Nurse Gives Lethal Dose of Vecuronium Instead of Versed - page 22

PET scans are typically performed in the outpatient setting and not inpatient. They are not emergent. This was a full body inpatient PET scan which might be said is inappropriate resource... Read More

  1. by   KatieMI
    Quote from BostonFNP
    Both methadone and methylphenidate would need to be filled directly by the pharmacist not a tech, if I'm not mistaken.
    They should... as all drugs for every patient in "special list" (for example, severe allergies). I had meds contaminated with substances I am allergic to several times. Every time there was an investigation, and every single time they reported, among other things, that the script was filled by tech because staff was short that day.
  2. by   Jguy
    You seem to be very knowledgeable of pharmacology. Your response I enjoyed reading, learning..you had my respect and interest until your last few sentences. "Either things in Vanderbilt are run by a group of recent Acute Psych unit escapees, or I do not know"...why would a well spoken, obviously intelligent nurse make a comment that is so unecessary and inappropriate after all of that great insight?
    The Psych patient comment is not funny or appropriate to post on a professional post.
    Please, stop and think...that statement just reinforced the stigmatigizing perception, of mental illness, this needs to be changed!
    As nurses we are to advocate for the physically and mentally ill!
    You had my absolute respect until you made that comment...Of course I'm a psychiatric nurse, and little statements like you just made, may seem innocent to you. Unfortunately they are words that have the ability to reinforce shame and fear for someone in need of help, though they may be to embarrassed to seek assistance because of the stigma and/or being 'seen as a crazy person'.... If you don't understand mental illness or the stigma that surrounds it please learn about these illnesses depression is the leading cause of disability according the the WHO. Suicide numbers are rising at an alarming rate! We need to change societies misconceptions regarding mental illness! The right words could save a life the wrong words could end a life. Just like with a medication error.
    Think before you administer the med., the words mental illness needs to be taken more seriously!
    Last edit by Jguy on Dec 6 : Reason: auto correct miisspelt a word
  3. by   canoehead
    Quote from Jguy
    You seem to be very knowledgeable of pharmacology. Your response I enjoyed reading, learning..you had my respect and interest until your last few sentences. "Either things in Vanderbilt are run by a group of recent Acute Psych unit escapees, or I do not know"...why would a well spoken, obviously intelligent nurse make a comment that is so unecessary and inappropriate after all of that great insight?
    The Psych patient comment is not funny or appropriate to post on a professional post.
    Please, stop and think...that statement just reinforced the stigmatigizing perception, of mental illness, this needs to be changed!
    As nurses we are to advocate for the physically and mentally ill!
    You had my absolute respect until you made that comment...Of course I'm a psychiatric nurse, and little statements like you just made, may seem innocent to you. Unfortunately they are words that have the ability to reinforce shame and fear for someone in need of help, though they may be to embarrassed to seek assistance because of the stigma and/or being 'seen as a crazy person'.... If you don't understand mental illness or the stigma that surrounds it please learn about these illnesses depression is the leading cause of disability according the the WHO. Suicide numbers are rising at an alarming rate! We need to change societies misconceptions regarding mental illness! The right words could save a life the wrong words could end a life. Just like with a medication error.
    Think before you administer the med., the words mental illness needs to be taken more seriously!
    I am bat shame crazy, and even I am not offended. It's not that big a deal.
  4. by   wondern
    Quote from bluebonnetrn
    I have read through more than half of the comments in this thread. I have not yet been able to read the 2nd half however I want to go ahead and make one point (forgive me if it has already been brought up).
    Everyone keeps mentioning that this is a world class, top notch facility and that overworking RNs has nothing to do with this error.
    The hospital admin has in the past demonstrated a flagrant disregard for the nursing profession and what makes us think there are not many many other examples of this? When you have a fairly new "baby" RN orienting another nurse then you can also assume the more experienced RNs have already fled.
    I just think it speaks to the overall working environment for the nurses.

    "Cleaning the room after the case, including pulling your trash and mopping the floor, are all infection-prevention strategies. And it's all nursing, and it's all surgical tech. You may not believe that, but even Florence Nightingale knew that was true," explained the hospital administrator. The additional requirements include "pull[ing] their own trash and linens, sweep up and spot mop."

    Nurses were even told to keep quiet about it.

    Nurses Get Bathroom Cleaning Duty At Vanderbilt University Medical Center | Care2 Causes
    Thanks, bluebonnetrn. Yes, as soon as I get done cleaning this room and toilet, I'll go hold that baby. Now, that is a brilliant idea! Come on people. It's called the 'germ theory', and on top of it all...as if the nurse isn't overworked already!
    Try finding a wheelchair or patient transport in one of these shortstaffed places. I's flat out ridiculous! Nurses can't do everything for everyone. Come on adminisrators, buy some wheelchairs. Hire enough adequate qualified staff.
    I bet nurses were told to keep quiet about it!
  5. by   wondern
    Quote from MunoRN
    A bit off topic, but some have questioned why midazolam (Versed) was ordered and not lorazepam (Ativan), suggesting lorazepam would have been safer. Between the two, midazolam is generally considered the safer procedural anxiolytic. It's shorter acting, so the CNS depressive effects will at least be of shorter duration, and even though both lorazepam and midazolam fall generally under benzodiazepines, midazolam has an added dissociative-like effect which for the same amount of procedure-tolerance effects will produce less respiratory depression and overall CNS depression.
    For the dissociative-like effect and decreased respiratory depression...That's why the anesthesia doc used it to help move the boys trapped in the cave underwater through the cave with their individual diver/rescuers. That doctor got their accurate weights to give very accurate doses. Sorry I got a bit off topic too but appreciated your description and just heard the same term, 'dissociative-like effect', in the trapped kids story. It helped the kids not panic going through the tight spaces and caves underwater, some didn't know how to swim even. That's a whole new thread probably on AN somewhere already.
  6. by   ladysyrah
    Audrey2976:

    Maybe they are allergic or it would was determined to be too risky of a combination with the current meds? Although benzodiazepines allergies are rare they do exist. Without a pertinent health history, we cannot reasonably surmise why one was chosen over the other. If benzos were off the table for whatever reason, they would need something fast acting which eliminates other anti-anxiety meds generally. I haven't had time to read the full report yet, so please forgive me if it was in there and I haven't gotten to that part!
  7. by   ladysyrah
    Well, I was having a brain-dead moment. I was forgetting that midazolam IS considered a benzodiazepine (I work home health and have limited experience with this drug;therefore, it is outside my wheelhouse). Therefore, please ignore my thoughts about the idea that allergies could have been a contributing factor to the choice of Versed; however, adverse reactions or ineffectiveness may still be a consideration. I know a someone who cannot use any other benzo except lorazepam for their panic attacks because the other meds just do not work as effectively in their body. Also, if the anxiety was more than a simple "talk you down" type of anxiety that was well put and though of (and should be first course of action if the patient does not have history of panic attacks/etc). These are just thoughts.

    Once again I am still working on reading the report so I do not know if that is included in it. I will probably state my *actual opinion on this topic once I read the whole thing but I can only look at potentials without having all the information at this point.
  8. by   Horseshoe
    Quote from ladysyrah
    Well, I was having a brain-dead moment. I was forgetting that midazolam IS considered a benzodiazepine (I work home health and have limited experience with this drug;therefore, it is outside my wheelhouse). Therefore, please ignore my thoughts about the idea that allergies could have been a contributing factor to the choice of Versed; however, adverse reactions or ineffectiveness may still be a consideration. I know a someone who cannot use any other benzo except lorazepam for their panic attacks because the other meds just do not work as effectively in their body. Also, if the anxiety was more than a simple "talk you down" type of anxiety that was well put and though of (and should be first course of action if the patient does not have history of panic attacks/etc). These are just thoughts.

    Once again I am still working on reading the report so I do not know if that is included in it. I will probably state my *actual opinion on this topic once I read the whole thing but I can only look at potentials without having all the information at this point.
    All of that is actually irrelevant to the OP. Nowhere in the literature is vecuronium prescribed for PET scan-induced anxiety. The nurse in question didn't give it because she thought it was a superior option to versed.
  9. by   Hematocrit13
    After watching a great special on PBS about the thai cave rescue, my understanding was that the boys were dosed with ketamine.
  10. by   wondern
    I believe it was a combination of the two. It was an interesting show!
  11. by   ladysyrah
    Quote from Horseshoe
    All of that is actually irrelevant to the OP. Nowhere in the literature is vecuronium prescribed for PET scan-induced anxiety. The nurse in question didn't give it because she thought it was a superior option to versed.
    I was specifically responding to a question that audrey2976 who asked about potentials of why versed would be prescribed instead of something like lorazepam. I was not directly talking about anything within the report, because as I said I have not finished reading it and want to do so before making any statements about the actual situation. I probably would not have even responded to her had I known that wondern posted such a great response for audrey2976.
    Last edit by ladysyrah on Dec 8
  12. by   Tenebrae
    Quote from pseudonym87
    How dare you even say that a nurse should lose her license without knowing her, her work ethic, the quality of her work throughout her tenure, and without knowing all of the facts. The CMS report does not address the nurses experience level, whether or not she had received the training and competence to be a Resource Nurse, and does not address other patient situations that may have led to her being rushed.
    ...
    The nurse overlooked the basic rights of medication administration.

    And a patient died, slowly suffocating to death, while being aware of everything that was happening.

    The patient didn't just die, her end was appallingly massive amounts of suffering


    She needs to under go some very serious remediation before ever being allowed to work as an RN again
  13. by   Tenebrae
    Quote from pseudonym87
    Right- but let's say she did the right thing and stayed with the patient, she would have most likely saved the patients life.
    point is she didnt.

    And the patient died, in immense suffering and agony

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