Nurse who left Peterborough City Hospital patient soaked in urine - along with dozens of other failings - struck off

Peterborough City Hospital
Peterborough City Hospital

A nurse who left a patient ‘soaked in urine’ at Peterborough City Hospital has been struck off.

Edgar Navarro admitted a string of failings during his time working at the hospital - and has now been taken off the nursing register at a hearing of disciplinary body the Nursing and Midwifery Council (NMC).

In total, the NMC said there were 67 failings in just four months - including leaving a patient - known as Patient AA - soaked in urine for around one hour, and attempting to change their dressings while Patient AA was soaked in urine. Other errors included being unable to provide appropriate treatment for a headache, failing to use the emergency bell in an emergency - and using it when it was not an emergency - and attempting to give another patients the wrong number of tablets

Mr Navarro has now moved to Spain.

A suspension had been imposed on Mr Navarro in August 2016, to allow him to learn from mistakes - but the panel said there was no evidence he had done so, following a number of reviews.

A report said: “The panel next considered imposing a further suspension order. The panel determined that Mr Navarro has continued to demonstrate a persistent lack of insight into his failings and that there is evidence of his attitudinal problems. The panel determined that a further period of suspension would not serve any useful purpose in all of the circumstances, particularly when considering Mr Navarro’s complete lack of compliance with the NMC’s recommendations as to remediation and his failure to engage with the NMC since 2016.”

The report added: “The panel decided that it was necessary to take action to prevent Mr Navarro from practising in the future and concluded that the only sanction that would adequately protect the public and serve the public interest was a striking-off order.”

Joanne Bennis, Chief Nurse at North West Anglia NHS Foundation Trust, which runs Peterborough City, Hinchingbrooke and Stamford and Rutland Hospitals, said: “I can confirm that Edgar Navarro has not been employed by the Trust since 2016.

“When concerns about his performance were raised the Trust’s Capability and Performance Policy was implemented. However, despite extensive support and development having been put in place, Edgar’s practice failed to improve to the level required for the role”.

He will be struck off the register on December 7 - when his suspension finishes.

The report said:

The charges found proved, by way of admission, which resulted in the imposition of the substantive order were as follows:

“That you, whilst employed as a Staff Nurse by Peterborough and Stamford Hospitals NHS Foundation Trust at Peterborough City Hospital on Ward A9 (“ the Ward”) between 16 February 2015 and 5 October failed to demonstrate the standard of knowledge

1. On 14 April 2015 you did not ensure that Patient D had been washed.

2. On 8 May 2015:

2.1. You did not check Patient S’s observations prior to administering medication;

2.2. You were not able to demonstrate that you understood the uses of the medication that you were administering to Patient S;

2.3. You recorded Patient U’s Glasgow Coma Score as 15 when it should have been 14;

2.4. You did not complete the admissions booklet for Patient V;

2.5. You were unable to show to Lesley Probert that you were aware of the process of a medication round.

3. On 11 May 2015:

3.1. You did not communicate clinical information to a doctor in relation to concerns with Patient W’s chest;

3.2. Following a medical review of Patient W you did not action the treatment requested in an adequately timely manner.

4. On 12 May 2015:

4.1. You attempted to administer Patient X with an incorrect number of Sinimet tablets;

4.2. You did not check the identity of Patient Y against the Medication Administration Record that you were using;

4.3. You dispensed another patient’s medication for Patient Y.

5. On 25 May 2015:

5.1. You did not use the emergency bell in an emergency situation;

5.2. You used the emergency bell in a non-emergency situation;

5.3. You were not aware that Co-codomol contained Paracetamol.

6. On 3 June 2015 you did not prioritise feeding patients over washing patients.

7. On 14 June 2015:

7.1. You did not ensure that you received a thorough handover;

7.2. You took around one hour to carry out the morning medication round;

7.3. You were not able to demonstrate knowledge of the uses of the medications that you were administering to your patients;

7.4. You were not able to demonstrate an understanding of the reason(s) for reviewing a patient’s observations prior to administering medication to them;

7.5. You did not update care plans for your patients;

7.6. You had to be reminded by Amy Williams to carry out observations for your patients throughout your shift;

7.7. You were not able to complete Patient FF’s fluid balance chart accurately;

7.8. You did not call a doctor back after 15 minutes to attend Patient GG who was suffering from chest pain;

7.9. You took around one hour and ten minutes to carry out the evening medication round.

8. On 25 June 2015:

8.1. You left Patient AA in bed soaked in urine for around one hour;

8.2. You attempted to change Patient AA’s wound dressing whilst Patient AA was lying in a bed soaked in urine;

8.3. You did not provide care to Patient E who was your allocated patient;

8.4. You did not recognise the need for standard observations to be performed whilst undertaking neurological observations;

8.5. You did not provide Patient G with oral fluids after Patient G had returned from a gastroscopy procedure;

8.6. You did not update care plans for your patients;

8.7. You were unable to recall basic information of your allocated patients including but not limited to the patients’ names, reason(s) for admission to the Ward and plans for the patients’ care;

8.8. You were not able to demonstrate knowledge of the basic medications that you were administering to your patients;

8.9. You attempted to leave Patient II whom you were feeding to start the dinner time medication round;

8.10. You attempted to leave the dinner time medication round to escort Patient JJ for an X-ray;

8.11. You were unable to complete Patient K

8.12. You did not prioritise the completion of your patients’ observations.

9. On 26 June 2015:

9.1. You stated that you planned to take observations for your patients and then began to take observations for another nurse’s patients;

9.2. You planned to change Patient H’s sacral dressing at a time that would have caused Patient H more discomfort than was necessary;

9.3. You did not complete fluid balance charts correctly;

9.4. You did not empty Patient I’s catheter when required;

9.5. You did not update the care plans for your patients.

10.On 29 June 2015 you did not use and/or maintain an Aseptic Non Touch Technique when attempting to change Patient BB’s wound dressing.

11.On 30 June 2015 you did not attempt to clarify information that you did not understand that had been provided to you at handover.

12.On 7 July 2015:

12.1. You were not able to show that you understood what would be an appropriate dressing for Patient J’s wound;

12.2. You began dressing Patient J’s wound from mid-way down Patient J’s arm;

12.3. You did not complete fluid balance charts for your patients;

12.4. When providing a handover for Patient K to another nurse you stated that Patient K was able sit in their chair with assistance when Patient

K was bed bound;

13.On 12 July 2015:

13.1. You took six and a half hours to read Patient CC’s clinical notes;

13.2. You could not provide Kirsty Ferguson with an adequate handover for Patient CC after reading Patient CC’s clinical notes for six and a half hours;

13.3. You could not provide appropriate treatment for Patient CC when Patient CC complained of a headache.

14.On 15 July 2015:

14.1. You did not to use the prescribed wound dressing for Patient Q’s wound;

14.2. You did not provide assistance to Patient L who was experiencing a vaso vagal episode.

15.On 18 July 2015 you attempted to have more Navorapid prescribed for Patient DD.

16.On 19 July 2015 you kept Patient DD in bed when Patient DD should have been mobilised.

17.On 22 July 2015:

17.1. You were not able to show that you understood that when 100ml of fluid per hour was being infused that 100ml of fluid would not have been infused from 10:00 to 10:05.

17.2. You performed an Electrocardiogram on Patient M because Patient M had low blood pressure;

17.3. You did not update Patient M’s care plan in a timely manner;

17.4. You did not update Patient M’s risk assessment;

17.5. You did not update Patient M’s fluid balance chart.

18.On an unknown date you did not provide appropriate care to Patient A when Patient A had a nose bleed.

19.On an unknown date you were unable to recognise that Patient B needed to be re-cannulated in order for Patient B to continue receiving anti-biotics.

20.On an unknown date you did not assist Patient O when Patient O had fallen.

21.On an unknown date you did not take any steps to assist Patient P when Patient P had an altercation with another patient.

22.On an unknown date you hoisted Patient HH alone and did not stop when Amy Williams told you that you needed to do this with another person.

23.On unknown dates you demonstrated a poor aseptic technique in that you would lean on dressing trolleys and/or would not clean dressing trolleys.

24.On an unknown date:

24.1. You handed over to another nurse that Patient R required more fluids when Patient R was showing signs of fluid overload.

24.2. You did not perform a bladder scan when Patient R had not passed urine for 12 hours.

And, in light of the above, your fitness to practise is impaired by reason of your lack of competence.”