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Wednesday, 30 July 2014

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Nurse accused of letting suicidal woman keep painkillers can carry on working

A nurse accused of allowing a suicidal patient to keep her stash of painkillers can carry on in practice, a tribunal has ruled.

Audrey McKie was responsible for monitoring the vulnerable woman while working as a care coordinator in the community mental health team of Cumbria Partnership NHS Foundation Trust.

The woman, known only as Patient A, was found dead by her son a few days after she had told her psychiatrist she was having suicidal thoughts and storing up her co-codamol.

She had a long history with the mental health services and had been diagnosed with a borderline personality disorder and bi-polar disorder.

Dr David Prosser, a psychiatrist at the Carleton Clinic, Carlisle, recommended her drugs should be dispensed daily and her stash of painkillers removed from her home after the patient told him: “I feel like topping myself.”

He said the medication should have been removed within 24 hours, certainly within 48 hours, but didn’t think the patient was at immediate risk of an overdose.

Ms McKie was responsible for co-ordinating Patient A’s care with the crisis resolution home treatment team and made an urgent referral to them about her medication. But a member of the crisis team had a conversation with the patient, and decided it was safe to leave the painkillers with her.

Panel chair Jane Kivlin said: “Ms McKie was not under a specific personal obligation to remove all stored medication from Patient A’s home as alleged. What is certain is that the crisis team picked up Patient A’s case swiftly, and it received a copy of [Dr Prosser’s] letter dated July 12, 2011, which made clear his expectation that the removal of stored medication would be undertaken by the crisis team.”

Ms McKie was accused of leaving 28 unknown tablets with the patient, but the panel found this was not inappropriate considering her psychologist was not overly concerned about her risk of self-harm.

She admitted a charge of incorrectly telling Patient A’s GP to prescribe the anti-psychotic drug Olanzapine, believing she may have confused the prescriptions of two different patients. But Dr Prosser couldn’t completely rule out the possibility he had discussed Olanzapine, and the panel found the GP could have misheard McKie in their conversation.

She was also accused of not updating care plans, but the panel found it was not her responsibility to do this, but only to make sure it was done and the crisis team had updated these records properly.

Other charges of poor record keeping were also not found proved, as the panel found that the notes were actually quite detailed and precise.

The only charge found proved related to failing to put clinical content in the patient’s written notes on three occasions, but the panel decided this did not amount to misconduct.

Ms Kivlin said: “The panel had regard to Ms McKie’s explanation that, at a time of stress and ill health, and while she was under the pressure of her caseload she had prioritised clinical care over making entries in her paper records.

“Ms McKie had alerted her employer to her difficulties and help was not forthcoming.”

The panel found there was no misconduct and Ms McKie is free to practice without restriction.

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