Observations are critical in patient safety

 A complaint alleging unsatisfactory professional conduct was made against a Registered Nurse (RN) who it was claimed failed in his obligations during a night shift when he was in charge of an Acute Mental Health Ward at a public hospital. 

During the night shift, one patient sharing a room with another, killed the other patient residing in the room. A  complaint made was about the nurses' observations of the patient's on the night. 

It was alleged that the practitioner:

  •  failed to conduct or ensure the required observations,
  • altered the frequency of observations to less than instructed by the medical practitioner, and
  • falsely entered records of observations, including not completing them in the manner required. 

A  Professional Standards Committee (PSC) held in May 2016, upheld the allegations and their findings determined that the RN did not undertake care level observations demonstrating the knowledge, skills, care and judgements expected of a nurse to his level, training and experience under s139B(1)(a) of the National Law.

A finding of unsatisfactory professional conduct was concluded (and was admitted by the RN), The RN was reprimanded and conditions were placed on his registration, including 12 months of mentoring.
 
Specifically the Committee found;
• Frequency of care level observations were altered from those instructed by the medical practitioner.
• Two observations were logged onto the patient's record and proved false due to the patients time of death being before the recorded observations.
• It was noted that the nurse had become complacent around administrating and documenting observations, a pattern of behaviour which had developed over time. 
• The nurse believed there were practical issues around waking the patients in the night, which may have contributed to the nurses' admission of complacency. He had not previously raised with his supervisor or hospital management.
• The Committee noted the nurse to have a high level of insight into his failing of responsibility and to be deeply affected by the death of the patient.
• He was found to be capable and competent particularly in the field of mental health.

Practice points

• Nurses and Midwives have a duty to complete observations according to the risk and clinical need of the patient.
• Under s139B(1)(e) of the National Law, there is a requirement to document these accurately. 
• If an observation is missed a note should be made of the reasons. 
• Do not sign an observation as having been conducted if it has not occurred. If an observation is delayed, record the correct time at which the assessment was carried out. 
• Observations and their accurate record-keeping are vital to patient safety and it is important not to become complacent around these.
• If you have any concerns around the practical difficulties in implementing required observations, please raise with you manager and discuss it with colleagues to identify strategies for management and improvement. This information may assist identifying when systems or culture may need improvement.