A PREGNANT woman gave birth to a stillborn child five days after an NHS 24 nurse recommended she took paracetemol if the pain got any worse.
Patricia Pillar told the patient to “call NHS 24 back” if the pain got any worse after being told that there had been “reduced foetal movement”.
She also failed to ask the appropriate questions of a patient who would go on to suffer a stroke the day after phoning the helpline.
Additionally, Mrs Pillar provided the wrong answers to a man complaining of severe groin pain and failed to spot what should have been obvious warning signs in a patient who later suffered a heart attack.
The nurse has admitted all the charges brought against her by the Nuring and Midwifery Council (NMC) at a hearing held in Edinburgh this week. The disciplinary panel will now decide whether her fitness to practice is impaired and, if so, whether to strike her off.
All of he charges relate to the time between July 2010 to December 2013, when Mrs Pillar was employed by NHS 24 as a nurse practitioner at the Clydebank contact centre.
William Togneri, a clinical services manager with NHS 24, described an investigation carried out after Mrs Pillar recommended to a pregnant woman who was complaining of pain and lack of foetal movement, to take more paracetemol and call back if the symptoms persisted.
The patient gave birth to a still born child five days after the phone call.
He said: “Patient C explained that there had been reduced foetal movement but had felt some that morning. She also said she had pain across her lower back.
“Patient C described that the baby at 30 weeks was in the breach position and also said that her hands and feet had swollen and she was suffering from heartburn.
“Patricia recommended paracetemol and to call NHS 24 back if it persists.”
He continued: “Patricia tried to pre-empt what the midwife would have done. She should have recommended her to contact the hospital or a midwife as this was beyond the scope of a nurse practitioner.”
Mr Togneri said a review panel decided that the patient should have been recommended to their local maternity services.
He also described an investigation he helped carry out following a 2010 call from the wife of a man suffering from “severe” pain in his groin.
Mrs Pillar told him to see his GP the following day – when he was admitted to hospital.
The nurse did not follow the pain algorithm properly, said Mr Togneri. “If she had answered correctly, the algorithm may have recommended a higher level outcome than seeing a GP,” he added. “Patricia should have used her clinical knowledge to over ride the system and recommended more urgent medical assistance.”
Mark Kelly, a general manager for NHS 24, described to the panel how Mrs Pillar failed in 2013 to explore the possibility of a stroke in a patient who would suffer from one a day later.
He said: “Patricia recommended to alter the dosage of medication to treat her shingles and to speak to her GP or call back if the symptoms worsen. She did not use the algorithm or ask the appropriate questions. She attributed the pain to shingles and did not explore the possibility of a stroke.”
“She recommended that she see her GP within 36 hours. The next day it was reported that the patient had had a stroke.”
Caroline Spence, general manager at the Clydebank contact centre where Mrs Pillar worked, told how in December 29 2013 Mrs Pillar “missed red flags” from a patient who would go on to suffer myocardial infarction, or heart attack.
She said: “Patricia failed to assess the cardiac symptoms and call an ambulance for the patient who suffered a myocardial infarction. From the symptoms described, it was clear what he was suffering from.
“Patricia missed so many red flags on this call that she should have noticed given her experience.”
She continued: “Cardiac symptoms are one of the most serious for a nurse practitioner to deal with.
“She was told of chest pains and should have called an ambulance.”
Malcolm Cameron, representing Ms Pillar at the hearing said that the “overwhelming majority” of calls handled by his client were dealt with appropriately.
He said: “In her career, Mrs Pillar would have dealt with tens of thousands of calls, 63,000 to be precise, and the overwhelming majority would be dealt with safely and appropriately.
“Mrs Pillar had a clean disciplinary record up to December 2013. At times she was taken offline, given remedial training and then allowed back online.
“Her coaching reports were positive and her supervised calls were handled safely and appropriately.”
