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.

[LilPeanut, MSN, RN, NP]

2 minutes ago, Truth66 said:

I know that I have been periodically ridiculed by various supervisors when I intervened in different situations in order to safe guard the patients under my care. One case in particular was during an influenza outbreak. The house physician had ordered every one of the elderly residents to be placed on an anti-viral medication. The medication didn’t arrive to the facility until shortly after 10:00 pm. By the time I had all of those prepackaged meds sorted for the 30 plus residents it was around 10:15 pm.

I spoke with the charge nurse and we agreed that the medication should not be given that late because nearly all of the residents were asleep. In addition, many of these residents had already been given their HS sedation a couple of hours prior. One of the principal side effects with this antiviral medication was nausea and vomiting. Therefore, it was also a safety issue of not giving the antiviral medication at that time. There would be no way to safely monitor that many residents. I put on my report (my shift ended at 11:00 pm) what we had done and for the staff on days to get the time for this medication checked by the physician.

The Assistant Director of Nursing had me in a disciplinary meeting several weeks later for not giving that medication that evening. I made it clear that it was discussed with the charge nurse and we had agreed that the administration time of that medication being so late was not appropriate. I was warned by both the Assistant Director of Nursing and someone from Human Resources that if that situation arose again, I was to give the medication.

How many nurses have been bullied into doing a nursing task that they know full well could jeopardize the safety of their patients?

I’ve been in situations where a call bell is ringing and when I went to answer it, I was told to stay where I was by a senior staff and told that one of the Personal Support Workers can answer it. If that call bell was a medical emergency and I didn’t answer it, what kind of trouble would I be in if that resident died and it could have been prevented?

These two examples are only a small glimpse of what I’ve experienced in my 15 plus years of nursing. The point is that many Nurses are routinely placed in situations where they could potentially injure/kill someone. One of the key aspects of Nursing is Critical Thinking. Yet, if the Nurse is not allowed to use their Critical Thinking because of their particular work environment, how many of those patients are at risk?

How many Nurses out there have been “ordered” to do various things that could potentially harm their patients? Many of those Nurses have done those things due to the high probability of being disciplined under insubordination, even though their Critical Thinking told them that it was wrong.

So, devil's advocate here. Antiviral medication, like an antibiotic, should never be put off "until the next day" without discussion from the ordering provider. Even if it causes nausea and vomiting, you can treat that, monitor them through the night, but it is one of those meds that needs to start as soon as it is received, IMO. Many antivirals need to be started within a certain time window to be effective.

And a call light is absolutely appropriate for non-licensed personnel to answer. A call light isn't an emergency. The non-licensed personnel could get you if they answer the light and it is an emergent situation, but otherwise, it is definitely an appropriate thing for them to answer.

Sometimes our critical thinking stops a step or two early.

Just now, Dsmcrn said:

Was Versed the appropriate drug of choice for claustrophobia during PET scan?

Yes, because it is short acting, she had a head injury, and while too many people don't understand versed and think it is only for conscious sedation, it is an absolutely valid benzo to have chosen. It is frequently used for procedures for children.

[Dsmcrn]

Just now, KJoRN81 said:

Do others have to have a witness simply to pull meds (controlled obviously) from the Pyxis, etc? We don’t, never have anywhere I’ve worked...only if we’re going to waste some of it of course.

Agree. In Texas (based off mY expereince) it is only if we waste. One nurse can pull.

[LilPeanut, MSN, RN, NP]

4 minutes ago, KJoRN81 said:

Do others have to have a witness simply to pull meds (controlled obviously) from the Pyxis, etc? We don’t, never have anywhere I’ve worked...only if we’re going to waste some of it of course.

Interesting. Yes, everywhere I've worked, you have to have a witnessed to pull all controlled substance, either to witness there is no waste or whatever waste there is.

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[Dsmcrn]

5 minutes ago, LilPeanut said:

So, devil's advocate here. Antiviral medication, like an antibiotic, should never be put off "until the next day" without discussion from the ordering provider. Even if it causes nausea and vomiting, you can treat that, monitor them through the night, but it is one of those meds that needs to start as soon as it is received, IMO. Many antivirals need to be started within a certain time window to be effective.

And a call light is absolutely appropriate for non-licensed personnel to answer. A call light isn't an emergency. The non-licensed personnel could get you if they answer the light and it is an emergent situation, but otherwise, it is definitely an appropriate thing for them to answer.

Sometimes our critical thinking stops a step or two early.

Yes, because it is short acting, she had a head injury, and while too many people don't understand versed and think it is only for conscious sedation, it is an absolutely valid benzo to have chosen. It is frequently used for procedures for children.

In Texas Ativan is the drug of choice because it is short acting. Versed is used for moderate sedation procedures. I wouldn’t say it’s confusion it’s more of what is preferred practice in that organization/Physician group.

[its_erin]

I don't think I could rightly vote, just with the question, I think something like this could be determined case by case. Just my two cents.

[KJoRN81, RN]

Doesn’t seem very time-effective to have a witness every time you pull a med...that’s ridiculous & sounds like the higher-ups don’t trust their own staff. I don’t know, just seems odd to me.

[Wuzzie]

45 minutes ago, Dsmcrn said:

In Texas Ativan is the drug of choice because it is short acting. Versed is used for moderate sedation procedures.

Versed is shorter acting than Ativan.

http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm

https://www.sciencedirect.com/topics/neuroscience/lorazepam

[Dsmcrn]

3 minutes ago, Wuzzie said:

Versed is shorter acting than Ativan.

http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm

Wuzzie, I was simply stating the practice of the Physicians in the area of the nation that I work.

I am leaving this thread as well.

[LilPeanut, MSN, RN, NP]

50 minutes ago, KJoRN81 said:

Doesn’t seem very time-effective to have a witness every time you pull a med...that’s ridiculous & sounds like the higher-ups don’t trust their own staff. I don’t know, just seems odd to me.

Seems odd to me that you could access a large amount of narcotics without any witnesses

[Dsmcrn]

1 minute ago, LilPeanut said:

Seems odd to me that you could access a large amount of narcotics without any witnesses

[Wuzzie]

19 minutes ago, Dsmcrn said:

Wuzzie, I was simply stating the practice of the Physicians in the area of the nation that I work.

Of course you need to do whatever your physician group prefers but I was correcting a frequently misconstrued concept that Ativan is shorter acting when it isn't. The appropriateness of Versed in the RV situation has been brought up several times and you questioned it too. This is simply a reference to support it's use. This is not a personal attack on you.