Transcript LEGISLATION FOR REGISTRATION

Fitness to Practise
An Bord Altranais National Conference
- Thursday, 12th June 2008.
Ursula Byrne,
Acting Deputy Chief Executive Officer,
An Bord Altranais
An Bord Altranais
What is the role of An Bord Altranais?
An Bord Altranais
• The role of An Bord Altranais is
protect the public.
• Implicit in the Nurses Act, 1985.
• Will be explicit in the new Nurses and
Midwives Act.
to
How does An Bord Altranais fulfil
it’s role?
• Proactively: Education Requirements
and Standards, Registration &
Professional Guidance.
• Reactively: The Fitness to Practise
process.
The Fitness to Practise Process
• Complaint → → → Application for Inquiry.
• Source: Directors of Nursing/Midwifery and
other nurse/midwifery managers; Non-nursing
health service managers; patients or members
of their family; medical practitioners.
• Any person or the Board can make an
application for Inquiry.
Grounds for an Application for an
Inquiry
• Alleged professional misconduct and/or
• Alleged unfitness to engage in the
practice of nursing (or midwifery) by
reason of physical or mental disability.
Part V, Nurses Act, 1985.
What is professional misconduct?
• Not defined in legislation.
• Evolving definition in Irish and English case
law.
Key cases:
Doughty v General Dental Council, 1987
Sean Antoine O’Laoire v The Medical Council, 1993
David Noel McCandless v The General Medical Council,
1996
Gloria Perez v An Bord Altranais, 2005.
(www.courts.ie)
Professional Misconduct
• Conduct which is “infamous” or “disgraceful” in a
professional respect is professional misconduct.
• Conduct which would not be “infamous” or “
disgraceful” in any other person , if done by a
nurse/midwife in relation to his/her profession, may be
considered as “infamous” or “disgraceful” in a
professional respect.
• “infamous “ or “disgraceful” conduct is conduct
involving some degree of moral turpitude, fraud or
dishonesty.
Professional Misconduct
• A serious falling short, whether by omission or
commission, of the standards of conduct
expected among nurses or midwives.
• It is irrelevant that such misconduct may be
attributable to honest mistake
(“… there is a duty to protect the public against
the genially incompetent as well as the
deliberate wrongdoers” O’Donovan J. in Perez
v An Bord Altranais).
Standards of Conduct
Determined by:
• Code of Professional Conduct for each
Nurse and Midwife and guidance
documents published by An Bord
Altranais.
• Evidence of a person of standing in the
nursing or midwifery profession.
• National or local policies.
Unfitness to Practice by reason of
physical or mental disability
• Health problems, on their own, rarely lead to a
fitness to practise complaint.
• Health problem may lead an individual to
behave in a way that may constitute
professional misconduct, e.g. attending for
work in an unfit state; misappropriation of
drugs/prescription pads/syringes & needles.
• A refusal to acknowledge a problem and accept
help.
The process
• Application for Inquiry received.
• Additional information sought – if
required.
• Clarify identify of nurse/midwife.
• All documents sent to nurse/midwife for
response.
• Considered by FTP Committee –
?prima facie case for holding an Inquiry
The Inquiry
• Notice of Inquiry and Book of Documents sent to
nurse/midwife.
• Witnesses sent a Subpoena.
• Inquiry convenes. Formal procedure.
• Chief Executive Officer must prove facts beyond
reasonable doubt.
• Evidence heard under oath.
• Closing submissions.
• Committee hears evidence and submissions & prepares
a Report for the Board.
The Board
• Nurse/midwife is sent a copy of the Report and
invited to attend Board meeting.
• Board considers Report and recommended
sanction:
Erasure;
Suspension;
Attachment of Conditions;
Censure; Advise; or Admonish.
• Board decides on sanction and publication.
No. of Complaints/Applications &
Inquiries
• 2002: 27 applications. 4 Inquiries.
• 2007: 66 applications.
22 Inquiries over 8 months. 1-5 days in length.
• 2008 to date:
15 Inquiries. 1-8 days in length.
Professional Misconduct issues
•
Intractable lack of competence: multiple episodes over period of time,
which are unresponsive to education, supervision and support at local
level. Ability to maintain patient safety is key issue.
•
Key issues: Medication management; infection control; documentation;
communication (including English language competence); failure to
monitor a patient’s condition; failure to appropriately seek medical
review; pressure area/wound care and management.
•
Refusal to acknowledge the problem may compound the situation.
•
New problem in someone previously competent - ?health or personal
issues.
Medication Issues - Competence
• Persistent or repeated failure to adhere to acceptable medication
management standards, leading to potential or actual compromise
of patient safety.
• Reality: Medication errors occur.
An Bord Altranais fully supports the reporting and management
of medication errors at local level within a clinical risk
management framework.
• Should not be a fitness to practise issue unless repeated errors by
same practitioner or error of significant magnitude.
Medication Issues – Use/Abuse
• Theft of drugs – for use by self or fiends/family.
• Theft of prescription pads; syringes & needles.
• Forging of prescriptions; Forging of co-workers
signatures; Falsification of patient’s records.
• May lead to patient not getting medication when it is
recorded that they have received it.
• Attending for duty in an unfit state.
• Taking drugs whilst on duty.
• Often undetected for a long time. Importance of stockcontrol procedures and audit.
Drugs abused
• MDA Schedule 2: Morphine, Cyclomorph &
Pethidine.
• Codeine preparations, including Neurofen Plus
& Solpadeine.
• Sedatives/Anaesthetic agents: Hypnovel
(Midazolam)& Propofol.
• Benzodiazepines.
• Other Hypnotics.
Drugs taken for use by self or
friends/family.
• Not prescribed by a medical practitioner –
antibiotics; analgesia; anti-inflammatories;
hypnotics; night sedation.
• Drugs legitimately prescribed by medical
practitioner but not obtained in pharmacy –
taken from ward stock.
• Over-the-counter drugs taken from ward stock.
Behavioural issues - patients.
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Use of foul or obscene language.
Inappropriate use of restraint.
Assault – physical/sexual.
Rudeness.
Lack of respect.
Hostility.
Lewd behaviour.
Sexual relationship – even if consensual.
Behavioural issues
• Falsification of educational qualifications;
employment experience or references.
• Sleeping on duty.
• Inappropriate use of the Internet whilst on
duty.
• Assault of a co-worker: physical or sexual.
• Failure to adequately supervise carers, students
or junior colleagues.
• Lying by commission or omission – to cover up
an error.
Nurses and Midwives Act?
• Inquiry Committee – majority nonnurse/midwife and includes non-Board
members drawn from a panel?
• Mediation?
• Health Committee?
• Inquiries in public?
Fitness to Practise
• A necessary, but reactive process.
• The importance of the proactive role of An
Bord Altranais, employers, nurse/midwifery
managers and individual nurses/midwives.
Are the public at risk?