Latest on RaDonda Vaught case

Asystole RN · Apr 8, 2019

28 minutes ago, wondern said:
You think it’s okay Charlene Murpheys family was told she died of natural causes for almost a year when they found out from the media on the news otherwise. Was that unintentional?

Ignoratio elenchi.

MunoRN, RN · Apr 8, 2019

13 hours ago, LilPeanut said:
Whew! I've gotten through the whole thread, all the articles and documents. Here come the quotes
I would really like to know this. I have not seen anything that says anything about whether she was tested for impairment when it happened.
I can address this a little, knowing EPIC well. When you override a medication on the pyxis under a patient name, it automatically goes to the MAR so it can be signed off. When you scan the med, it will say "link to override pull of x med?" It's in a different color box (pink maybe?). Now, it doesn't record it as given, it just puts it in the MAR in preparation for being signed off. Epic was relatively recently new to the hospital, and my guess is the NM did not understand the difference between those two things. She knew that if you overrode something, it would automatically go to the MAR, but not that it wouldn't document as given (and I think the override pull eventually will drop off if you don't sign it). Everyone should have known that she should have signed off the med she gave, but the likelihood that it was in any way intentional is low, IMO...

Epic is an EMR platform so how it works varies by facility / organization. In the default configuration of EPIC you can only "link" an override pull to an order, outside of things like the Code Navigator or some procedural flowsheets. In this case, the manager was correct, she should not have entered an order after the fact in order to chart to it. What EPIC had captured at the point was accurate; that a med had been pulled from the Pyxis and that there was no order for that med. What RV should have done, possibly against the protest of the manager, would have been to have entered a note describing what had happened.

wondern, ASN · Apr 8, 2019

Vanderbilt allowed her to work as a 'Resource Nurse'. Seems like a more experienced nurse could be assigned that role. That's where I'm coming from. I don't think anyone approved of her mistake or not following protocol, or said her practice in that was OK. Just the name itself though, 'Resource Nurse' implies some kind of expertise. At least it does to me. Doesn't it to y'all?

That could have contributed in a very big way. Sorry if you don't see that at all in anyway contributed to Charlene's death.

Also, I don't speak Italian or Latin but I think Asystole called me ignorant above. Aww, so what but that's not very nice! It takes one to know one lady, whatever you called me!

So no, I don't see it as 2 different issues. Just don't! 'Resource Nurse' ...really?!

Also if it was in a kit instead of a vial that may have helped her stop what she was doing.

Or maybe have a separate red box or something similar for paralytics specifically.

wondern, ASN · Apr 8, 2019

Can we not have even a constructive conversation about it other than attacking our own and putting all the blame on her who probably already is punishing herself more than anyone else could ever! Just stop already.

Or maybe Vanderbilt could have a full time nurse in Radiology like they now plan to do after the fact. How about that?

It feels as if Vanderbilt has reps on this site.

Most everyone knows, '...if you didn't chart it you didn't give it'. Her manager told her not to sign/chart it. Why?

wondern, ASN · Apr 8, 2019

https://careertrend.com/facts-6730943-clinical-resource-nurse-job-description.html

From above link, first sentence..."A clinical resource nurse is actually a registered nurse whose responsibilities exceed that of a normal registered nurse..."

TriciaJ, RN · Apr 8, 2019

1 hour ago, wondern said:
Also, I don't speak Italian or Latin but I think Asystole called me ignorant above. Aww, so what but that's not very nice! It takes one to know one lady, whatever you called me!

I didn't know the meaning of the phrase, either, so I looked it up. The phrase means "irrelevant conclusion". It's when an assertion is made to refute something, but actually refutes something else which is not necessarily pertinent. So she didn't actually call you anything.

**canoehead, BSN, RN** · Apr 8, 2019

In the August 2016 ISMP Nurse ERR newsletter they talk about ten similar cases. Some just as careless as this one, but none of those people were charged. I don't think she used appropriate care, but she is definitely being used as an example.

TriciaJ, RN · Apr 8, 2019

57 minutes ago, wondern said:
Can we not have even a constructive conversation about it other than attacking our own and putting all the blame on her who probably already is punishing herself more than anyone else could ever! Just stop already.
Or maybe Vanderbilt could have a full time nurse in Radiology like they now plan to do after the fact. How about that?
It feels as if Vanderbilt has reps on this site.
Most everyone knows, '...if you didn't chart it you didn't give it'. Her manager told her not to sign/chart it. Why?

Just stop what, already? Engaging in a discussion on a discussion board? There has been very little attacking on these threads, except for a few people who go after those with whom they disagree.

Not too many of us sticking up for Vanderbilt, either. They have their own culpability, at least for how they handled the situation after the fact.

It's not unusual for hospitals to make sweeping changes after one person messes up. But I thought they already had nurses in Radiology. Like the ones who refused to give the Versed because they weren't in a position to monitor the patient afterwards.

wondern, ASN · Apr 8, 2019

Stop blaming the nurse for the entire thing! She feels bad enough I'm sure.

No culpability on Vanderbilts part before the fact though? None? Really?

They used her as a 'Resource Nurse', TriciaJ. Was that okay? Obviously not.

She was orienting another employee even who also did not catch it.

Why use a new nurse to float all over the medical center? Short staff?

Yes, maybe her unit was staffed well but Radiology evidently was not. I think they said the tech could not stay to monitor but I did not see where there were other nurses there. I could be wrong.

TriciaJ, RN · Apr 8, 2019

12 minutes ago, wondern said:
Stop blaming the nurse for the entire thing! She feels bad enough I'm sure.
No culpability on Vanderbilts part before the fact though? None? Really?
They used her as a 'Resource Nurse', TriciaJ. Was that okay? Obviously not.
She was orienting another employee even who also did not catch it.
Why use a new nurse to float all over the medical center? Short staff?
Yes, maybe her unit was staffed well but Radiology evidently was not. I think they said the tech could not stay to monitor but I did not see where there were other nurses there. I could be wrong.

Check out the TBI report. That should help clear up a whole lot of this.

Wuzzie · Apr 9, 2019

19 minutes ago, wondern said:
Stop blaming the nurse for the entire thing! She feels bad enough I'm sure.
No culpability on Vanderbilts part before the fact though? None? Really?
They used her as a 'Resource Nurse', TriciaJ. Was that okay? Obviously not.

But Wonder she was responsible for the whole thing. She ignored every safety measure that was put in place by the hospital and didn’t follow any of the standards of safe medication administration that even a first year nursing student understands. What Vandy did after is an entirely separate issue. As far as her being a resource or help-all nurse. Basically it’s just an unassigned nurse who is free to help with tasks. Someone with 2 years experience is more than qualified to fill this role. The job description you provide dis ha entirely different thing.

wondern, ASN · Apr 9, 2019

Okay. I thought I did check it out but I'll go back. Thanks.