Nurse injected medication 'inappropriately'
A senior lecturer at the Royal College of Surgeons has told a jury that, according to witness statements, a nurse accused of poisoning two elderly patients injected the patients in an inappropriate manner.
Ms Alison McGarvey, a registered nursing tutor and an expert on the method and use of intra muscular injections, was giving evidence in on day-14 of the trial of the nurse who denies four charges relating to two elderly patients at Naas General Hospital three years ago.
Ms Noreen Mulholland (aged 35), now living in Park Road, Portadown, County Armagh and previously of Runabeg Close, Kildare, has pleaded not guilty to assault causing harm to Mr John Gethings (aged 77), of Baltinglass, County Wicklow on March 1, 2003 and Mr Seamus Doherty (aged 80), Rathcoffey, Naas, County Kildare, between June 18-19, 2003.
She also denies intentionally or recklessly administering a substance, Serenase, to both men, knowing it was capable of interfering substantially with their bodily functions without their consent on the same dates.
Ms Orla Crowe BL, prosecuting, has told the jury that Mr Gethings died on March 2, 2003 but emphasised that it was not the State’s case that Ms Mulholland was responsible for his death.
Ms McGarvey said after reading statements from Ms Daphne Leopardi and Ms Sinead Noone-Norton, regarding the allegation of assault against Mr Doherty, she concluded that the accused acted inappropriately because she hadn’t carried out the normal checks of the patient’s cardex, she gave him an unprescribed drug, and she didn’t use the appropriate needle to administer the drug.
Ms McGarvey told Ms Crowe that she also concluded from Ms Leopardi and Ms Sharon Baxter’s garda statements that Ms Mulholland had used unnecessary force when administering the Serenase to Mr Gethings and that she shouldn’t have used a white needle.
She concluded from Ms Mulholland’s garda statement that the amount of Serenase she claimed was prescribed to Mr Gethings was too small for an intra muscular injection.
Ms Mulholland had also used a method she (witness) never heard of drawing the medication up by using a diabetic syringe and transferring it to a 2 ml syringe for administration.
Ms McGarvey said Ms Mulholland description of how she prepared to give the injection to Mr Doherty was consistent with good practice but she (witness) would never use a white 16 gauge needle to administer an intra muscular injection and there was no need to use it to even draw medication up into a syringe.
Ms McGarvey agreed with Mr Giollaiosa O Lideadha SC (with Ms Anne B Rowland BL), defending, that injecting a patient in a dart-like motion was considered a valid and safe technique in Ireland, the United Kingdom and the United States of America.
However, she stressed that it should be inserted quickly and smoothly with steady pressure and should be passed through the skin, rather than forced.
She added that a needle should be injected in such a way to allow a nurse to feel resistance and if they felt such resistance they should withdraw the needle immediately.
Ms McGarvey couldn’t accept a suggestion from Mr O Lideadha that a nurse dealing with an agitated person should take the sheath off the needle and hold it back away from the patient, while locating the injection site with the other hand, before injecting the patient.
"If a patient is that agitated a nurse should call for a colleague to help them settle them before they administer the injection. The needle should be held close to the patient so it is less likely to be knocked from their hand", the witness replied.
She added that in her opinion holding a needle away from a patient could cause more damage to the nurse and the patient.
Inspector Patrick Mangan agreed with Mr O Lideadha that following a full investigation the only charges that are laid against Ms Mulholland were the ones before the court.
Ms Barbara Murray, a defence witness and a clinical nurse manager at Blackrock Clinic, told Ms O Lideadha that Ms Mulholland was first employed there as a nurse in February 2002 but was dismissed in November the same year after she failed to improve her clinical skills.
She said the accused was on a probation period and underwent an assessment in June where she was told she had poor attention to detail and didn’t have the level of clinical skills needed to carry out night duty work.
Ms Murray said she advised Ms Mulholland to get 18 months to two years general clinical experience in a teaching hospital closer to home before she considered specialised work in a unit like that in Blackrock Clinic.
She said the accused disputed these and many other criticisms and a further assessment in August concluded that she hadn’t made significant improvements to her clinical skills.
Ms Murray said that Ms Mulholland was dismissed on November 30, 2002 but she told Mr O Lideadha that during her time in the hospital the accused was a caring nurse but she had no insight into her own limitations.
The trial continues before Judge Frank O’Donnell and a jury of six women and six men.
