A pensioner's leg had to be amputated after a care home nurse failed to give him a week's worth of medication for deep vein thrombosis, a hearing has been told.
Stella Nthinya, 34, is said to have failed to administer the drug on five consecutive days and did not call a doctor when the man's foot turned blue.
She then faked records and threw away the missed medication to cover her tracks, the Nursing and Midwifery Council heard.
The alleged blunders happened between February 8 and February 12, 2007, at the Southern Cross-run Newark Care Home in Port Glasgow, Inverclyde.
The patient, referred to only as resident A, was taken to hospital where he had to have his leg amputated.
Giving evidence, then manager Mary Inglis-Davidson said a doctor should have been called as soon as the blue foot was discovered rather than the following day, particularly given the man's history of blood clots.
She added: "There had been a time delay from the blue foot being seen and the GP being contacted. From memory, it was about 12 to 18 hours between finding it and the GP's assessment. I would expect the nurse to have undertaken a certain level of assessment, to have documented that and sought medical advice."
Asked by Neil Moloney, for the NMC, who was the first to observe the foot, Mrs Inglis-Davidson replied: "It was Stella Nthinya. I also noted there had been gaps in medication, in the administration of enoxaparin, the anticoagulant. When I tried to piece that together in relation to looking at the medication administration record (MAR) chart, there seemed to be a number of entries which appeared to be over-written. They were very heavily marked with ink."
The NMC also alleges that Nthinya disposed of the unused syringes between the same dates.
Mr Moloney told the hearing Mrs Inglis-Davidson had found five empty syringes in the clinical waste bin, "lying side by side in a uniform line" as though they had been disposed of together.
Mrs Inglis-Davidson also took photos of the syringes, photocopies of which were shown to the panel today.
Nthinya is attending the hearing in central London. She admits failing to administer the enoxaparin on February 8, but maintains she gave it to him on each of the four following days, and accepts she did not call for a doctor on February 11 when she noticed the man's foot had turned blue.
She denies fixing the MAR chart and care plan records to make it look as though the drug had been administered, and failing to inform the deputy manager or the nurse who took over from her of his condition.
If convicted of misconduct, Nthinya could be struck off the nursing register. The hearing continues.
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