charge proven true due to the absence of evidence for completed Intravenous (IV) training.
Despite Nurse X’s claim of prior training at another trust, they couldn’t provide evidence of this or that they had fulfilled the necessary requirements and competencies for their current role. A witness in the case emphasised the importance of specific PICC line care training for community nurses and that training should have been signed off at their new trust as part of their induction. Nurse X admitted to a lack of in-depth PICC line training but asserted completion of a standard IV therapy course and that they had been observed and signed off after shadowing a colleague for their current role. However as no evidence of this was found Nurse X was found guilty of this charge highlighting the need not just for ensuring proper training but also for keeping accurate records of training and competencies.
Medication Administration Errors: Consequences of Improper Training
The panel, considering multiple instances of misconduct, including dishonesty, lack of professionalism with colleagues and breaking patient trust, decided that removing Nurse X from the register was the appropriate sanction. Nurse X’s case serves as a cautionary tale, highlighting the critical importance of accurate documentation and adherence to established procedures to reduce medication administration errors. It also highlights the need for comprehensive and ongoing training, especially when employees are transitioning between healthcare settings. Full details on this case can be found in the report on the NMC website.
Vitamin B12 training
Note: Vitamin B12 injections are ‘Prescription only Medications’ (POMs) in the UK. This requires that a Vitamin B12 injection is prescribed by a registered prescriber. Anyone administering a Vitamin B12 injection should only do so under legal frameworks of delegation, such as a PGD or PSD.
Although a Vitamin B12 injection is not an immunisation, the practical skills required and knowledge base required is in line with that of administering an immunisation. Therefore in order to administer Vitamin B12 injections, the training guidance in the National Minimum Standards and Core Curriculum for Immunisation Training should be adopted for both non-registered professionals and registered professionals. It is also recommended that a period of supervised practice in addition to any training is competed until both the healthcare professional and their employer are satisfied that an individual is competent before they practice alone.
Further details on our training courses can be found in our Vitamin B12 training and our Immunisation Training course pages. You can also click on the image below to find out more about the Mandatory and Compliance Training Courses that we offer.