Nurse Charged With Homicide

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

    • 395
      She should not have been charged
    • 128
      She deserved to be charged

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Radonda Vaught, a 35 year old nurse who worked at the University of 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.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
11 minutes ago, Jory said:

We don't know that she was distracted. There is nothing in the CMS report to demonstrate that.

The CMS report is not detailed enough to prove that she is not distracted. She had an orientee and she was heading to the ED after carelessly finishing her task in Radiology.

11 minutes ago, Jory said:

Anything that is not emergent, you need to wait until it is loaded by pharmacy...period. That would have prevented this entire cascade from happening. Do you know how many times I have pulled a medication on override that wasn't emergent?

Never. In 10 years, never. Have people got impatient? Upset? Irritated? Yes, yes, and yes. But it is for their own protection as well as mine.

I agree but I am seeing the situation from a Monday Morning Quarterback situation. I had a family member in a hospital recently but just in Step Down, I know mistakes happen and I did catch a few while there, they were not egregious or life threatening fortunately.

11 minutes ago, Jory said:

What's going to happen is eventually the Joint Commission is going to have a regulation where you'll need to start entering tons of codes or a second badge scan for even emergent drugs if nurses keep pulling drugs on an override just because they are too impatient to wait.

Yes, I see more changes happening. The ISMP already had recommendations,.

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5 minutes ago, JKL33 said:

Where can I find the information about what type of order it was?

Override has not historically been used only in the manner you are suggesting. I don't know what else to say.

It is in the CMS report. She only had a verbal order and it was not yet loaded into the system where Versed could show up under the patient.

At my hospital, if you pull drugs that are not emergent on override, it's a write up. Only the ER and ICU has some leeway..but no other department.

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1 minute ago, juan de la cruz said:

The CMS report is not detailed enough to prove that she is not distracted. She had an orientee and she was heading to the ED after carelessly finishing her task in Radiology.

.So you are assuming...got it.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
1 minute ago, Jory said:

It is in the CMS report. She only had a verbal order and it was not yet loaded into the system where Versed could show up under the patient.

It was actually an order entered on Epic and it only took the Pharmacist a couple of minutes to approve the order. She went to the Pyxis about 10 mins after and would have seen it in the patient's profile if she took the time.

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14 minutes ago, Jory said:

There are three types of pharmaceutical needs: Emergent, Immediate/non-emergent, routine.

Anything that is not emergent, you need to wait until it is loaded by pharmacy...period. That would have prevented this entire cascade from happening. Do you know how many times I have pulled a medication on override that wasn't emergent?

Never. In 10 years, never. Have people got impatient? Upset? Irritated? Yes, yes, and yes. But it is for their own protection as well as mine.

What's going to happen is eventually the Joint Commission is going to have a regulation where you'll need to start entering tons of codes or a second badge scan for even emergent drugs if nurses keep pulling drugs on an override just because they are too impatient to wait.

Agree that if she believed the med simply had not been profiled yet (which is what I assume she thought but have no way of knowing, the correct thing would have been to either call pharmacy and request that it be profiled right away, or else simply wait. I'd pick the former.

But STAT, NOW, and Routine are order types whose meanings have become perverted by processes and systems. There are places where you actually do need to enter an order as STAT if you must have it in under an hour or so. It most certainly isn't an order status that is strictly limited to some hair-on-fire emergency.

2 minutes ago, Jory said:

It is in the CMS report. She only had a verbal order and it was not yet loaded into the system where Versed could show up under the patient.

At my hospital, if you pull drugs that are not emergent on override, it's a write up. Only the ER and ICU has some leeway..but no other department.

I didn't see the order status (STAT/NOW/Routine) in the report. I just went and specifically looked for it but perhaps I am overlooking it.

You are incorrect about the verbal order thing, though. The order was in fact already profiled when she went to the cabinet. She didn't think the order was profiled because she was searching under generic names while trying to find Versed.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
4 minutes ago, Jory said:

.So you are assuming...got it.

No I'm giving her the benefit of the doubt and want an investigation that goes further from the CMS report.

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She was in an ICU....she may have been accustomed to the leeway of which you speak, Jory. I'm not saying she used the privilege appropriately - - just that it takes on a different shape than this wacko idea that she got into some "dangerous medication vault" to purposely access a more dangerous "death row" medication. (And I know those aren't your words, but they represent the belief of various news outlets and various nurses participating in these discussions) ?

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Specializes in NICU/Neonatal transport.
3 minutes ago, Jory said:

It is in the CMS report. She only had a verbal order and it was not yet loaded into the system where Versed could show up under the patient.

At my hospital, if you pull drugs that are not emergent on override, it's a write up. Only the ER and ICU has some leeway..but no other department.

That's actually incorrect, it was loaded into the patient profile 10 minutes prior to the nurse attempting to remove it from the ADC.

We know it wasn't stat because when they discussed the order, it was not ordered as a stat medication and the warning was flashed to not override non-stat orders, which was one of the errors she made.

But she only had a verbal order from another nurse, technically speaking, since she never bothered to look at an order or MAR on her own. Which is another huge problem, taking a verbal order for a controlled substance from another RN without any verification of the order, and then overriding it out of the cabinet even.

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Just now, juan de la cruz said:

No I'm givng her the benefit of the doubt and want an investigation that goes further from the CMS report.

The investigation, from my understanding, from a CMS standpoint, is over. At this point, the nurse is gone and they are working with Vanderbilt on some changes, but the rest is up to the DA's office.

RV, even if she was distracted...what is going to sink her ship is everything else she overlooked and the other policies she violated.

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4 hours ago, hppygr8ful said:

This is exactly why safeguards are put in place and why nurses and caregivers should never employ "work arounds" or "shortcuts" no matter how busy they are.

Which means nurses should always be willing to quit or be fired. I have not seen a nursing job yet which does not have impossible demands to the extent that some shortcuts are necessary (unless you are VERY experienced and superhuman) in order to be a "good worker". It's true that being a good nurse is more important -- just harder for some to remember when they need to keep their job. I think we should be taught in nursing school that if we anticipate needing a nursing job desperately enough that we will remain working as a nurse in conditions that are unsafe for patients and that jeopardize our licenses, we ought not to become nurses.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
6 minutes ago, Jory said:

The investigation, from my understanding, from a CMS standpoint, is over. At this point, the nurse is gone and they are working with Vanderbilt on some changes, but the rest is up to the DA's office.

RV, even if she was distracted...what is going to sink her ship is everything else she overlooked and the other policies she violated.

Well from my standpoint, she is damaged goods. No matter what happens, no facility will hire her with that reputation. All her "friends" and supporters from the gofundme page would have forgotten about her in a few months. Just a cursory google sleuthing on the similar case of the nurse in Florida brings up that though the RN license is still active, the LinkedIn page shows him working in a different field with a court order indicating trouble with the condo homeowners association that the RN belongs to. That's if I have truly searched the right person.

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2 minutes ago, JKL33 said:

She was in an ICU....she may have been accustomed to the leeway of which you speak, Jory.

...but that is at my hospital. Vanderbilt may be different. I have never worked there, so I have no idea. But it is a dangerous practice overall if you don't truly need it right then.

Even the ER and ICU doesn't get a complete free pass.

Example: Let's say you have someone coming in with intractable vomiting. I think we can all agree nobody is going to die in the next 15 minutes with intractable vomiting, especially after an IV is started and flowing. The ER doc may tell you to pull some IV Zofran to get it going...patient absolutely needs it now because while not emergent...it is urgent. Everyone saves the bottles and scans it after-the-fact.

But if that same patient is just very nauseous...you need to wait until that drug is loaded so you can pull it.

Drugs pulled on override not verified with pharmacy also runs the risk of drug interactions with something else the patient is on.

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