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.

[Corey Narry, MSN, RN, NP]

2 hours ago, LovingLife123 said:

Why is the nurse who obtained the order and then sent the resource nurse to push it not also being held accountable? If we are going this far to charge this nurse, why not the other? How far does this go?

I'm curious why you think the primary nurse has culpability too. She clearly gave some sort of report to the "Help All" or resource nurse that the patient is in Radiology and needs Versed because she was anxious to undergo the PET scan. It is a case of "this is your mission should you choose to accept it..." and she accepted it and should carry the responsibility. Of note, the primary nurse was the one to discover the tell tale evidence...a baggie containing syringes and a vial of reconstituted vecuronium falsely labelled as Versed in pink ink.

[JKL33]

Well, Nurse #2 (primary nurse) is the one who got on the phone and argued with the rad techs after they said their nurses wouldn't push a med because the patient needed to be monitored. She shut that right down and told them that the patient didn't need to be monitored and that she would send someone down to give the med...

[Still not excusing Nurse #1!!]

[Corey Narry, MSN, RN, NP]

12 minutes ago, JKL33 said:

Well, Nurse #2 (primary nurse) is the one who got on the phone and argued with the rad techs after they said their nurses wouldn't push a med because the patient needed to be monitored. She shut that right down and told them that the patient didn't need to be monitored and that she would send someone down to give the med...

[Still not excusing Nurse #1!!]

Oh that is right! I had to re-read the report. Well then RN#2 (primary nurse) may have been guilty of downplaying the situation to RN#1 (help all nurse) making RN#1 assume that her role was really just to inject and leave. But I agree, at that point it's all on RN#1 to do the right thing and she didn't.

[Wuzzie]

10 minutes ago, JKL33 said:

Well, Nurse #2 (primary nurse) is the one who got on the phone and argued with the rad techs after they said their nurses wouldn't push a med because the patient needed to be monitored. She shut that right down and told them that the patient didn't need to be monitored and that she would send someone down to give the med...

[Still not excusing Nurse #1!!]

I wonder if there was some confusion over what was meant by “monitoring”. We kind of use it interchangeably to mean patient needs to be on an actual monitor and also we need to watch or monitor the patient. I’m betting the rad tech was talking about watching the patient since she was going to be in a holding area and Nurse #2 was talking about ECG/SaO2 monitoring. It’s a good point to bring up. We need to make sure we are understanding each other, especially between disciplines.

[JKL33]

1 hour ago, juan de la cruz said:

What's with the conspiracy theories? The investigation was conducted by the federal government through the CMS independently and quite thoroughly if one reads the report. All employees involved, Epic data, and Accudose (Pyxis) reports were corroborated.

Not picking on you, juan -

I did not find the report thorough.

If you are investigating a facility, how do you not ask more questions than that? Come on. They were sure to find out whether an alert had been placed on the Med Exec Committee agenda, but they weren't concerned about:

- Anything regarding the large discrepancy in preparation steps for Versed vs vecuronium (reconstitute) and the apparent utter lack of familiarity that would imply. There wasn't even so much as a "have you ever administered [x, y] before" or "how often would you say you administer [x, y]"

- Asking to see any sort of policy related to this particular situation of administering anxiolytics w/ sedation potential in outpatient departments

- Asking the rad techs or rad nurses what usually happens in a situation like this (i.e. any particular reason no one down there seemed to know that a nurse always does x, y, z [stays to monitor] in this situation - - - or don't they

- Asking to see proof that this RN was up-to-date on sedation education per usual competencies

- Asking anyone about normal staffing procedures and what the staffing was that day since the RO claimed zero knowledge of a "help-all" role and was allowed to make it sound like that was just some invention of the staff

- Asking why, under the circumstances, nothing in particular had been done with the baggie/evidence, but then noting the contents of the baggie as if it were some kind of evidence at that point...

- Asking whether anything about the pyxis process had changed/was in flux related to the new EMR...

I'm sure I'll think of more

None of this is to excuse the nurse. But remember, they were there to investigate the facility and whether it was capable of keeping patients safe. The nurse was long gone at that point.

ETA: And I am not endorsing any crazy conspiracy theories!!

[Corey Narry, MSN, RN, NP]

20 minutes ago, JKL33 said:

Not picking on you, juan -

I did not find the report thorough.

If you are investigating a facility, how do you not ask more questions than that? Come on. They were sure to find out whether an alert had been placed on the Med Exec Committee agenda, but they weren't concerned about:

- Anything regarding the large discrepancy in preparation steps for Versed vs vecuronium (reconstitute) and the apparent utter lack of familiarity that would imply. There wasn't even so much as a "have you ever administered [x, y] before" or "how often would you say you administer [x, y]"

- Asking to see any sort of policy related to this particular situation of administering anxiolytics w/ sedation potential in outpatient departments

- Asking the rad techs or rad nurses what usually happens in a situation like this (i.e. any particular reason no one down there seemed to know that a nurse always does x, y, z [stays to monitor] in this situation - - - or don't they

- Asking to see proof that this RN was up-to-date on sedation education per usual competencies

- Asking anyone about normal staffing procedures and what the staffing was that day since the RO claimed zero knowledge of a "help-all" role and was allowed to make it sound like that was just some invention of the staff

- Asking why, under the circumstances, nothing in particular had been done with the baggie/evidence, but then noting the contents of the baggie as if it were some kind of evidence at that point...

- Asking whether anything about the pyxis process had changed/was in flux related to the new EMR...

I'm sure I'll think of more

None of this is to excuse the nurse. But remember, they were there to investigate the facility and whether it was capable of keeping patients safe. The nurse was long gone at that point.

The report was thorough in terms of the analysis of the sequence of events but I feel that your questions were somewhat answered in some form in the report.

This situation wasn't a true sedation procedure and I doubt there are many ICU nurses out there unfamiliar with administering Versed under similar circumstances. Typically, if the intensivist intended a true sedation procedure, a provider would be present as that is outside the RN scope. The dosing instruction convinced me of that plan.

Policies and procedures don't always exist for everything and if you notice, the report invoked Lippincott's Manual of Nursing Practice at times in terms of validating the standard practice of nursing. PET scans being typically out-patient tests likely does not have clear policies as far as far as handling patients receiving IV benzodiazepines but the scenario involved an in-patient who is under the care of an ICU nurse, hence, the standard for how an ICU nurse would act will prevail.

I think there were glaring evidence of poor organizational structure on the part of Vanderbilt in how it wasn't really clear what the "Help All" nurse role is all about. I also think that a lot of your questions will come up in this nurse's cross examination in court.

[JKL33]

Yes, you bet I took note of the Lippincott and other references. And understand/agree.

It's just that if one is investigating a death and a facility's role in it, I would want to know what expert sources say should be happening here and I want to know exactly how you set yourself up to adhere to it. In detail. Maybe that is beyond the purview of this type of interaction/investigation.

[Corey Narry, MSN, RN, NP]

45 minutes ago, Wuzzie said:

I wonder if there was some confusion over what was meant by “monitoring”. We kind of use it interchangeably to mean patient needs to be on an actual monitor and also we need to watch or monitor the patient. I’m betting the rad tech was talking about watching the patient since she was going to be in a holding area and Nurse #2 was talking about ECG/SaO2 monitoring. It’s a good point to bring up. We need to make sure we are understanding each other, especially between disciplines.

That's a good point. Nurse 2's answer may mean, yes, she is coming down with a heart monitor and continuous pulse oximetry but not necessarily a nurse staying for the entire procedure not knowing the fact that the test requires the patient to be in an area away from being "eye balled" by anyone.

Remember it was a transporter that recognized that something was wrong. Did she actually have a heart monitor and continuous pulse oximetry on her? she should have and someone should have been present to look at it. That might have been another layer of patient protection since a low O2 sat alarm would have gone off.

[Corey Narry, MSN, RN, NP]

4 minutes ago, JKL33 said:

Yes, you bet I took note of the Lippincott and other references. And understand/agree.

It's just that if one is investigating a death and a facility's role in it, I would want to know what expert sources say should be happening here and I want to know exactly how you set yourself up to adhere to it. In detail. Maybe that is beyond the purview of this type of interaction/investigation.

Maybe, but you do raise a good point. I am just as curious with the questions you had.

[Nurse-Bell]

@SouthernLPN2RN wow really. So no consequences for her actions non whatsoever?? She killed someone! Charging her with homicide may be a stretch but forget just 're-educating' her. Accidents do happen and this was a horrible mistake. However, "nursing 101" if you don't understand something ASK FOR HELP, and the other principle when dealing with medications you don't know anything about RESEARCH and again ASK FOR HELP. How do you mix up those two medications and how did she even have access to the wrong medication?? You can't trust pharmacy is always sending the proper medication -- clearly she failed to either follow the 5 rights or just lacked competence altogether. I don't know all the details of the case. Nobody will ever know everything but as nurses we are held to a standard to at least practice prudence. We all have to learn some time and there needs to be no shame in admitting when you don't know something. Forget feeling embarrassed, or else you'll end up paying for it with consequences like this. If your pride is bigger than your license then you don't deserve to be a nurse.

[Pippynurseuk]

I've read the report and I have a question. They interviewed everyone except the orientee who was with her. She was a direct witness. Why would they have not talked to her? I suppose it wouldn't have added anything extra, they've clearly got all the facts but even still....

[Horseshoe, BSN, RN]

11 hours ago, juan de la cruz said:

This situation wasn't a true sedation procedure and I doubt there are many ICU nurses out there unfamiliar with administering Versed under similar circumstances. Typically, if the intensivist intended a true sedation procedure, a provider would be present as that is outside the RN scope. The dosing instruction convinced me of that plan.

Juan, what do you mean by "the dosing instruction convinced me of that plan"? Which "plan" do you mean?

Also, can you clarify what you mean by a "true sedation" procedure, because many states specifically state that it is within the scope of an RN to provide "moderate" sedation. This is specifically distinguished between "deep sedation" and "general anesthesia."

In my state, it would be entirely within an RN's scope of practice to give Versed/fentanyl for a procdure like a colonsocopy, where the patient maintains his airway and can follow simple commands. 1mg Versed with another 1 mg Versed to follow in the event of continued anxiety would have been well within an RN's scope and would not have necessitated the presence of an anesthesia "provider."

I *think* we are saying the same thing; just wanted to clarify.