Nurse Charged With Homicide

johsonmichelle · Feb 9, 2019

9 minutes ago, johsonmichelle said:
No do you have the link? Even amongst ICU's , there can be differences, although from my research, versed is commonly given in the ICU. Was the nurse involved familiar with that unit? Also it appears that hospital has issues for a fairly newer nurse to already have an orientee. Speaking of the physician, was the original order of versed , even appropriate for the patient and situation?

johsonmichelle · Feb 9, 2019

1 minute ago, Tenebrae said:
I would never give a medication that I didnt know what it was for.
I certainly would never pull a medication and give it without double checking it against the order. I work as an agency nurse (think resource nurse) and one day am on a pysch ward and the next day doing conscious sedation for women undergoing egg harvesting in a fertility clinic. I make damm sure I understand the drugs and the protocols before jumping in at the deep end.
And its somewhat of a moot point in this case anyhow the nurse was specialised as an ICU nurse, so should have known the difference between versed and vercuronium

I look up medication before I administer them especially one thats I'm not so familiar with. Plus I would not work in any area that I do not recieve proper adequate training to work. From what I have witnessed, a float pool nurse is suppose to have adequate training/ work experience in the areas they are being pulled to work.

Wuzzie · Feb 9, 2019

12 minutes ago, johsonmichelle said:
No do you have the link? Speaking of the physician, was the original order of versed , even appropriate for the patient and situation?

It’s on page 14 of this thread. Yes the medication was appropriate. In fact if you read the report you’ll see that it was ordered as 1mg Midazolam with an additional 1mg to be given if the first wasn’t enough. Which seems to imply that the physician expected the nurse to stay with the patient. What she actually did was push what she thought was the entire 2mg dose of Midazolam at one time (she admits she has no idea how much Vecuronium she actually gave) and then left the patient alone in the holding room after telling the rad tech that she didn’t need monitored.

Workitinurfava, BSN, RN · Feb 9, 2019

Was something medically wrong going on with the nurse? Was she looked at for having experienced any psychiatic issues at the time of the incident? Was she drug tested? Something is very odd about about this whole situation. It may come out later that she has some psychiatric issues. It just seems that if she is going to be charged with homicide that she should be given the proper mental evaluation like all other criminals that are charged with homicide. Shouldn't she be given the opportunity to claim insanity?

johsonmichelle · Feb 9, 2019

10 minutes ago, Wuzzie said:
It’s on page 14 of this thread. Yes the medication was appropriate. In fact if you read the report you’ll see that it was ordered as 1mg Midazolam with an additional 1mg to be given if the first wasn’t enough. Which seems to imply that the physician expected the nurse to stay with the patient. What she actually did was push what she thought was the entire 2mg dose of Midazolam at one time (she admits she has no idea how much Vecuronium she actually gave) and then left the patient alone in the holding room after telling the rad tech that she didn’t need monitored.

I read the report and I still stand by my points. The nurse was negligenent , no doubt, but there is also systematic problems that worsened the situation. The nurse should definitely be disciplined by the board of nursing, but charging her with criminal charges is just too much.

Advanced Practice Columnist / Guide · Feb 9, 2019

9 hours ago, JKL33 said:
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...

PET Scans are typically out-patient tests. The equipment is similar to a CT scanner and not remotely similar to MRI which has more restrictions as far as monitoring equipment that can be used while the test is happening. The patient was lying on an ICU bed in a room where she received a radioactive material and the Radiology Tech was in another area (maybe looking through a window) while waiting for the prescribed "dwelling in period" for the radioactive dye to work and allow the test to happen.

If I remember right, it was going to take an hour for the test to actually start. Maybe that was the reason why the Tech asked Ms. Vaught if the patient needed to be monitored. Based on Ms. Vaught's response, she really thought she gave Versed because she said she only gave 1 mg (or 1 ml) and that the patient may need more. She left the premises while saying to the Tech that another nurse will come down to see the patient maybe hoping that by then the primary nurse would be available since the test wasn't going to be quick.

Again, these are all conjecture. I guess the question is why was it so important for this patient to get the PET Scan in such a hurry? It wasn't going to affect the patient's plan of care at that point. To me, this is a situation that calls for more open communication between providers and nurses. If the nursing staff in the ICU were so busy that day, the providers should have been made aware of the situation and maybe agree to cancel the test especially since the kind of medication that was ordered for her to tolerate the test wasn't so simple.

The case is actually quite tiring to dissect to be honest. But then again, it boils down to a nurse not observing the 5 rights and not being prudent enough to allow enough time to assess a patient's response to an IV medication that she administered which led to the patient's demise. It's a classic case of "what should have been" and I've seen other nurses make a similar mistake that did not end up getting sensationalized as this one.

We are now in the social media era and public outcry towards incidences like this one are ripe for triggering emotional responses from both sides especially when words such as "murder" is being invoked. Unfortunately, I feel that criminal prosecution is going to be a trend in dealing with high profile malpractice cases such as this one.

Medic_to_BSN, BSN, RN · Feb 9, 2019

10 hours ago, JKL33 said:
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...

At least in the ER (all I can speak for at the moment), sedating pain medication is routinely given before and during imaging procedures (primarily for pain, of course). Usually opiates as opposed to benzos, but still sedating and CNS depressant. SpO2 and other telemetry is still watched carefully.

mtmkjr, BSN · Feb 9, 2019

36 minutes ago, juan de la cruz said:
PET Scans are typically out-patient tests. The equipment is similar to a CT scanner and not remotely similar to MRI which has more restrictions as far as monitoring equipment that can be used while the test is happening. The patient was lying on an ICU bed in a room where she received a radioactive material and the Radiology Tech was in another area (maybe looking through a window) while waiting for the prescribed "dwelling in period" for the radioactive dye to work and allow the test to happen.
If I remember right, it was going to take an hour for the test to actually start. Maybe that was the reason why the Tech asked Ms. Vaught if the patient needed to be monitored. Based on Ms. Vaught's response, she really thought she gave Versed because she said she only gave 1 mg (or 1 ml) and that the patient may need more. She left the premises while saying to the Tech that another nurse will come down to see the patient maybe hoping that by then the primary nurse would be available since the test wasn't going to be quick.
Again, these are all conjecture. I guess the question is why was it so important for this patient to get the PET Scan in such a hurry? It wasn't going to affect the patient's plan of care at that point. To me, this is a situation that calls for more open communication between providers and nurses. If the nursing staff in the ICU were so busy that day, the providers should have been made aware of the situation and maybe agree to cancel the test especially since the kind of medication that was ordered for her to tolerate the test wasn't so simple.
The case is actually quite tiring to dissect to be honest. But then again, it boils down to a nurse not observing the 5 rights and not being prudent enough to allow enough time to assess a patient's response to an IV medication that she administered which led to the patient's demise. It's a classic case of "what should have been" and I've seen other nurses make a similar mistake that did not end up getting sensationalized as this one.
We are now in the social media era and public outcry towards incidences like this one are ripe for triggering emotional responses from both sides especially when words such as "murder" is being invoked. Unfortunately, I feel that criminal prosecution is going to be a trend in dealing with high profile malpractice cases such as this one.

So the nurse told the tech she gave 1mg? I thought she gave the whole 2mg.

How did she even know how much she gave?

Advanced Practice Columnist / Guide · Feb 9, 2019

13 minutes ago, mtmkjr said:
So the nurse told the tech she gave 1mg? I thought she gave the whole 2mg.
How did she even know how much she gave?

It's a long read but it's all in the CMS report which Wuzzie linked to in one of her posts. She didn't tell the Tech that but she admitted later that she gave 1 ml (or 1 mg) of a drug she thought was Versed based on the math she did in her head after reconstituting the medication. Of note, Versed comes already reconstituted in a brown vial, vecuronium is supplied in a clear vial in powder form that must be reconstituted.

https://www.documentcloud.org/documents/5346023-CMS-Report.html?fbclid=IwAR2xQsxlfKxis4mecgrCSt-6XvKnSmKDeN7Sb_20is2oBbFICt_9xUDkyvQ#document/p6

HomeBound · Feb 9, 2019

1mL? She reconstituted 10mg of vec with 1mL of NS or SW?

Or did she actually take the 10mL of diluent that is supposed to be used, and then give 1mL?

Because I call b.s. on that. If she reconstituted with 10mL, then that meant she read the bottle. If she reconstituted with the range amount, which would have been 1-2mL, then that meant she gave 5-10mg of vec, depending on how much she really infused.

Here's the thing. If she reconstituted with 10mL, would that, right there....not be a huuuuuuuuuuuuuuuuuuuge red flag that this isn't the drug she wants?

Induction dosage is .05mg/kg for general anesthesia adjunct with sux. For relaxation it jumps to .15mg/kg.

This is for intubation with airway kit standing by.

Say patient weighed 150 lbs. That's 68kg. That's 3.4 - 6.0 mg of vec in order to paralyze for intubation.

If Ms. Vaught drew up 2mL of diluent, reconstituted the 10mg of vec, pulled 1mL and gave it?

She gave Ms. Patient 5mg of vecuronium. More than enough for an average sized woman to be induced for intubation.

If she gave 2mL? She gave enough to paralyze a 200 lb person at the low end.

If she diluted the vec with 10mL? She read the label. In other words, she's lying that she gave 1mL---because holding a 10mL syringe of versed? I don't think so.

The other thing that is really ticking me off is the deletion of her twitter, facebook, snapchat and all that social media--

her lawyer is advising her well. Why?

Because they can and will pull every single social media post of hers, and perhaps even get hold of her phone---to see if she posted anything in the minutes preceding or directly post infusion, when she should have been WORKING.

Put the phones down, folks. Just a word from an old timer. It's getting really, really disgustingly annoying to those of us who turn the phone off and do the job--to see you all on your phones. It's going to be a big thing at this point, that when a nurse is involved in these mistakes, their social media crap is going to be entered into evidence. IT SHOULD BE.

If Radonda is found to have been diddling on her phone during the hour this woman was dying?

Maybe THAT is exactly what tipped the prosecutor's office to charge her. Just a thought.

put the phones away.

Advanced Practice Columnist / Guide · Feb 9, 2019

29 minutes ago, HomeBound said:
1mL? She reconstituted 10mg of vec with 1mL of NS or SW?
Or did she actually take the 10mL of diluent that is supposed to be used, and then give 1mL?
Because I call b.s. on that. If she reconstituted with 10mL, then that meant she read the bottle. If she reconstituted with the range amount, which would have been 1-2mL, then that meant she gave 5-10mg of vec, depending on how much she really infused.
Here's the thing. If she reconstituted with 10mL, would that, right there....not be a huuuuuuuuuuuuuuuuuuuge red flag that this isn't the drug she wants?
Induction dosage is .05mg/kg for general anesthesia adjunct with sux. For relaxation it jumps to .15mg/kg.
This is for intubation with airway kit standing by.
Say patient weighed 150 lbs. That's 68kg. That's 3.4 - 6.0 mg of vec in order to paralyze for intubation.
If Ms. Vaught drew up 2mL of diluent, reconstituted the 10mg of vec, pulled 1mL and gave it?
She gave Ms. Patient 5mg of vecuronium. More than enough for an average sized woman to be induced for intubation.
If she gave 2mL? She gave enough to paralyze a 200 lb person at the low end.
If she diluted the vec with 10mL? She read the label. In other words, she's lying that she gave 1mL---because holding a 10mL syringe of versed? I don't think so.
The other thing that is really ticking me off is the deletion of her twitter, facebook, snapchat and all that social media--
her lawyer is advising her well. Why?
Because they can and will pull every single social media post of hers, and perhaps even get hold of her phone---to see if she posted anything in the minutes preceding or directly post infusion, when she should have been WORKING.
Put the phones down, folks. Just a word from an old timer. It's getting really, really disgustingly annoying to those of us who turn the phone off and do the job--to see you all on your phones. It's going to be a big thing at this point, that when a nurse is involved in these mistakes, their social media crap is going to be entered into evidence. IT SHOULD BE.
If Radonda is found to have been diddling on her phone during the hour this woman was dying?
Maybe THAT is exactly what tipped the prosecutor's office to charge her. Just a thought.
put the phones away.

Vecuronium is supplied as a 10 mg dose vial in powder form that must be reconstituted. The nurse mixed the powder with 10 ml of sterile bacteriostatic saline to make it a 1:1 concentration. The nurse gave 1 ml (or 1 mg) because the order was for Versed 1 mg IV x 1, may give another 1 mg x 1 if needed. She did read the instructions for reconstituting the drug but not the drug name and ignored the warning on the cap that says paralytic agent. The whole story is outright inconceivable but that's how it happened.

Again, this is all in the CMS report.

Advanced Practice Columnist / Guide · Feb 9, 2019

OK last point which I think is very important and could have saved this poor patient. Why doesn't Vanderbilt have bar code scanning for med administration in Radiology? All that is needed is a workstation on wheels with a scanner in all departments. I work for a similar-sized institution and nurses are not allowed to administer medications without bar code scanning in non-emergent situations, no exceptions!

Nurse Charged With Homicide

Should Radonda Vaught, the nurse who gave a lethal dose of Vecuronium to patient at Vanderbilt University Medical Center, be charged with reckless homicide?