Vanderbilt is having a rough patch. First the lethal Vecuronium error and now a "never event".
A woman at Vanderbilt undergoing kidney surgery suffered a wrong-site surgery to her kidney- a "never event". She filed a 25 million dollar lawsuit due to extensive damage and is now dependent on dialysis. Neither here nor there, but one news report said the woman was a certified nursing assistant (CNA).
In the first case, the RN was arrested and charged with reckless homicide. Should the surgeon likewise be arrested and face charges?
There really wasn't any snark intended, I was trying to offer that there was an understandable reason why you didn't respond to the question instead of just saying you were intentionally ignoring it.
I’m not sure where you're getting the "slam it" description for the RV incident, but no, it's not the legal standard of practice.
I think we often confuse the vernacular use of 'standard of practice' and 'reckless' with the legal definitions. A failure to follow the legal standard of practice is defined as a practice which cannot be found in typical practice, and while it certainly could be argued that it's better to provide continuous direct monitoring after giving any IV med, it's not particularly difficult to find frequent instances where nurses give an IV med then move on to the next task with the reassessment to come later, which makes far from a legal standard of care.
The onset of Vecuronium is pretty fast. Certainly well under a minute. She gave the Versed rapid push and booked too quickly to see what was happening. Had she administered it more slowly or actually looked at the patient I would hope she would have noticed the lack of respirations.
I’m a little confused by your use of the term “legal” when it comes to nursing SOP. For example the 5 rights of med administration are not legislated but they are the basis for safe medication practice throughout the US and I imagine the rest of the developed world. It is not illegal to omit doing them but they are the usual and customary process we follow and to not do so is reckless. Each BON has rules for the practice for nurses in their own state. Those aren’t legislated either. They are the rules of licensure but not necessarily the law. However, not following the usual and customary practices can get you in trouble with the law if the patient is harmed or dies. And so it should.
As far as monitoring a patient after an IV push med, you keep using terms like “continuous monitoring” which clouds the picture. I’m talking about a few minutes of observation not ongoing monitoring in the strictest sense. Adverse reactions generally will occur very rapidly after IV push administration. We reassess later for efficacy not reactions. This is standard of practice and I don’t really care how many nurses aren’t doing it. It’s just plain crappy nursing practice. RV displayed multiple examples of poor practice in just this one instance and look what happened to a vulnerable patient. Sloppy practice begets more sloppy practice and the patients are the ones who pay.
I don’t really subscribe to the notion that we are all at risk for criminal charges for even the simplest of mistakes. It just hasn’t happened despite precedent being set over 20 years ago for nurses being criminally charged for patient deaths related to medication mishaps. The source stating the reason for the charges against RV being isolated to the Accudose override is the news media and I believe the real truth is that the prosecutor looked at the entire series of events which were absolutely hair raising.
Maybe she monitored the patient to ensure she wasn't flailing around on the bed. Perhaps the nurse felt that the versed had done the trick because the patient was not moving. Obviously the patient wasn't tele monitored.
Nurse gives a med, expects the patient to calm down. Patient calms down (or so she thinks). All is good and she leaves. How does that possibility fit into your narrative?
Because the patient wasn’t flailing around and she STOPPED BREATHING. Also, someone getting 2mg of Versed is not going to be completely unresponsive. Someone who got Vecuronium is.
Maybe she monitored the patient to ensure she wasn't flailing around on the bed. Perhaps the nurse felt that the versed had done the trick because the patient was not moving. Obviously the patient wasn't tele monitored.
Nurse gives a med, expects the patient to calm down. Patient calms down (or so she thinks). All is good and she leaves. How does that possibility fit into your narrative?
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 3/27/2019 at 8:44 AM, missmollie said:
Perhaps the blame does belong to the system and not so much on the individual employees. Don't you dare draw a comparison, since so many were so eager to hang this nurse out to dry. Do the same for the doctor, or at least acknowledge there is a fault in the system.
We can't yet draw a comparison, because we have not yet seen the CMS report on this situation. The CMS report on the RV situation made it abundantly clear that her practice was sub-par. We have no idea yet how the wrong kidney came to be operated on. It would be premature to blame the doctor or anyone else until we see the investigative report.
Tennessee legal statutes defines 'reckless' as a gross deviation from (common) practice. This would mean that every instance where a nurse uses the override function could result in a criminal charge of reckless endangerment. The DA's charge is based on the premise that the override function is never used in the process of appropriate practice, which isn't accurate at every place I've worked.
Overriding a medication without giving the the medication name a single glance beyond the first two letters on the Pyxis, nor giving the physical medication a single glance, let alone checking anything else is not "common practice."
The fact it is a debate here is evidence is is worthy of a debate within a courtroom.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, Asystole RN said:
Overriding a medication without giving the the medication name a single glance beyond the first two letters on the Pyxis, nor giving the physical medication a single glance, let alone checking anything else is not "common practice."
The fact it is a debate here is evidence is is worthy of a debate within a courtroom.
The fact that it's being debated here ad nauseum is chilling. What corners are routinely being cut that people are rushing to defend a practice that doesn't come close to meeting basic nursing standards? At the risk of sounding old and crotchety what the hell are they teaching in nursing schools nowadays?
I just responded to a sweet young thing who was absolutely aghast that she missed giving someone their morning Lasix. But other people aren't fussed at the idea of giving a med without even looking at the vial. Is nursing education that hit and miss?
Maybe she monitored the patient to ensure she wasn't flailing around on the bed. Perhaps the nurse felt that the versed had done the trick because the patient was not moving. Obviously the patient wasn't tele monitored.
Nurse gives a med, expects the patient to calm down. Patient calms down (or so she thinks). All is good and she leaves. How does that possibility fit into your narrative?
The fact that flailing was mentioned but the oh so basic of basic assessments, "the ABCs" if you will, were not mentioned speaks volumes to priorities.
Wuzzie
5,238 Posts
I apologize for my misunderstanding then. ?