Conduct and Competence Committee Substantive Hearing. 30 November December Nursing and Midwifery Council:

Transcription

1 Conduct and Competence Committee Substantive Hearing 30 November December 2015 Nursing and Midwifery Council 2 Stratford Place, London E20 1EJ Name of Registrant Nurse: NMC PIN: Ms Loretta Mary Humphreys 72Y1163E Part(s) of the register: Registered Nurse Sub Part 1 Midwifery November 1978 Adult Nursing August 1985 Lecturer Practice Educator June 1986 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Merseyside Misconduct Ms Naseem Malik (Chair & Lay member) Ms Stella Armstrong (Registrant member) Dr Judy Allfrey (Lay member) Mr Oliver Wise Mr Ian Dennehey Representation: Nursing and Midwifery Council: Registrant: Represented by Ms Louise Hartley, Counsel, instructed by NMC Regulatory Legal Team. Ms Humphreys was present and was represented by Mr Thomas Buxton, Counsel, instructed by the Royal College of Nursing. Facts Proved by Way of Admission: All (as amended) Impairment: Sanction: Currently Impaired by reason of misconduct Conditions of Practice Order: 9 Months Interim Order: Interim Conditions of Practice Order: 18 Months

2 Detail of Charges That you, whilst employed as a Registered Nurse at the Walton Centre NHS Trust: 1. On 21 January 2014 you failed to correctly prepare and or administer an IV infusion of Caffeine for Patient A in that you: Admitted and Found Proved 1.1. Failed to endure that a second person checked the drugs before administering the IV infusion. Admitted and Found Proved 1.2. Administered saline which had not been prescribed. Admitted and Found Proved 1.3. Failed to stop the IV infusion once you had realised that you had mixed the wrong amount. Admitted and Found Proved 2. On 21 January 2014 failed to obtain a prescription for saline before administering it to Patient A; 2. On 21 January 2014 you failed to correctly adhere to the Walton Centre Caffeine Protocol in that you incorrectly mixed the IV Caffeine in the wrong amount of diluent by using 500mls of saline instead of 1000mls. Admitted and Found Proved 3. On 25 June 2013 you administered an incorrect drug Lignocaine via an intravenous infusion to Patient B instead of the Hepsal flush which was prescribed. Admitted and Found Proved 4. On 25 June 2013 you failed to ensure that a second person checked the drug before administering it to Patient B. Admitted and Found Proved And in light of the above your fitness to practise is impaired by reason of your lack of misconduct. Found Proved Determination on Amending the Allegation: Ms Hartley informed the panel that it was accepted between the parties that existing Charge 2 in effect duplicated Charge 1.2. On that basis she sought to amend the allegation by striking out existing Charge 2. Mr Buxton confirmed that he supported Ms Hartley s application.

3 The panel accepted the advice of the Legal Assessor that there appeared to be duplication between the charges in question. Rule 28 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended, ( the Rules ) states: At any stage before making its findings of fact the Conduct and Competence Committee may amend a. the charge set out in the notice of hearing; or b. the facts set out in the charge, on which the allegation is based, unless, having regard to the merits of the case and the fairness of the proceedings, the required amendments cannot be made without injustice. The panel determined to grant the application and directed that the remaining Charges be renumbered appropriately. Determination on application to consider evidence in private under Rule 19; As a consequence of Ms Humphreys providing contextual information about her health during her evidence in chief, Ms Hartley applied for permission to conduct part of her cross examination in private under the provisions of Rule 19. Mr Buxton supported the application. The sections of Rule 19 relevant for the purpose of the application state: (1) Subject to paragraphs (2) and (3) below, hearings shall be conducted in public. (2)... (3) Hearings other than those referred to in paragraph (2) above may be held, wholly or partly, in private if the Committee is satisfied- (a) (b) having given the parties, and any third party from whom the Committee considers it appropriate to hear, an opportunity to make representations; and having obtained the advice of the legal assessor,

4 that this is justified (and outweighs any prejudice) by the interests of any party or of any third party (including a complainant, witness or patient) or by the public interest. The panel determined that there was no public or third party interest in evidence of Ms Humphreys health being heard in public and also that she was entitled to privacy and confidentiality in relation to such matters. Both parties agree that this information should be heard in private. Having accepted the advice of the Legal Assessor, the panel granted the application for the above reasons. Determination on Misconduct and Impairment: This case has been considered in accordance with the provisions of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended. The facts of this case arise from Ms Humphreys work as a registered nurse at the Walton Centre NHS Trust on two dates, namely: 25 June 2013 and 21 January Ms Humphreys was employed within the Walton Centre from July At the time of the incident in 2014, she had been acting as a Band 6 Sister on Jefferson Ward since August 2013 in the absence of the Ward Manager. At the time of the 21 January 2014 incident, Ms Humphreys was subject to a formal warning by her employer issued on 2 August 2013 in relation to a drug error in June At the start of this hearing, Ms Humphreys admitted all of the facts, as amended, and the panel recorded that the facts were found proved by way of that admission. All of the facts being admitted, the panel moved to the misconduct and impairment stage of the proceedings. In considering those matters the panel took account of all of the oral and documentary evidence. The panel received live evidence from the following: Ms 1, currently employed as Matron for the Intensive Care Unit at Walton Centre NHS Trust, who conducted an investigation into the events of 21 January 2014.

5 Ms 2, currently employed as a Staff Nurse by the Walton Centre NHS Trust. Ms Humphreys. The panel also had regard to the content of a witness statement dated 23 February 2015 from Ms 3, employed as a Ward Matron at Walton Centre NHS Trust, who conducted an investigation into the events of 25 June The panel took account of the submissions made by Ms Hartley on behalf of the NMC together with the submissions made by Mr Buxton on behalf of Ms Humphreys. Ms Hartley submitted the facts amount to misconduct. She invited the panel to determine that Ms Humphreys fitness to practise is currently impaired. She submitted that Ms Humphreys had put patients at risk of unwarranted harm, brought the profession into disrepute and may have breached a fundamental tenet of the profession. Ms Hartley reminded the panel that Ms Humphreys made the medication error on 21 January 2014, despite having made a broadly similar medication error in June 2013 after which she had given an assurance that she had learnt from her mistake. Mr Buxton conceded that Ms Humphreys fitness to practise is currently impaired. The panel accepted the advice of the Legal Assessor. Misconduct and current impairment are matters for the exercise of its independent judgment and there is no standard or burden of proof to be applied. The panel had regard to the legal authorities to which it was referred, namely: Roylance v General Medical Council No 2 [2000] 1 AC 311; and, Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin). Applying a two stage process, the panel first determined whether or not the facts found proved amounted to misconduct. In the case of Roylance Lord Clyde said that: Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of

6 propriety may often be found by reference to the rules and standards ordinarily required by a [nursing] practitioner in the particular circumstances... The panel therefore took account of the NMC document, The code Standards of conduct, performance and ethics of nurses and midwives (2008 edition) [ the Code ], The panel found the extracts from the Code cited below to be applicable to this case: The people in your care must be able to trust you with their health and wellbeing. To justify that trust, you must: 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. Failure to comply with this code may bring your fitness to practise into question and endanger your registration. [the preamble to the Code] You must deliver care based on the best available evidence or best practice. [paragraph 35 of the Code] You must recognise and work within the limits of your competence. [paragraph 39 of the Code] The panel had in mind that not every instance of falling short of that which would reasonably be expected in the circumstances, nor a breach of professional standards, will, in themselves, necessarily constitute misconduct sufficiently serious that it can properly be described as misconduct going to a nurse s fitness to practise. Rule 31 (7) makes this clear, stating: Where the Conduct and Competence Committee finds that a registrant has failed to comply with the standards established by the Council under article 21 (1) (a) of the Order and set out in the Code such failure (a) (b) may be taken into account by the Committee in determining whether or not that registrant s fitness to practise is impaired; and shall not, of itself, be taken to establish that the registrant s fitness to practise is impaired.

7 It follows from the above that there must be a serious departure from those standards expected of a registrant involving conduct that can properly be described as misconduct going to fitness to practise. On 25 June 2013 Patient B attended for on-going long term intra-venous (IV) antibiotic therapy. The panel understands that the IV antibiotics were administered without incident. Following administration a Hepsal flush should have been administered. However, Ms Humphreys administered Lignocaine by mistake to Patient B via an intravenous infusion, instead of the Hepsal flush which had been prescribed. She also failed to ensure that a second person checked the medication before she administered it. The second check process is used to prevent such errors occurring. Ms Humphreys recognised quickly that she made a mistake, slowed the infusion and alerted a doctor. The evidence before the panel is that Patient B experienced some of the recognised side effects of IV Lignocaine, namely palpitations and tingling of the lips. She was said to be extremely anxious. Patient B reportedly also experienced an acute tachycardia and was admitted for monitoring and observations. An Electrocardiogram (ECG) identified an abnormality (Left sided bundle branch block) but a Cardiologist advised this was unlikely to be related to the small dose of lignocaine that had been administered. An Echocardiograph was performed on 16 June 2013, Patient B was reviewed by a Cardiologist on 27 June 2013 and, following blood tests, was discharged home with a follow up appointment in 2 months time. During a local investigatory interview on 18 July 2013, Ms Humphrey gave her account of what had occurred. She accepted that she was aware of the need for two people to check the administration of the medication. She also accepted that she had made a conscious decision to administer it on her own. She said: Yes, I don t know why I did it. I ve been doing this for years and always get someone to check. Ms Humphreys stated that she had not thought to get a colleague to return from their break as they had: not been gone long and said: I really don t know what made me do it on my own, it s not like me. Ms Humphreys was asked if she had learnt from this incident and said: Oh Yes, definitely. A Patient can sit for 6 hours if they need to I will not be giving medication on my own...i am so gutted about all of this...i knew I shouldn t have given it

8 on my own and I will take the punishment. There was a history of heart disease in [Patient B s] family and her having the ECG found something. They said what I did didn t cause it. I m so glad I didn t harm her. Following a local disciplinary hearing, Ms Humphreys received a written warning for a period of 1 year with effect from 2 August 2013 and was required to undertake further training and assessment in respect of IV drugs. The panel heard that she completed the training and passed the assessment. However, on 21 January 2014, Ms Humphreys made a further error regarding the administration of IV medication. Patient A was a young man who was prescribed IV caffeine. This drug was used on the ward by the Consultant, off-licence, as a treatment for headaches, and ought to have been administered according to the provisions of the Walton Centre s PROTOCOL FOR USE OF INTRAVENOUS CAFFEINE in effect at that date. That document indicates that IV caffeine should be administered as follows: 500mg caffeine in 1 litre of sodium chloride 0.9% given over 1-2 hours. In fact, Ms Humphreys administered IV caffeine to Patient A in 500mls saline and not 1000mls. Ms Humphreys told the panel that 21 January 2014 was the final day of three consecutive days when Patient A was to receive IV caffeine. It had been administered without any adverse effects on the two preceding days. During the investigatory interview on 12 March 2014, Ms Humphreys stated that she was both Acting Ward Sister and Ward Co-ordinator on 21 January Patient A had been admitted early that morning and had been cannulated in preparation for the IV infusion. Ms Humphreys said the ward was quite busy. She said she had used 1 litre of saline in which to dilute the IV caffeine on the first day of Patient A s treatment. Ms Humphreys then described the process by which the infusion had been prepared on 21 January A copy of the IV caffeine protocol had not been with Patient A s case notes, although one had been there on the first day of his treatment. She said she checked the prescription, believed that Ms 2 had also checked it and that they were then both called away. On returning, Ms Humphreys drew up the IV caffeine with 500ml

9 of saline, disposed of the ampoules which had contained the caffeine in a sharps bin and asked Ms 2 to sign Patient A s records to indicate she had checked the medication. Ms Humphreys recalled that Ms 2 refused, saying: No, I haven t checked it. Despite this, Ms Humphreys started the infusion because the man was waiting. Shortly afterwards she obtained a copy of the protocol, realised the error and slowed the infusion right down. She asked the ward doctor to check another bag of 500ml saline in the belief that this would dilute [the IV caffeine] and flush though. She also noticed that no saline had been prescribed that day at all and so she asked the ward doctor to write it up. Ms Humphreys also said during the investigatory interview that she had told Ms 2: I m going to get in trouble for this and stated: I had to make a quick decision, hopefully for the right reasons...yes, I should have never put it up and should have discarded it, but we didn t keep it [the caffeine] in stock and it would have had to be rewritten up and ordered and god knows how long that would have taken...i know I will probably be dismissed and I never meant my patient any harm. I was working beyond my scope; I wasn t qualified to do it...i know I ve done wrong. In her oral evidence to the panel and in her written reflection Ms Humphreys referred to Patient A having waited for approximately two hours for treatment to commence. She said that Patient A s partner had just given birth, that the babies were in Intensive Care and that he was becoming agitated as time passed. Ms Humphreys and Ms 2 had checked the caffeine in the treatment room but then both had been called away. Ms Humphreys had been delayed longer than she had anticipated and, on returning to the treatment room, added the caffeine to 500mls of saline in the belief that the caffeine had been checked and that the saline used was the correct amount. Ms Humphreys told the panel that she thought 500mls saline to be the amount in which the caffeine should be diluted as this was the quantity she believed had been used in the past. She accepted that she should not have relied upon her memory and that she ought to have ensured that a copy of the protocol was in place; the correct solution of caffeine in saline was used; and that she should have waited until a second trained nurse was available to check the caffeine being drawn up and added to the saline. Ms Humphreys also told the panel that, in the circumstances, she should have discarded the solution and started afresh but did not do so because of her concern that

10 Patient A would be subjected to a further lengthy wait whilst the medication was reordered from the off-site pharmacy. She accepted that she took the decision to commence treatment on her own initiative and realises that this was a mistake. In the panel s judgment, the facts of this case demonstrate that Ms Humphreys acts and omissions detailed in the charges represent serious departures from the standards of conduct to be expected of a Registered Nurse, as set out in the elements of the Code cited above. The panel determined for those reasons that Ms Humphreys actions amount to misconduct. The panel then went on to consider whether Ms Humphreys fitness to practise is currently impaired by reason of her misconduct. In considering the issue of impairment, the panel had regard to all the relevant information available to it. Neither the Nursing and Midwifery Order nor the Rules define what is meant by impairment of fitness to practise. The Nursing and Midwifery Council has defined fitness to practise as a registrant s suitability to remain on the Register without restriction. In deciding this matter, the panel has exercised its independent judgment. The purpose of these proceedings is not to punish the practitioner for past failings but to protect the public against the acts and omissions of those who are not fit to practise and to maintain public confidence in the profession and the regulatory process. The panel thus looks forward not back. However, in order to form a view as to Ms Humphreys suitability to practise without restriction today, the panel takes account of the way in which she has acted or failed to act in the past. Applying those elements of Dame Janet Smith s test from her Fifth Shipman report, cited with approval by Mrs Justice Cox in the case of Grant v NMC cited above, relevant to this case, the panel considered whether Ms Humphreys misconduct indicates that her fitness to practise is currently impaired in the sense that she: has in the past and/or is liable in the future to put patients at unwarranted risk of harm; and/or, has in the past brought and/or is liable to bring the [nursing] profession into disrepute; and/or,

11 has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the [nursing] profession. In a letter about the incident on 25 June 2013, Patient A recorded her sympathy for Ms Humphreys, acknowledged her previous professionalism and made clear that she would not have any concern about being treated by Ms Humphreys in future. Notwithstanding this, in the panel s judgment Patients A and B were both put at risk of unwarranted harm by Ms Humphreys acts and omissions and Patient B was caused distress and an avoidable admission to hospital for monitoring and investigations. The panel is satisfied that Ms Humphreys misconduct involves a breach of a fundamental tenet of the profession. Registered nurses are expected to deliver a high standard of practice and care and not to put those in their care at risk of unwarranted harm. It follows that Ms Humphreys misconduct will have undermined public confidence in the profession, thereby bringing it into disrepute. The panel next considered whether Ms Humphreys is liable to repeat misconduct of the kind found proved. In assessing the risk of repetition the panel had regard to evidence of Ms Humphreys insight and remediation. Ms Humphreys admission to all the charges and her acceptance that her fitness to practise is impaired demonstrate insight and that is to her credit. However, the panel found she struggled to explain why it should be reassured that she had learnt from her mistakes, given that she had made a similar assertion following the incident in June 2013 yet had then gone on, just a few months later, to make a comparable error in January In the panel s judgment, Ms Humphreys misconduct occurred not because she did not know what to do, but because, on both occasions, she followed a different course of action to that laid down, albeit under some pressure. In the case of Patient B, who was about to be discharged, Ms Humphreys confused one drug with another. She was under pressure and, at the time, had been left without assistance. Instead of waiting until her colleague returned from a break, thereby allowing for the preparation and administration of the prescribed medication to be checked as was required, Ms Humphreys proceeded on her own. In the case of Patient A, despite the earlier incident, the local investigation, the written warning she had been given, the training she had undertaken, and her

12 previous assurance that patients could wait and she would not give medication on her own, Mrs Humphreys again allowed her sympathy for a patient who had been waiting to commence treatment to outweigh the need to ensure his safety by following established procedures for checking medication. In the panel s judgment, the misconduct in this case is capable of being remedied. Ms Humphreys is currently working as a Healthcare Assistant, via an agency, at Aintree Hospital Trusts, mostly on medical wards. Although she is working in a healthcare setting, she has not been able to remedy her errors by demonstrating that she will always follow procedure under pressure, while practising as a registered nurse. As a consequence, the panel considers that Ms Humphreys remains at risk of repeating her misconduct. Having reached this conclusion the panel also had regard to paragraph 74 of Mrs Justice Cox s ruling in the case of Grant v NMC as follows: In determining whether a practitioner s fitness to practise is impaired... the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances. The panel determined that Ms Humphreys fitness to practise is currently impaired by reason of her misconduct because of the risk of repetition and because such a finding is necessary in the public interest, in order to declare and uphold proper standards of professional conduct. Determination on Sanction: This determination should be read in conjunction with the panel s previous determinations. Having found that Ms Humphreys fitness to practise is currently impaired by reason of her misconduct, the panel has now considered what sanction, if any, should be imposed in respect of her registration.

13 The panel had regard to all of the information available to it relevant to this stage of the hearing. It took account of the submissions made by Ms Hartley, together with those made by Mr Buxton. Ms Hartley invited the panel to have regard to the NMC s Indicative Sanctions Guidance (ISG) document. She reminded the panel of the need to protect patients and the wider public interest, which included the maintenance of public confidence in the profession. Although Ms Hartley made no submission as to what particular sanction was appropriate, she drew the panel s attention to what she contended were relevant aggravating and mitigating factors. She confirmed that Ms Humphreys had no other adverse regulatory history. Mr Buxton invited the panel to conclude the case by imposing a conditions of practice order. He submitted that Ms Humphreys had a long and otherwise exemplary career as a caring and dedicated nurse. Ms Humphreys had allowed her sympathy for two patients to blind her to the protocols to which she should have adhered. These regulatory proceedings had been a salutary lesson for her and she fully recognised the importance of following policies, practices and protocols. Mr Buxton invited the panel to accept that Ms Humphreys contrition was genuine. He invited the panel to allow her an opportunity to demonstrate, under supervision, that she could practise safely. He proposed conditions of practice which would require her to be directly supervised when preparing and administering intravenous medication. Mr Buxton submitted that a suspension order or a striking-off order would be disproportionate. The panel accepted the advice of the Legal Assessor. The decision as to what sanction, if any, to be imposed is a matter for the panel s independent judgment. It applied the principle of proportionality, weighing the interests of the public with those of Ms Humphreys. The panel considered all of the sanctions available. The panel must impose the least restrictive sanction necessary to maintain public confidence in the profession and the NMC as its regulator, taking full account of the principle of proportionality. It is aware that the purpose of imposing a sanction is not to be punitive, although it may have a punitive effect.

14 The panel had regard to the aggravating and mitigating features of the case which it identified as relevant, as follows: a. aggravating features: Both of the IV medication errors were serious. The incident involving Patient A on 21 January 2014 occurred despite the previous incident involving Patient B on 25 June 2013 and notwithstanding Ms Humphreys being trained and assessed in IV medication administration. Patient B was caused short term harm. Both Patient A and Patient B were placed at risk of serious harm. b. mitigating features: Ms Humphreys engaged with the NMC proceedings, attended the hearing and gave evidence on oath. Ms Humphreys made full and early admissions. Ms Humphreys has reflected on her misconduct and apologised for it. She has demonstrated substantial insight and has given a commitment as to her future behaviour. There has been no subsequent repetition of the misconduct. Ms Humphreys has a long and hitherto unblemished career. Apart from the matters complained of in this case, no evidence of adverse regulatory or disciplinary proceedings has been put before the panel. Ms Humphreys personal circumstances, including her health, at the time of the incidents. The particular nature of the ward and staffing issues at the time of the incidents. The panel first considered and rejected taking no action. In coming to this view, the panel had in mind that Ms Humphreys has not been able to demonstrate that she has remedied her misconduct. There remains a risk of repetition which requires that her registration be restricted at this time. Patients in her care would be at risk of harm if Ms Humphreys allowed her sympathy for them, and their need to be treated in a timely manner, to override the importance of following the procedures designed to ensure the safe administration of IV medication.

15 The panel then considered imposing a Caution Order. Such an Order is the least restrictive sanction. It does not restrict a registrant s ability to practise but is recorded on the NMC Register and is published on the NMC s website. It can be imposed for any period between one and five years and, if imposed, would be disclosed to anyone enquiring about Ms Humphreys fitness to practise history. The panel rejected such an order because it would offer no protection for the public and would not satisfy the wider public interest. The panel next considered a Conditions of Practice Order. The ISG identifies factors which might suggest that a Conditions of Practice Order may be appropriate. The panel determined that the following apply to this case: there is no evidence of harmful deep-seated personality or attitudinal problems; there are identifiable areas of Ms Humphreys practice in need of assessment and/or retraining; there is no evidence of general incompetence; Ms Humphreys has potential and willingness to respond positively to retraining; conditions of practice that are workable, reasonable, proportionate, measurable and enforceable can be devised that will protect patients during the period that they are in force; provision can be made as to how the conditions might be monitored. Furthermore, in the panel s judgment, there is significant evidence to attest to Ms Humphreys exceptional qualities as an experienced, dedicated and caring nurse who is well respected by former professional colleagues and former patients and their relatives. The references also attended to her excellence in mentoring student nurses. The panel nevertheless considered whether a Suspension Order was necessary and proportionate. The ISG makes clear that a key consideration is whether the seriousness of the case requires temporary removal from the Register. In the panel s judgment, although the misconduct occurred on two occasions and was serious, the limited risk of repetition and the risk to patients and the wider public interest, which is restricted to a discrete aspect of Ms Humphreys practice, can be addressed without temporary removal from the Register. A sanction which prevented her from practising at this time

16 would be disproportionate and punitive and would not be in the public interest as it would remove and otherwise good nurse from practice. The appropriate sanction in this case is a conditions of practice order in the following terms: 1. You must notify the NMC within 14 days of any nursing or midwifery appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 2. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them. 3. You must within 14 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. 4. You must within 14 days of entering into any arrangements required by these conditions of practice provide the NMC with the name and contact details of the individual/organisation with whom you have entered into the arrangement. 5.a. 5.b. 5.c. Until such time as you are assessed by a registered nurse of not less than two years experience as competent to do so, you must not undertake the preparation and/or administration of intravenous (IV) medication, unless you are under the direct supervision of a registered nurse of not less than two years experience. You must keep a personal development log recording every time you have undertaken the preparation and/or administration of intravenous medication. Until you have been assessed as competent pursuant to 5a, the log must be signed by the person who supervises you, and contain that person s comments on how you carried out the procedure(s). You must provide a copy of this personal development log, or confirmation that you have not carried out the preparation and/or administration of intravenous medication to the NMC not less than 14 days before any NMC review hearing or meeting. 6. You must work with your line manager, mentor or supervisor (or their nominated deputy) to formulate a Personal Development Plan specifically designed to address the deficiencies in the following areas of your practice:

17 a. dealing with stress in the work place and, in particular, clinical decision making under pressure; b. compliance with clinical policies, protocols and working practices designed to ensure patient safety. 7. You must meet with your line manager, mentor or supervisor (or their nominated deputy) at least monthly to discuss the standard of your performance and your progress towards achieving the aims set out in your personal development plan. 8. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance and your progress towards achieving the aims set out in your Personal Development Plan to the NMC not less than 14 days before any NMC review hearing or meeting. 9. You must allow the NMC to exchange, as necessary, information about the standard of your performance and your progress towards achieving the aims set out in your personal development plan with your line manager, mentor or supervisor (or their nominated deputy) and any other person who is or will be involved in your retraining and supervision with any employer, prospective employer, and at any educational establishment. 10. You must immediately inform the following parties that that you are subject to a conditions of practice order under the NMC's fitness to practise procedures, and disclose the conditions listed at (1) to (9) above, to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing or midwifery work. b. Any agency you are registered with or apply to be registered with (at the time of application). c. Any prospective employer (at the time of application). d. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply. The panel directs that this Conditions of Practice order be imposed for a period of nine months. This should allow Ms Humphreys an opportunity to obtain employment as a registered nurse and to undertake the steps required to remedy her misconduct and to demonstrate to a future panel that she has worked safely without further concerns

18 regarding her fitness to practise for a significant period. The duration also reflects the gravity of the facts found proved. A review hearing will take place before shortly before the end of the period of the Order. It is open to Ms Humphreys or the NMC to seek an early review of this order if circumstances suggest that to do so would be appropriate. The panel has borne in mind that its sanction will restrict Ms Humphreys ability to practise her chosen profession and, as a consequence, she may be caused financial and professional hardship. However, the panel determined that the need to protect patients and maintain public confidence in the profession outweighed Ms Humphreys own interests. Right of Appeal: Ms Humphreys will have 28 days from the date when written notice of the result of this hearing is deemed to have been served upon her in which to exercise her right of appeal. A note explaining that right of appeal will be supplied to her. Unless she exercises her right of appeal, the direction imposing the conditions of practice order on her registration will take effect 28 days from when written notice of the decision is served upon her. Determination on Interim Order: Ms Hartley invited the panel to impose an interim conditions of practice order in the same terms as the substantive order for a period of 18 months. Mr Buxton did not oppose the application. The panel accepted the Legal Assessor s advice. The panel determined to make an Interim Conditions of Practice Order in the same terms as the substantive Conditions of Practice Order. The panel is satisfied that such

19 an Order is necessary for the protection of the public. Not to make such an Interim Order would be inconsistent with the panel s previous determinations in this case. The period of the order is 18 months. In coming to the conclusion that 18 months is the appropriate duration, the panel had regard to the time which may elapse before any appeal which is lodged is determined. The panel is satisfied that Ms Humphreys suffers no prejudice by the imposition of an Interim Conditions of Practice Order for the maximum period. If there is no appeal, this Interim Order will lapse at the end of the 28 day appeal period, when the panel s substantive Conditions of Practice Order will take effect. In the event that an appeal is lodged but concluded before the expiration of 18 months, this Interim Order will lapse at the conclusion of the appeal. If an appeal is lodged but not concluded within the period of 18 months, it will be necessary for the NMC to apply to the High Court for an extension of this Interim Order. In the meantime, Ms Humphreys entry in the NMC register will show that she is subject to an Interim Conditions of Practice Order. Anyone who enquires about her registration will be told about the Order. The panel s decisions will be confirmed in writing. That concludes this hearing.