A senior nurse has appeared before a fitness-to-practise inquiry over her failure to properly assess a resident of a care home who had fallen in a bathroom which meant he went six days untreated with a broken hip.
The inquiry heard that the nurse, Patricia Lloyd, had also not informed the resident’s family, his GP and his occupational therapist as well as her own managers about the incident in which he fell while going to the toilet.
Ms Lloyd, a registered intellectual disability nurse, made admissions in relation to six allegations over her conduct while working as a clinical nurse manager at Galtee View House in Ballylanders, Co Limerick five years ago.
The centre, which is operated by St Joseph’s Foundation, is a 10-bed residential care unit for people with intellectual disabilities.
The inquiry by the Nursing and Midwifery Board of Ireland heard that Ms Lloyd had failed to carry out a full assessment of a resident who had fallen while going to the toilet on New Year’s Day in 2018.
The NMBI’s fitness to practise committee was informed that the resident was a man in his 50s with Down syndrome who also suffered from dementia and severe intellectual disabilities.
It heard that the resident suffered a fall while in the bathroom while he was being attended by a care assistant.
Counsel for the NMBI, Eoghan O’Sullivan BL, said other staff including Ms Lloyd, who was the nurse in charge, were alerted to the incident.
He claimed the nurse had closed an incident report on what happened on the same day which had the consequence of the incident not being escalated.
“Effectively there was very little done or recorded after the fall,” said Mr O’Sullivan.
He said some other nurses were made aware at the end of Ms Lloyd’s shift that day about what had happened but had not been given the expected level of detail in nursing notes.
The inquiry heard that although the resident had shown no obvious signs of an injury, he had spent the next six days in a wheelchair.
Mr O’Sullivan said the resident was not able to vocalise his feelings or if he was in any pain.
However, he said there was a noticeable change in the man the following day when he became more agitated and vocal and was “not himself.”
Mr O’Sullivan said concern about the resident’s condition was raised on January 6, 2018 by a care assistant with another nurse which resulted in him being brought to hospital by ambulance where a suspected broken hip was confirmed.
Although there was no official falls policy in place at Galtee View House at the time, Mr O’Sullivan said Ms Lloyd had still not conducted appropriate observations of the resident after his fall.
He said this had resulted in the delay of six days in diagnosing the fracture of his hip which had caused him “distress, discomfort and pain.”
In a statement, the care assistant who was with the man at the time of his fall said he was “crying and screaming” about one hour after the incident.
The barrister said the nurse should have made everyone aware of the fall so that the resident could have been monitored.
He said the man’s family doctor who visited him on January 3, 2018 was not told about the fall.
Mr O’Sullivan said Ms Lloyd has mistakenly attributed the man’s decreased mobility and his increased distress to his dementia and low sodium levels.
The inquiry heard that the nurse had not regarded the fall as a significant incident because he did not seem to have any injuries.
She told managers who reviewed the incident that the resident did not seem distressed and was able to stand up without any assistance after the fall.
Ms Lloyd also faced an allegation that she retrospectively documented the incident in the centre’s nursing notes without clearly identifying that they were being made retrospectively.
Mr O’Sullivan claimed the allegations amounted to poor professional performance as well as breaches of the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives.
“It is not an inquiry about the fall but the management of the fall,” said Mr O’Sullivan.
He acknowledged that the admissions made by Ms Lloyd, who has been a registered nurse since 2007, had removed the need for the NMBI to call 15 witnesses.
Counsel for Ms Lloyd, Matthew Jolley BL, said his client had apologised for the mistake she had made for which she would be “eternally sorry.”
Mr Jolley said the nurse had followed “a flawed logic” in relation to the incident.
Pleading for leniency, he said the nurse had an otherwise impeccable history of work before and after the incident.
The inquiry heard that she was suspended for a period of around eight months by St Joseph’s Foundation and ultimately resigned her position at Galtee View House.
Mr Jolley said Ms Lloyd had questioned her ongoing employment as a nurse as a result of what happened and she feared the consequences of the current inquiry.
The inquiry’s chairperson, Anne-Marie Duffy said the committee would deliver its findings “in due course.”
