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.

[Wuzzie]

1 minute ago, indienurse said:

Our Pyxis looks for generic or brand names.

That wouldn't have made a difference in this situation unfortunately.

[JKL33]

Except that if she was searching on a brand list...Versed would've come up.

[Horseshoe, BSN, RN]

10 minutes ago, Wuzzie said:

Makes me wonder if the medication actually was available in the patient's profile (contrary to what she said) but was listed as Midazolam and she didn't know that was Versed hence the override. ?

If I were a betting person, I'd lay very great odds that you are correct. Sounds like a very inexperienced nurse-so even more mind boggling that she was given the additional responsibility of TEACHING an orientee. Just crazy.

[JKL33]

I don't know what happened but originally it read to me as completely rote behavior. [not defending that]. Rote as in, 'The [cabinet I usually use] has a default setting that is brand names.'

Hell that's why she wanted VE to begin with.

If she wasn't used to getting things out by brand name then I guess she would've typed MI

[JadedCPN, BSN, RN]

1 minute ago, Horseshoe said:

If I were a betting person, I'd lay very great odds that you are correct. Sounds like a very inexperienced nurse-so even more mind boggling that she was given the additional responsibility of TEACHING an orientee. Just crazy.

Mind boggling, yet also not surprising at the same time. I am still always surprised to float to different units and find a nurse with just a year's experience orienting a new grad. It has become the norm, and not just at my current hospital but previous ones as well.

[Wuzzie]

2 minutes ago, JKL33 said:

Except that if she was searching on a brand list...Versed would've come up.

Can you switch a patient's profile back and forth between Generic/Brand on an Accudose? I'm more familiar with Pyxis and I just checked and we cannot.

[mtnNurse., BSN]

1 hour ago, SaltineQueen said:

I don't know that I agree with "deserved to be charged" but LEGALLY this fits the definition of reckless homicide.

What she did does not fit the definition of reckless homicide. Hopefully I chose a good source to quote the following:

Quote

Reckless vs. Criminally Negligent Homicide

Reckless homicide and criminally negligent homicide are more loosely defined in Tennessee to address the wide variety of behaviors that could be considered beyond the realm of acceptable to the degree that the actions are criminal. One example of reckless homicide is playing Russian roulette by picking up a gun with a single bullet in it and shooting it at a friend. There's a substantial risk the friend will die. In comparison, picking up a gun you believe is empty but failed to check before shooting at your friend could be criminally negligent, as you should have looked to be sure it was empty but had no knowledge or belief that it was loaded.

"Beyond the realm of acceptable to the degree..." -- this subjectivity is why we're debating whether she should be charged. The behavior that we all regard as unacceptable is that she grabbed the wrong medication and administered it. Grabbing the wrong medication and administering it is unacceptable -- but not to the degree of being criminal. Why is it not criminal? Because depending on what led up to her horrible mistakes, we might be able to understand how she ended up in the unaware mindset she was in to make such a mistake. Anyone who has worked as a nurse in an understaffed hospital could make a long list of factors that could, if all horrifically aligned in one moment, cause mistakes of this magnitude.

She was not aware in those moments that she was picking up a loaded gun and shooting it at the patient -- she should have been aware (as people wisely pointed out, all nurses should always be aware that any medicine could be fatal to any patient) -- but she was not aware. If she had the presence of mind to think she might possibly kill this patient, then she would have had the presence of mind to double-check what the medicine was.

So if anything, what she did fits the definition of criminal negligence, not reckless homicide.

[Nightowl805]

Dear Beth,

This is very much a system’s problem. These electronic medication dispenser’s (Phyxsis, Omnicell) have a huge problem. Why don’t the databases display both brand and generic names and searchable by both. It’s fairly obvious that she did not remember midazolam by it’s generic name. Many times a medication can be entered under either name depending on the dose. This is such an easy fix that would enhance all of us....always list both names and searchable by both names. Also, why is it that not every single hospital is using a scanning system at the bedside....could it be cost? Patients are not worth more then inventory systems at almost every single store?

Make no mistake, we all know she made a horrendous mistake at many levels. As much as we want to perfect we have all been imperfect in our careers. She will loose her license and now potentially face prison time along with a felony? Why do I want to continue to be a nurse? You want us to step forward and admit when we make mistakes? This is a political hit job, nothing more. I hope a jury can see through this. It’s tragic beyond belief.

[ruby_jane, BSN, RN]

So much is wrong.

Yes, she blew through every safeguard imaginable and failed to properly monitor a patient whom she thought was getting versed. Med error, failure to provide care...for that, she goes to her BON.

Yes, it seems that the hospital has thrown her under the bus to salvage their ability to bill CMS. Because she was the last to check. Which is what we do. Which is why I hate hospital nursing.

And yes...I think it's overreach on the prosecution of this case (but I don't disagree with those who've presented that while she didn't do it on PURPOSE, she wasn't CAREFUL.) But I think that's a BON issue to decide.

The whole thing has made me stop and think more, though. We get into the habit of doing things by rote. Sometimes the rote needs a bit of shaking up.

[JKL33]

8 minutes ago, Wuzzie said:

Can you switch a patient's profile back and forth between Generic/Brand on an Accudose? I'm more familiar with Pyxis and I just checked and we cannot.

I can. Yes. Now. But that is something that, like every blanking other thing, has changed, changed back, and changed again.

All of these things relate to how someone programmed the capabilities of that particular machine. And they haven't always been uniform throughout departments/units.

My original "take" back in December was that she typed VE (because she is used to being able to get her med that way/brand name). The med didn't come up, and she thought that was because it wasn't there and it was supposed to be. Another thing that happens not infrequently.

She did wrong. But all of this (and more) is why I'm saying there is more.

I mean, if "override" is some big ginormous procedure, then it wouldn't be one's automatic instinct.

Meh....another med not profiled correctly...override.

[Wuzzie]

2 minutes ago, Nightowl805 said:

Why don’t the databases display both brand and generic names and searchable by both. It’s fairly obvious that she did not remember midazolam by it’s generic name. Many times a medication can be entered under either name depending on the dose. This is such an easy fix that would enhance all of us....always list both names and searchable by both names.

Even if it was and we don't know for a fact that it wasn't it wouldn't have mattered because all she typed in was "V-E" and selected the first med that came up without even looking.

[LibraNurse27, BSN, RN]

I agree she most likely did not know that midazolam was the generic name for Versed and also did not know much about the effects of Versed or monitoring usually associated with it. However since it was not emergent or even urgent to give this medication she should have taken the time to ask someone about the medication or ask for help when she couldn't find it rather than overriding it. And she DEFINITELY should have looked at the vial, after she pulled it, while she was drawing from it, before she administered the med... at all the times when nurses are supposed to look at what they are doing.

I understand nursing is super stressful and there is pressure to get things done quickly and it is difficult to find someone who is available to consult with. However it is much better to be reprimanded for being too slow because you insisted on doing things safely than to cause injury or death.

I am afraid to ask this but I have a safety question regarding a practice at my facility: We do not have a monitor that we are able to bring into the MRI room (poor community hospital!) so if a patient cannot be off monitor we have to wait for them to be stable to do MRI. If the patient is claustrophobic sometimes the doctor will order PO ativan 30 mins to one hour before (usually 0.5mg for patients with no benzo tolerance and 1-2 mg for those chronically using benzos) and in some cases they order IV (with same dosing as the PO but 5 to 15 mins before or to be given during the MRI if patient gets anxious during the test). In this case we are expected to wait for order and pharmacy verification, pull the med (not override) and scan, etc. but we ARE expected to go to MRI and give it and then go back to the floor to care for our other patients. I usually stay for a few minutes or ask someone to stay if I am truly worried about the patient. Also the MRI techs talk to the patient continuously and can see the patient during the entire scan. They call us immediately if any concerns. I know ativan is different than versend and 0.5mg is not much but after reading this I am so nervous about this practice. Would it be best to advocate that a nurse needs to stay in MRI if a patient gets any type of possibly sedating med? We are always short staffed so will be difficult to implement but I don't want to compromise patient safety. Thanks all!