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.

[Susie2310]

3 hours ago, Lorie Brown RN, MN, JD said:

Every day nurses are put in difficult situations. If criminal charges are looming over our head, who would want to be a nurse?

This was not just a nurse error but a system error.

"If criminal charges are looming over our head, who would want to be a nurse?" Being charged with a criminal offense is not the same as being convicted of a criminal offense. Nursing/medicine aren't specially sanctified fields where the licensed professionals should expect to receive preferential treatment.

Every day licensed professionals in a variety of fields are put in difficult situations; it isn't just nursing/medicine. Any professional occupations that involve public safety where the licensed professionals are trained in safety procedures and fail to adhere to them with harm/death resulting to members of the public can be subject to criminal charges. Why require professional licensure if licensed professionals aren't held to professional standards of practice? The licensure is meant to protect the general public, and the licensed professionals are held to certain industry standards of practice and conduct - this is for the protection of the PUBLIC, not for the protection of the licensed professional.

It's not inappropriate for criminal charges to be brought where the circumstances and information available appear to warrant this, when an investigation of what happened has taken place. Some nurses appear to think that all "errors" in care that result in patient harm or death, however caused, should simply be dealt with informally, as a "systems error" with no legal consequences for the nurse. I think we need to grow up a bit and recognize that we are held legally responsible and accountable for the care we provide, and that our failures to practice to professional standards can indeed lead to criminal charges. I have known this since nursing school.

[Workitinurfava, BSN, RN]

Over-riding is all in just pushing yes, yes, yes etc. The machine is like okay, so here you go. It is not a human. It can only help you so much. I wonder why we are required to train nurses at the pyxis? I thought that as a nurse you were to be a the pyxis alone and undistracted.

[brandy1017, ASN, RN]

22 hours ago, juan de la cruz said:

Well, you know it's not

In response to the hell that rained down on Vandy and the threat to withhold medicare/medicaid funding, ( I missed the entirety of your quote Juan de la cruz, sorry). That's because they tried to cover it up! They were not forthright with the coroner or the charting in the patient's chart. Frankly, I'm not impressed with a hospital that makes nurses do housekeeping because that is all about Florence Nightingale as they made that pitch a few years back when they were cost cutting! They don't impress me at all!

I agree the nurse was very careless, pulling out the med and not looking at it, not seeing the paralytic warning because she was too busy talking to her orientee. Sad that a 2 year nurse is considered experienced enough for a resource role, but that is what things are coming to when you drive out the majority of the experienced staff due to poor working conditions!

Back before the corporate take over we had educators on the floor who really did there best to help nurses do a good, safe job and provide quality care. We actually had a "no talking" policy in the med room and we were not supposed to be interrupted during med pass to help prevent med errors. Sadly the educators all got the boot after the takeover. Everything is now on the computer even ACLS which is crazy if you ask me!

Also if there was a med scanner in MRI this med error probably wouldn't have happened, but they the great Vandy hadn't gotten around to spending the money on that yet! So yes they bear some responsibility too!

[student24]

This is such a sad situation. We as nurses dedicate our compassion and care for patients even in stressful time. We are humans and mistakes occur, why are nurses always punished for errors. This will make the shortage of nurses even worse, frontliners are scared to implement any task because at the end of the day, the nurses are always blame. I hurt for this nurse and hurt for the patient and family. We cannot blame because we do not know the whole scenerio, this could have been one of US. We need to band together and not throw this nurse under the bus, we all know how this occupation can be demanding.

[brandy1017, ASN, RN]

19 hours ago, AlTennRN said:

I worked at Vanderbilt for a few years up until last month. (I only left so I could stay st home with a baby). The “help all” Nurse is an extra nurse that is staffed to go around helping anyone who needs help and who helps cover lunches. If you’re busy and a pt needs a new IV or a glucose stick or help pulling up a pt, etc...it’s just an extra set of hands (and a brain) to keep everyone caught up. There is no extra training required beyond an RN license. Normally though the “help all” might watch the other nurses patients so he or she could run down to radiology and administer the medication themselves.

Too bad that isn't what happened. Why wasn't the resource RN used to cover for the ICU nurse rather than give the versed? Yes I read the ICU patient's nurse was covering another nurse's patients, but couldn't the resource nurse had done that as she had been an ICU nurse before?

If you worked there and that was the common protocol why did things break down like this? Just asking your opinion.

I've never given versed and wouldn't remember myself the generic name although I do know conscious sedation requires monitoring and there appears to have been no plan in place for the resource nurse to stay and monitor the patient. Was there a miscommunication, did she think the radiology nurse would be monitoring the patient? Where I work the radiology nurse would be able to give the med and monitor the patient.

[student24]

1 hour ago, jjmadigan said:

Yes - because the medication error is directly related to the nurse overriding safeguards of the hospital’s medicine dispensing cabinet. According to a CMS investigation report, the death occurred because Vaught could not find Versed. She triggered an “override” feature that unlocked more powerful medications. She then typed the first two letters in the drug’s name – “VE” – and selected the first medicine suggested by the machine, not realizing it was vecuronium, instead of Versed. The prudent nurse would NOT have 1) overridden the dispensing cabinet 2) typed in only the first two letters of the medication 3) removed the wrong medication 4) administered the wrong medication. Under the law this charge is justified.

33 minutes ago, brandy1017 said:

In response to the hell that rained down on Vandy and the threat to withhold medicare/medicaid funding, ( I missed the entirety of your quote Juan de la cruz, sorry). That's because they tried to cover it up! They were not forthright with the coroner or the charting in the patient's chart. Frankly, I'm not impressed with a hospital that makes nurses do housekeeping because that is all about Florence Nightingale as they made that pitch a few years back when they were cost cutting! They don't impress me at all!

I agree the nurse was very careless, pulling out the med and not looking at it, not seeing the paralytic warning because she was too busy talking to her orientee. Sad that a 2 year nurse is considered experienced enough for a resource role, but that is what things are coming to when you drive out the majority of the experienced staff due to poor working conditions!

Back before the corporate take over we had educators on the floor who really did there best to help nurses do a good, safe job and provide quality care. We actually had a "no talking" policy in the med room and we were not supposed to be interrupted during med pass to help prevent med errors. Sadly the educators all got the boot after the takeover. Everything is now on the computer even ACLS which is crazy if you ask me!

Also if there was a med scanner in MRI this med error probably wouldn't have happened, but they the great Vandy hadn't gotten around to spending the money on that yet! So yes they bear some responsibility too!

It is the hospital fault and of course the nurse should have some responsibility but lets not eat our young and see the big picture. This nurse should not be in jail with criminals because honestly this was an accident, her license should be revoked (that's it). These health facilities have to face fault too because they put US in situation where we are stressed and do the best we can with what we have until something like this go wrong. Sometimes I wonder why nurses never stick together, you know how demanding the profession is. Thank GOD I left bedside because of nurses like you that immediately would throw another nurse quickly under the bus. This is soooo sad but it should bring awareness to these health organization that increases the staff ratio because these are one of the event that could occur.

[JKL33]

34 minutes ago, jjmadigan said:

The prudent nurse would NOT have 1) overridden the dispensing cabinet 2) typed in only the first two letters of the medication

Comments like this make me suspect that people don't know anything about the override function.

The purpose and function of "override" is NOT to "unlock more powerful medications" as some reporter wrote. There's a reason why, historically, every staff nurse who might remotely ever need enact "NOW" or "STAT" orders has been able to override. EASILY. As an expected means of acquiring necessary medication. People are acting like override is some technological vault that you have to break into with the technological version of a crowbar and dynamite while flashing lights and fire alarms blind and deafen you.

It is not that, and it is used all the time.

The primary mistake/error/reckless choice was in not conscientiously looking at the screen and vial. Period.

[Wuzzie]

19 minutes ago, student24 said:

We are humans and mistakes occur, why are nurses always punished for errors. This will make the shortage of nurses even worse, frontliners are scared to implement any task because at the end of the day, the nurses are always blame.. We cannot blame because we do not know the whole scenerio, this could have been one of US.

Read the CMS report for a detailed description of what happened.

[Wuzzie]

6 minutes ago, student24 said:

It is the hospital fault and of course the nurse should have some responsibility but lets not eat our young and see the big picture. This nurse should not be in jail with criminals because honestly this was an accident, her license should be revoked (that's it).

This has nothing to do with nurses eating their young.

[Daisy4RN]

6 minutes ago, JKL33 said:

Comments like this make me suspect that people don't know anything about the override function.

The purpose and function of "override" is NOT to "unlock more powerful medications" as some reporter wrote. There's a reason why, historically, every staff nurse who might remotely ever need enact "NOW" or "STAT" orders has been able to override. EASILY. As an expected means of acquiring necessary medication. People are acting like override is some technological vault that you have to break into with the technological version of a crowbar and dynamite while flashing lights and fire alarms blind and deafen you.

It is not that, and it is used all the time.

The primary mistake/error/reckless choice was in not conscientiously looking at the screen and vial. Period.

Exactly!! The last hospital job I had nurses used the override function on a daily basis because of necessity, it was no big deal (and this was med-surg). What do people think nurses did prior to having med dispense machines.

The (human) error was the nurse overriding safe practices (which could be done with or without a pyxis), but I still think that if she is held legally responsible then the hospital should be as well.

[JKL33]

7 minutes ago, brandy1017 said:

I've never given versed and wouldn't remember myself the generic name although I do know conscious sedation requires monitoring and there appears to have been no plan in place for the resource nurse to stay and monitor the patient. Was there a miscommunication, did she think the radiology nurse would be monitoring the patient? Where I work the radiology nurse would be able to give the med and monitor the patient.

A minor point of clarification:

A single dose of a benzodiazepine, whether po/IM/IV, is not considered conscious/moderate sedation. Not trying to nitpick, but I think people are imagining some big procedural sedation thing.

A single small dose of versed is considered "minimal sedation" aka anxiolysis, and is not expected to affect airway, ventilatory, or CV function. Per the ASA. However, a reason to do very basic monitoring is that the provider is expected to be prepared to manage a situation where expected sedation ends up affecting a patient differently/results in a deeper level of sedation than the one planned. So yes, the patient clearly and obviously should have had basic monitoring, and the setting in which the patient receives 'minimal sedation' should be one where handling an unexpected effect is easily possible.

[JKL33]

Just to play devil's advocate...

How many patients actually do receive some kind of "minimal sedation" in settings like this, and is that (ever) appropriate?

Are PET scan/outpatient radiology departments prepared to quickly rescue a deeper level of sedation down in their PET scan area? In this particular case, they have testified to CMS that they can't decipher whether a patient is breathing or not...