A nurse has denied claims she administered “heavy-hitting” sedatives to children without them being prescribed. Ms H, who has interim name suppression, appeared before the Health Practitioners Disciplinary Tribunal facing a professional misconduct charge. On Tuesday, the panel heard Ms H reportedly administered sedatives she was either not allowed to give without supervision, or which were not prescribed, to two patients while working as an intern clinical nurse specialist at an Auckland hospital emergency department in 2017. While Ms H accepted she failed to document the names of doctors who gave verbal prescribing orders for the medicines, or those who supervised, she denied administering them without prescriptions or supervision. The Professional Conduct Committee (PCC) alleged Ms H gave a patient propofol, fentanyl and ketamine when they were not prescribed or documented in his chart. Propofol has strict guidelines for use, and Ms H was not qualified to give it without supervision. She also allegedly gave ketamine and propofol to a second child with a fracture, when neither drugs were prescribed or documented. On Wednesday, Ms H denied the PCC’s submission that she compromised patient safety. Giving procedural sedation was a “very large part” of her role in the emergency department, she told the tribunal. As an intern, Ms H managed her own patients under the supervision of a senior medical officer (SMO). She would discuss each patient with a supervising doctor, who would then decide whether they wanted to see the child directly. If they were happy with her assessment and plan, the SMO would give Ms H verbal orders to continue with the discussed treatment, she told the tribunal. She said this was done with both patients in this case, who were given medicines under verbal orders. No concerns were raised at the time about the medicines used in either case, she told the tribunal. Ms H said she had administered propofol or fentanyl many times during resuscitation situations directed by an SMO, as was “usual practice” for any ED or ICU nurse. Ms H told the tribunal her orientation to the DHB and the CNS intern role was “poor”, and maintains she was never told clinical nurse specialists could not give propofol. Ms H said she “mistakenly” believed she was able to administer propofol and fentanyl having attended procedural sedation courses, but always did so with supervision. “If I was told to never give propofol, I would have never given propofol,” she said. On reflection, Ms H said she was “really concerned” she could have made this “mistake”. Asked by her lawyer what she would do if a doctor told her to administer the medicines today under verbal order, Ms H said: “Absolutely not, I wouldn’t go there.” A five-person panel, led by barrister Alison Douglass, will decide on Thursday whether the allegation against her are established.
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