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Nursing care of a patient with motor neurone disease (12HDC00953)
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(12HDC00953, 24 February
Registered nurse ~ Public hospital ~ District health board ~
Nursing agency ~ Motor neurone disease ~ Medication administration
~ Respect ~ Abbreviations ~ Swallowing difficulties ~ Refusal of
services ~ Rights 1(1), 4(1), 4(3) and 7(7)
A woman with motor neurone disease was admitted to hospital
because of a sudden onset of chest pain. She was unable to speak,
and communicated via an iPad. She had difficulty swallowing, which
was documented numerous times in her clinical records and the
handover note. Her clinical records also noted her preference for
intravenous (IV) rather than oral paracetamol.
Overnight, an agency registered nurse (RN) provided care for the
woman. The clinical notes, including a written handover sheet,
noted that the woman had "MND" (ie, motor neurone disease). The RN
did not recognise the abbreviation "MND" and did not take steps to
find out what it meant. However, the RN said that she read the
clinical notes during the shift. The notes clearly stated that the
woman had motor neurone disease.
The woman rang the bell because she needed to go to the toilet.
The RN assisted the woman to the toilet and back to bed. The woman
asked for pain relief, and the RN offered her paracetamol elixir.
The woman wrote on her iPad that she required IV paracetamol and
could not swallow elixir. The RN administered IV paracetamol.
Later the woman again needed to go to the toilet and was
assisted by the RN. The woman requested more pain relief, and the
RN again brought paracetamol elixir. The woman indicated that she
could not take it, but the RN administered some of the elixir into
the woman's mouth. During administration of the elixir, the woman
felt as though she was choking. Later the RN returned with IV
paracetamol, but did not flush the luer and, after administering
the paracetamol, threw the syringe on the woman's bed and walked
It was held that the RN's conduct and manner towards the woman
were unkind and unprofessional. Her behaviour demonstrated a lack
of respect for the woman and, as a result, the RN breached Right
1(1). The RN should have been aware of the woman's diagnosis of
motor neurone disease and familiarised herself with the woman's
needs and preferences in order to provide safe care to her. The
RN's failure to take those steps meant that she failed to provide
services in a manner consistent with the woman's needs and breached
In addition, by failing to flush the woman's luer prior to
administering IV paracetamol the second time, the RN failed to
provide services with appropriate care and skill and, in doing so,
breached Right 4(1). In disregarding the woman's refusal to take
paracetamol elixir, the RN breached Right 7(7) of the Code. She was
referred to the Director of Proceedings. The Director decided not
to issue a proceeding.
It was held that that neither the district health board nor the
nursing agency breached the Code.