A former paediatric nurse intern is facing 10 charges of allegedly administering restricted sedatives without approval, and putting two young patients at risk.
The nurse, who has interim name suppression, appeared before the Health Practitioners Disciplinary Tribunal in Auckland today.
She is accused of medical misconduct for treatment provided to two patients in March and June 2017.
The charges against her allege that while working as a registered nurse and clinical nurse specialist intern at an Auckland hospital's emergency department she gave the drugs Propofol, Fentanyl and Ketamine to two patients without a prescription and supervision.
She is also accused of not providing full and accurate clinical notes.
In March 2017, the nurse allegedly treated a 15-year-old boy with a fractured ankle.
The patient was required to be "quite heavily sedated" in order to plaster the wound, Tribunal notes said.
Records show the nurse administered Ketamine, Propofol and Fentanyl. However, none of these drugs were prescribed or documented on the patient's medical chart.
In June 2017, the nurse allegedly treated an 11-year-old girl who had fallen at home and suffered a broken leg.
This girl also suffered from ADHD, obesity, autism and sleep apnoea.
Records show the nurse administered Ketamine and Propofol, and again these medications weren't prescribed or documented.
A witness statement given at the tribunal by an emergency medicine specialist, said the drug Propofol was not used often with children and rarely used on its own due to the risk of airway compromise.
She said Propofol shouldn't be given to a patient without a senior registrar or consultant being present.
"I would not allow registrars to administer Propofol to a patient on their own," she said.
"Propofol is always administered in the resuscitation room in case the patient requires resuscitation and airway management.
"Appropriate monitoring must be undertaken to recognise any adverse consequence."
The specialist said administration of Propofol was out of the scope of practice of a clinical nurse specialist intern and a registered nurse.
"It cannot be given under a standing order and must be prescribed by a doctor before it can be administered," she said.
In terms of Ketamine, nurses need to be credentialed before they could administer it.
Tribunal notes state the nurse in question had this credential, which meant she "was able to administer, if necessary, the prescribed dose of Ketamine with a medical practitioner in the room".
Fentanyl must be prescribed and is not able to be given under a standing order.
In the Tribunal report, when questioned by a clinical nurse specialist, the nurse was said to have explained that she attended a teaching session on airway management and had completed her Ketamine credentials and "therefore thought she was able to give Propofol".
However, in her statement, the specialist said "we always tell nurses, registrars and house officers who had done this teaching module that just because they had completed the teaching model, it did not mean they could administer Propofol".
The nurse in question also explained that she had "discussed giving Propofol prior to giving it with a senior medical officer, but could not recall which SMO that was".
She said the drug "was best for the patient and a better option than Ketamine".
A clinical nurse specialist who gave evidence at the tribunal hearing, said she approached the nurse after hearing about her deviation from practice.
"I recall [the nurse] justifying her actions by saying that at the time, it was best for the patient and was a better option than Ketamine," she said.
This statement related particularly to the second patient - an 11-year-old girl with ADHD, obesity, autism and sleep apnoea.
The first specialist explained how a patient with these conditions would have an increased risk of airway obstruction under sedation, therefore even using Ketamine for sedation would not be straightforward.
"Procedural sedation should only be used on people who did not have comorbidities, or if it is absolutely necessary, the risks and benefits should be discussed," she said.
The second specialist said the nurse had also explained that she was confident the first patient's sedation was done in the resuscitation room and the doses of medication were well under the minimum for the patient's weight and age.
The specialist said she had known the nurse for some time, and despite the charges against her, she described her as "confident" and "a really good nurse".
The Tribunal will decide whether the nurse's actions in administering the drugs without a prescription or supervision, and not documenting them correctly, compromised the safety of the patients and amounted to professional misconduct.
A decision is expected later this week.