‘No system’ for ED prescription pads

A “suboptimal” security process for prescription pad management at a regional hospital came to light when a nurse faced a charge of unlawfully possessing one

On 16 January 2020, the Health Care Complaints Commission applied to the Civil and Administrative Tribunal NSW for action against an enrolled nurse, complaining that she had been convicted of an offence.

On 10 January 2019, she faced one charge of unlawfully obtained goods (personal custody).

On that date in the regional town in NSW, the nurse had been pulled over by the police while she was a passenger in a car, in which some of her daughter’s possessions were in the boot.

When police searched the vehicle, they found a prescription book from the regional hospital where the nurse worked – with the first five scripts missing.

The nurse worked at this hospital’s Emergency Department, though she had been on leave from 29 December 2018 and was not due back at work until 19 January 2019.

Two more scripts were found to be partially filled in with the name of the nurse’s daughter.

The nurse admitted that the book belonged to her, that it was the property of the hospital, that she was not entitled to be in possession of it and that she had misappropriated it.

On 17 January 2019, the Hospital told AHPRA that they had been informed by police that the prescription pad had been found – as well as that the car was being driven by the nurse’s partner, who was known to police for drug-related issues.

An investigation found that the prescription pad was missing from the hospital’s ED.

The nurse’s registration was suspended at a 25 February 2019 hearing by the Nursing and Midwifery Council.

In April, she was convicted on one charge of goods suspected stolen in/on premises contrary to the Crimes Act.

She had been ordered to pay a fine of $350.

The Tribunal heard that the nurse denied taking the prescription pad from the hospital, and said that when the police pulled the car over she had “no clue” it was there.

She said that she would take the blame for the pad’s being there, given that if her partner faced any more charges he would go to prison, but said that in hindsight, this was a “poor choice”.

Her daughter, who was using Ice, was involved with “underworld people,” who were threatening her and her parents for money, the nurse said, saying that her daughter was also pregnant at the time, had stopped using and was now doing well.

The nurse said she had also been homeless for three months and was now in community housing; she had not worked since losing her job at the regional hospital.

She said that in April 2019 she had been convicted in her absence because despite being told of the date of her court listing, she had not realised it was actually her date and did not attend. She said it was not proven that she had taken the prescription pad and was paying off the fine.

She also said that there was “no system” in the Emergency Department for keeping prescription pads, which would be left on doctors’ desks, nurses’ stations or in treatment and procedure rooms, and that there was easy access on the main corridor.

The nurse’s daughter had on a number of occasions slept at the ED.

The HCCC said at the hearing that the Tribunal should find that the practitioner, not her daughter or anyone else, took the pad from the hospital, because the former partner had said it was hers, and there was no evidence the daughter had taken it.

The Tribunal found that while it was “satisfied that the practitioner had the opportunity to take a prescription pad, having worked in the Emergency Department for some time including up to two weeks before 10 January 2019, the evidence from the Hospital supports her evidence that security measures were such that any other worker or patient could have had access to the prescription pad”.

The director of nursing and midwifery at the hospital confirmed that the pad had come from its ED.

She gave evidence that “during the investigation it was realised that at that time the security process for prescription pad management in the Hospital was suboptimal”.

“Pads were ordered directly from the printers by the department and held by administration staff for distribution to Medical Officers,” the Tribunal noted.

“There was no structured tracking process for documenting distribution of pads or return of used pads and nor were the pads dispensed sequentially. Hence it was uncertain when or if it was dispensed or when it went missing from the department.

“Due to the nature of the Emergency Department, with several doctors working in varying clinical locations around the department, prescription pads were readily accessible to staff at that time.”

The director said a centralised dispensing process for prescription pads through Pharmacy had since been implemented.

The Tribunal decided that it was unlikely that the nurse’s daughter had taken the pad; however it was also plausible that the nurse had been attempting to cover for her.

It ultimately said it was “not persuaded that it is established that the practitioner misappropriated the prescription pad”.

“The Tribunal agrees with the HCCC that misappropriation of a prescription pad, with the high possibility of misuse, would be a serious breach of the ethical obligations imposed on the practitioner, and not be consistent with the high standards expected by both the public and the profession,” it noted.

“While the Tribunal considers that it is plausible that she did, the Tribunal has not found it established to an appropriate level of satisfaction that the practitioner misappropriated the prescription pad from the Hospital.

“The charge and conviction reflect, however, the fact that the prescription pad was located in a vehicle in which she was travelling with her then partner and in which there were items belonging to her.”

It decided to reprimand the nurse, and order her to pay the HCCC’s costs of $7,000.

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