Former nurse at Cheltenham General Hospital gave patient diazepam to 'calm him down'

A former nurse at Cheltenham General Hospital left a ward unattended and joked he gave a patient diazepam to “calm him down”. Mark Andrew Hamilton was a Band 6 charge nurse where he was seconded from the Acute Care Unit to a practice development role with the A&E department in September 2019.

He returned to his nurse role on January 11, 2021 where numerous concerns were raised about his performance at work. A recently held disciplinary Nursing and Midwifery Council hearing found Mr Hamilton left the ward unattended and nurses were left wondering where he was.

The panel heard how Mr Hamilton’s conduct was investigated and a disciplinary hearing was scheduled. He failed to attend the hearing, causing the meeting to be adjourned. Mr Hamilton later resigned on October 27 2021, prior to the second disciplinary hearing.

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On January 18, 2021, a patient on the ward was due to be given diazepam to help treat their alcohol withdrawal. Nurses should follow a Clinical Institute Withdrawal Assessment – Alcohol revised scale (CIWA-Ar) to decide if more medication is needed, or to withhold treatment if withdrawal symptoms are absent.

Mr Hamilton did not use this scale on the patient, which had been in place at the hospital for two years, and did not record a rationale for administering diazepam four times, incorrectly administered lower doses of the medication and failed to give any clinical justification.

Mr Hamilton claimed he gave a score in his head and this was satisfactory given another nurse gave a similar score to him - but the panel felt this was unacceptable as “clinical presentation of patients is changeable”.

On the same day, a bed-bound patient with multiple sclerosis was inappropriate towards female staff and Mr Hamilton gave him diazepam to “calm him down”. One colleague observed: “we had a patient in A4 that had he was inappropriate towards staff/using inappropriate language and Mark mentioned as a joke that he would keep giving him Diazepam to calm him down.

“Throughout the day speech became very slurred. I witnessed three pots of meds being given to (…) with multiple small tablets in them. The CIWA questions were not asked by Mark. The medication was just given.”

Mr Hamilton told another staff member he would continue giving the patient Diazepam as he is already prescribed it, rather than review his symptoms.

On January 19, 2021, Mr Hamilton took a strip of unknown medication from the analgesia cupboard and consumed the medication. When asked if he was feeling unwell, he shrugged his shoulders, laughed and said “no no” and walked away.

He was observed taking more medication from the cupboard on January 21, 2021 and consuming a tablet from a strip during his shift. Mr Hamilton claimed this medication was Nicorette's, which aims to help smokers quit, but the panel believed the medication was from the same cupboard.

Further questions were raised about his conduct, namely when he made flippant remarks. He told colleagues on the ward words to the effect of “If you sedated your patients like I did, you would have less problems with patients wandering” and “Every time Patient A looks at me, he is earning himself more diazepam.”

Mr Hamilton denied he made the comments, but multiple colleagues heard him. Mr Hamilton sparked confusion when he left the ward for more than an hour on January 21, 2021. He failed to produce a handover for a skilled member of staff and believed the patient-to-staff ratio was “safe”.

One witness recalled: “He came into the corridor and he said I've been in ED. I asked where you been?' and he said I've been in ED, and I said what's wrong.

“He said I've been at the meeting, and I asked what meeting? You don't work in ED, and he said it's good to support them. There was no definite answer, he didn't say what it was, he just said it was good to support them.

“I said to him you have patients here, where have been, he just said been to ED. Then he said I've been to the performance thing. He knew about it as [… ] had rang and I said about it to him. I was coordinating and said to […] about the meeting.

“He said I've been to that meeting, I knew it was later in that day. He implied that he had gone to 'the' meeting”.

During the hearing, Mr Hamilton offered minimal insight into his actions and disputed some of the evidence and allegations against him. The panel however observed he returned to a previous role without a supernumerary period and Mr Hamilton struggled within the working environment during Covid-19.

Describing Mr Hamilton's conduct, one witness said: “Like I said at the start, Mark was a fantastic nurse before he went on secondment to the Emergency Department but when he came back, he was different, he was still good according to me but I don’t know if others would say so.

“I think what has happened in relation to this NMC referral was a shock to most people. That he did something like he did, and all this has come off it. I am not in touch with him since it all happened.”

The panel concluded that Mr Hamilton should be struck off the nursing register on the expiry of his suspension. The report concluded: “Mr Hamilton’s actions were significant departures from the standards expected of a registered nurse, and are fundamentally incompatible with him remaining on the register.

“The panel was of the view that the findings in this particular case demonstrate that Mr Hamilton’s actions were serious and to allow him to continue practising would undermine public confidence in the profession and in the NMC as a regulatory body.”

This striking-off order will take effect upon the expiry of an 18-month interim suspension order. The full report can be found through this link.