A paediatric nurse intern has been cleared of charges after being accused of giving strong sedatives to children without a prescription or supervision.
The nurse, who has interim name suppression, appeared before the Health Practitioners Disciplinary Tribunal in Auckland last week.
She was accused of medical misconduct for treatment provided to two patients in March and June 2017.
The charges against her alleged 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 was also accused of not providing full and accurate clinical notes.
A tribunal of five panel members on Friday ruled that while the nurse had failed to correctly document some details, all other particulars weren't established.
Of 10 charges against her, the nurse was found to have failed to document the name of the senior medical officer (SMO) who gave the verbal order to give the drugs, and failed to write the acronym "pp", plus the prescriber's name - for both patients and each drug given.
She was also found to have failed to record that one of the patients had received intravenous propofol and fentanyl on their medical notes.
However, the tribunal went on to say that neither separately nor cumulatively, the particulars that were established were sufficiently serious enough to warrant disciplinary sanction - so there was no penalty to be imposed.
The initial charges related to two patients the nurse saw in 2017.
In March 2017, the nurse 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, it was alleged none of these drugs were prescribed or documented on the patient's medical chart.
In June 2017, the nurse 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 charges alleged these weren't prescribed or documented.
A witness during the three-day hearing spoke about how 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.
The specialist said administration of propofol was out of the scope of practice of a clinical nurse specialist intern and a registered nurse.
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 a statement of evidence given at the hearing, the nurse in question denied all charges of administering the drugs without a prescription or supervision.
"While I agree to some and/or part of the charges laid in relation to my documentation, I deny the charges laid that I did not have supervision or I did not obtain a verbal order from a senior medical officer, and was therefore practising outside my scope," she said.
The nurse said a very large part of her role was to undertake procedural sedations, including administering propofol and fentanyl, and in terms of her patients she would discuss them all with a supervising doctor.
"They would then decide whether they would see the child themselves or if they were happy with my assessment and plan, they would provide me with verbal orders and then allow me to continue with the discussed plan," she said.
"While this supervision was indirect rather than direct, I considered that such supervision was appropriate."
Because the main allegations were not proven, the nurse remains practising at a hospital in the South Island.