Nurse Charged With Homicide

[Nurse Beth]

Radonda Vaught, a 35 year old nurse who worked at the University of Vanderbilt University Medical Center, has been indicted on charges of reckless homicide. Read Nurse Gives Lethal Dose of Vecuronium

Radonda is the nurse who mistakenly gave Vecuronium (a paralytic) to a patient instead of Versed. The patient died.

[NurseJenRN1975]

There is absolutely NOTHING that an undo or make this situation OK for that poor patient or her family. NOTHING. With that being said, making the RN a scapegoat for a broken system just adds insult to injury in my opinion. There were MANY breakdowns that occurred to create this horrible scenario and not all of them were the fault of the nurse in question.

Number one, Versed should never have been ordered. It’s inappropriate. Overkill. A little Valium or Ativan would have done the trick without placing the patient in as much risk.

Second, the doctor should have put in the order himself. (Or herself—whichever is appropriate). All to often, we as nurses receive verbal orders that are then supposed to be entered into the patient’s charts as an actual ORDER but are not. We are then forced to put in the order ourselves and/or OVERRIDE the existing electronic MAR, in order to get the medication that the doc gave us a verbal order for. Having to override meds should not be the norm, but all too often, it is. It has become so frequent that we can all do it on autopilot.

Third, nurses need to educate themselves frequently in order to stay abreast of current drugs’ brand names and generic equivalents. “Midazolam” and “Vecuronium” are not even close to sounding alike, just as “Versed” and “Norcuron” do not sound alike. This lack of knowledge on the part of the nurse is a poor respresentation of our profession.

Finally, EVEN IF she’d pulled and administered the CORRECT medication, the patient should have been closely monitored for respiratory depression during the scan. A cardiac monitor with pulseox and BP monitoring capabilities should have been the standard of care.

I think that we can all agree that the acceptable and appropriate standards of care were not upheld in this incident and the nurse should be disciplined appropriately for her failure to do these things that should have been automatic.

However, the physician is not innocent in all of this. His or her failure to enter the order into the system in a timely manner could have prevented this entire scenario. Had the med popped up in the patients MAR, an override would not have been necessary.

Another safety feature that would have helped prevent this tragedy would have been to require another RN to validate the action of pulling and administering a paralytic drug, especially one not currently listed on the patient’s MAR, requiring an override on the part of the nurse. Paralytics are dangerous drugs that should be treated with respect and double-checked for the safety of the patient. I mean, good Lord, we do that with regular insulin and blood products—why not PARALYTICS???

In my opinion, handling this situation in a manner similar to narcotic abuse would be the most appropriate response. Suspend her license, fine her if you want, require further education and remediation, then SLOWLY, allow her to work under the supervision of a mentor and give her a chance to redeem herself. This is not a person who woke up that morning and said to herself, “ I want to kill a patient today.”

Criminal charges are overkill to be polite, and in my opinion are only being considered because she is “just” a nurse. Nurses have been, and always will be the “fall guy” for docs and broken healthcare and/or hospital systems. It’s much easier to just fire the nurse, yank their license, and do nothing to address the physician’s role in all of this nor does it address the failure of the PROCESS. IT SHOULD NOT HAVE BEEN SO EASY to pull and administer a DANGEROUS and life-threatening medication such as a paralytic.

Just my 2 cents.

[Smiles0426]

All nurses know protocol for meds. She deserves to be charged.

[offlabel]

....

[Yosemite9000]

First off, does this nurse have a record of making med errors? Was she over-worked? Everyone likes to hop on the hate bandwagon against nurses to feel good about themselves but no real details have been released as far as I know. Also, the hospital should be held accountable as well, especially if this was not the nurses regular area and if the hospital didn't have safety protocols in place. Additionally, like someone pointed out before, if this was an MD, would you react differently? Should she get away scott free? No, she didn't follow the 6 rights. She should have her license suspended pending satisfactory re-education with strict restrictions for a while. Should she be convicted of murder? No. Should the hospital be held accountable for the mistake? Yes. And they should be under a microscope until stricter protocols are put into place. This type of thing has happened before but you don't hear about it. If you take a look at certain correctional institutions in the past 10 years, many had high mortality rates and plenty of med errors forcing the state to take control and instill proper protocols.(I'm writing this from my phone, sorry in advance for errors)

[Bumex, DNP, NP]

On 2/5/2019 at 8:46 PM, Nurse Beth said:

Red or white? ?

Sounds like a red to me. I always like a red to go with my nursing stories at night.

[mtmkjr, BSN]

I came across a Facebook comment section today where a nurse, I believe, from radiology who spoke as if she was there that day, was saying that the reason the helper nurse came to administer the sedation was because the radiology nurses refused to give it to an unmonitored patient.

She went on to say that the ability to communicate with patients undergoing the scan is there, and that having just received the supposed Versed, the techs or whoever was doing the scan should have been communicating with her. Simply asking her how she was doing would have alerted them that something was wrong when she didn't answer.

[Kratoswife]

This is so sad. I hope she's not convicted. She just got her license and was made to be a resource nurse.

[hopeful14]

This is terrible for nursing. It will compromise safety everywhere as providers, doctors and nurses, will be afraid to report errors. One of her charges was the same charge the LPN who raped and impregnated the woman in Arizona was charge with: abuse of an impaired adult. Terrible. I know, we as nurses are responsible for the 5 patient rights when administering medications, but the hospital should have systems in place for patient safety as well. This case is a process failure rather than a criminal case and will erode what little trust there is between management and frontline health care providers. The hospital is reacting to CMS coming down on them for not implementing process improvement around this incident, it has made her a scape goat AFTER the Tennessee Board of Nursing reviewed the case and did not find cause to revoke her license. This is something I feel surprising strong about. I am terribly sorry for the woman who lost her life (I have been there having lost my mother to medical error in 2010), but I also feel terrible for this nurse who is being "hung out to dry" for an accident that was not intentional....Human error. This case is setting a dangerous precedent. IMHO.

[LovingLife123]

This is absolutely crazy that she is being charged. By doing this, nurses will no longer report errors and new safety measures will never come about.

This was a med error. A tragic med error. After reading comments online, and now in here, it’s very obvious that many nurses don’t understand that in the ICU, it’s common to override paralytics. Overrides do not require a second nurse. Try finding one in an emergent situation. Yes, paralytics have a bright, orange label. They are not only found in anesthesia carts. Anesthesiologists do not come to paralyze your patient. Nor is versed only used for procedures. It’s often given for anxiety.

I’m not understanding why this patient was not on a monitor. I’m guessing this nurse was not an icu nurse. I don’t know why she thought to give IV versed an hour before a procedure. It’s very obvious she didn’t understand the med she was giving, or the med she was supposed to give. But neither have many of the nurses I’ve seen comment online. She was obviously placed in a position she was not qualified to do. That’s not only on her, but her superiors.

It reflects to the fact that Vanderbilt does not adequately train and orient nurses to positions. That’s on them. They needed a fall guy. They are blaming an inadequately trained nurse which is their fault.

She did a lot of things wrong. But it’s not the Pyxis fault, pharmacist, or doctors fault. We have to be able to override the Pyxis in the icu. On my last shift, I had two emergent situations within an hour that required overrides. There was no second nurse available to leave that room to second verify an override. There were no orders yet, and no time to wait in pharmacy to verify even if we had orders.

I’m sure this nurse is beating herself up, she should. Should she ever practice again? I don’t know. But we can’t live in fear of criminal prosecution for med errors.

How about we first prosecute the patients who have assaulted me? Oh yeah, that’s right, we don’t. But we sure as heck will prosecute no malice, no intent. But the guy who kicked me on the head last week maliciously or the guy who spit on me doesn’t get anything. Not even a reprimand from the hospital. Sounds about right.

It angers me.

[TriciaJ, RN]

4 hours ago, OnTheGo1989 said:

Well I don't even think that she should lose her license.. that is her livelihood - what's she gonna do now? flip burgers? I don't think so and I wouldn't wish that on anyone.. I'm SURE she already learned her lesson - maybe put practice restrictions on her but not lose her license. I'm sure jobs will be very limited but give her a chance to salvage herself. I mean, I feel like there are many doctors out there who also commit mistakes that ends people lives and they are still practicing.

Flipping burgers is one option. By your logic, no nurse should ever lose her license since nursing is her livelihood. As far as learning her lessons, those lessons were all taught in nursing school. She didn't learn them then.

If doctors are commiting such egregious practice errors they should lose their licenses too. And flip burgers if need be. Whether justice actually prevails is another thing altogether.

[TriciaJ, RN]

3 hours ago, Roseann M said:

Perhaps there should be more stringent controls for the Vecuronium? Ie; 2 nurses to verify? I'm sure a physician would not have been charged- a nurse should not be charged unless she had intent to harm.

1. She didn't know she had vecuronium. 2. She bypassed all the other safety measures. 3. There wasn't another nurse in the area.

Nope. The patient would still be dead.

[rural-rn-15, ADN, BSN, RN]

If you read the report of the investigation (which was available online when this was in the news a while ago):

1) she admits she did not even look at the name of the medication on the vial. Zero checks. Zero. For what would have been a high-risk medication even if it was Versed.

2) She overrode the Pyxis and selected "the first drug that started with a V" from the list.

3) She administered the drug and then left right away. Again, even if the drug was Versed, you do not leave a patient alone and unmonitored after a dose. Patients sedated with IV Versed should have Q5 vitals and sedation checks.

This isn't just an oops that could happen to anyone and it just happened to have dire consequences this time. This is a failure to act as a prudent nurse. No matter what department you work in, no matter where you're floated, no matter what the medication even, it's our bound duty to double- and triple-check the med against an order. It's our duty to know the med we are giving and its side effects. I know it's terrifying and I know we are all seeing ourselves in her shoes but in my opinion, this is not an "all nurses are human" type of error. It's criminal negligence.