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Ohio Hospital Fires 23 After Fentanyl Overdose Deaths

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by J.Adderton J.Adderton, MSN (Member) Writer Innovator Expert

J.Adderton has 20 years experience as a MSN .

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48 Nurses and Pharmacists Reported to State Licensing Boards

A hospital in Ohio recently fired 23 physicians, nurses and pharmacists after 25 patients died from excessive doses of fentanyl. In addition, 48 nurses and pharmacists were reported to state licensing boards for their roles in the overdoses. You are reading page 10 of Ohio Hospital Fires 23 After Fentanyl Overdose Deaths. If you want to start from the beginning Go to First Page.

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On 7/24/2019 at 7:24 AM, Wuzzie said:

So what you are saying then is if a doctor ordered you to administer Vecuronium to a patient and immediately extubate a patient you would question it but go ahead and do it if he gave you a good enough explanation? Not trying to be contrary just trying to wrap my head around your viewpoint.

Overall I do not believe there is enough data, as I have not read the nurses testimonies and seen the charting leading up to each incident, for any of us to be definitive that the blame is on the nurses & pharmacists. And the consistent comments of “they should have know better, these are crazy doses” has no real meaning as none of us were in the situation. Those are all just speculation....as much speculation as I am having saying they are not guilty.....mostly I’m not sure they are guilty because I can see how a reasonable, safe person can still end up administering some of these doses. No, I have no idea how a nurse or respiratory therapist could end up agreeing to extubate a patient after administering a paralytic. But I am opposed, on the small amount of biased information we know, to say the nurse was practicing poorly until I have more information. 

What comes out in the news is sensationalized and biased, I would consider an internal report made by the hospital biased, innocent people are often damned because only the most shocking parts of the story are out. This is why I cannot just go along with ‘everyone’.

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osceteacher has 15 years experience and specializes in Practice educator.

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I really don't need any more information than 'Nurse administered 2000mcg of Fentanyl', that is more than enough to know you should lose your job.

There isn't a circumstance or situation in the world that would make me give 10x the normal maximum dose, crying sensationalism is a waste of time when the facts are so clear.

 

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On 7/25/2019 at 9:40 PM, KalipsoRed21 said:

No, I have no idea how a nurse or respiratory therapist could end up agreeing to extubate a patient after administering a paralytic.

But I wasn't asking what you thought of the events that occurred at Mt. Carmel. I was speaking to your hard stance that as a nurse we are to follow orders, even those we question because it is our job to do what the physician tells us to do. You have repeatedly stated that. So I want to know what you, personally,  would do in this situation (giving a paralytic prior to extubation) given your position on the subject. 

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As someone who has been in a situation where the employer was raking them over the coals over questioning a doctor’s order, I find this entire discussion to be very disturbing on a gut level. One time in my early working life I was told, “You can be right, and you can be dead right.” In either situation, it does not feel satisfying to be “dead right.” I only wish I had knowledge of all of this before I signed on the dotted line for nursing school. 

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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10 hours ago, osceteacher said:

I really don't need any more information than 'Nurse administered 2000mcg of Fentanyl', that is more than enough to know you should lose your job.

There isn't a circumstance or situation in the world that would make me give 10x the normal maximum dose, crying sensationalism is a waste of time when the facts are so clear.

 

It's certainly not the typical dosage required in a terminal wean, but I have given this amount and more (more commonly in morphine of opiate dose equivalents) during a terminal wean, this is based off established protocols.  In a terminal wean there is no "normal maximum dose", it's highly patient specific.

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Luchador has 5 years experience as a CNA, EMT-B.

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6 minutes ago, MunoRN said:

It's certainly not the typical dosage required in a terminal wean, but I have given this amount and more (more commonly in morphine of opiate dose equivalents) during a terminal wean, this is based off established protocols.  In a terminal wean there is no "normal maximum dose", it's highly patient specific.

I've not seen it in my limited student experience (Nursling !) , but don't some burn victims and cancer pts get doses that are incredibly high, too?

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13 hours ago, Wuzzie said:

But I wasn't asking what you thought of the events that occurred at Mt. Carmel. I was speaking to your hard stance that as a nurse we are to follow orders, even those we question because it is our job to do what the physician tells us to do. You have repeatedly stated that. So I want to know what you, personally,  would do in this situation (giving a paralytic prior to extubation) given your position on the subject. 

I probably would have reviewed with my supervisor and if s/he said it was okay I would have assisted in this order. I do fundamentally agree that these orders are more in the doctor’s realm of decisions than mine. And when a I disagree with both the doctor and the supervisor I do attempt to pull family aside and express my personal concerns.

Edited by KalipsoRed21

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Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

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14 hours ago, KalipsoRed21 said:

I probably would have reviewed with my supervisor and if s/he said it was okay I would have assisted in this order. I do fundamentally agree that these orders are more in the doctor’s realm of decisions than mine. And when a I disagree with both the doctor and the supervisor I do attempt to pull family aside and express my personal concerns.

I think that you may be putting yourself more at risk by doing this. If you disagree with both the MD and Sup re: a pt trmt it is not your personal concern, rather it is your professional concern. After having admitted your professional concern to the pt/family and then performing the intervention anyway this (IMO) creates more trouble for you if something goes wrong. Family will be upset and questioning why you did this/that if you knew better. And of course management will still throw you under the bus.

 

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14 hours ago, KalipsoRed21 said:

I probably would have reviewed with my supervisor and if s/he said it was okay I would have assisted in this order. I do fundamentally agree that these orders are more in the doctor’s realm of decisions than mine. And when a I disagree with both the doctor and the supervisor I do attempt to pull family aside and express my personal concerns.

While I don't agree with your viewpoint I do appreciate your honesty. 

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3 hours ago, Daisy4RN said:

I think that you may be putting yourself more at risk by doing this. If you disagree with both the MD and Sup re: a pt trmt it is not your personal concern, rather it is your professional concern. After having admitted your professional concern to the pt/family and then performing the intervention anyway this (IMO) creates more trouble for you if something goes wrong. Family will be upset and questioning why you did this/that if you knew better. And of course management will still throw you under the bus.

 

Agree. Advancing any serious concern up the chain of command is our responsibility/duty. And, at the very least, you refuse to participate. KalipsoRed: Maybe that sounds scary but it really isn't. We aren't refusing to do something every time we turn around; it's for those rare occasions where you know this seriously isn't right or there is a high risk of completely avoidable badness and a much less risky and more standard way that things could proceed. Then you put your foot down. Work for a safer compromise, provide rationales, etc., etc., but in the end if there is a stand off about something serious, you have to stand your ground. I have done it a time or two - and in those instances the procedure/process did not go on without me; alternatives were found because when those involved were left on the hotseat by themselves, they quickly realized how inadvisable their plan was.

Although much of what we do does require a physician's order, that does not mean that if something is ordered we are then blindly compelled and *must* do it.

Another thing to keep in mind is that doctors typically don't  know the ins and outs of our role (scope of practice) and our professional ethical duties; some of them think that we are legally allowed to do whatever they say we can do, or whatever they tell us to do. That is just not the case. It is perfectly fine to, as collegially as possible, inform them that your duty goes beyond what they say. "I'm sorry but professionally I am not on solid footing with this from a nursing standards/scope of practice perspective; there is nothing I can refer to that would support my doing this" (I have said that almost verbatim).  Sometimes they just don't know and they haven't really thought too much about their plan/order until someone registers a concern.

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ZenLover has 6 years experience as a BSN and specializes in ICU.

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8 minutes ago, JKL33 said:

Agree. Advancing any serious concern up the chain of command is our responsibility/duty. And, at the very least, you refuse to participate. KalipsoRed: Maybe that sounds scary but it really isn't. We aren't refusing to do something every time we turn around; it's for those rare occasions where you know this seriously isn't right or there is a high risk of completely avoidable badness and a much less risky and more standard way that things could proceed. Then you put your foot down. Work for a safer compromise, provide rationales, etc., etc., but in the end if there is a stand off about something serious, you have to stand your ground. I have done it a time or two - and in those instances the procedure/process did not go on without me; alternatives were found because when those involved were left on the hotseat by themselves, they quickly realized how inadvisable their plan was.

Although much of what we do does require a physician's order, that does not mean that if something is ordered we are then blindly compelled and *must* do it.

Another thing to keep in mind is that doctors typically don't  know the ins and outs of our role (scope of practice) and our professional ethical duties; some of them think that we are legally allowed to do whatever they say we can do, or whatever they tell us to do. That is just not the case. It is perfectly fine to, as collegially as possible, inform them that your duty goes beyond what they say. "I'm sorry but professionally I am not on solid footing with this from a nursing standards/scope of practice perspective; there is nothing I can refer to that would support my doing this" (I have said that almost verbatim).  Sometimes they just don't know and they haven't really thought too much about their plan/order until someone registers a concern.

I like the way you explain this and people should think of it in terms of WWII and the Nuremberg trials.  Never again did we want to create an atmosphere of “I was just following orders” and if you feel compelled to ever say this it should make you stop and take great pause.  Human beings are dependent upon us acting as a double check system all the way up and all the way down the chain of command so that we can avoid similar situations ever occurring.  It is the most extreme example of following orders, but this is what gave birth to the thought process of nurses not blindly following orders.  Also take into consideration well documented inappropriate clinical trials or the horrors of what was happening as recently as the 19th and 20th centuries in “mental health wards”.  Our scope of practice and the ethics of our practice was carefully crafted to help protect people and hopefully avoid similar situations.

Edited by ZenLover

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subee has 45 years experience as a MSN, CRNA.

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On 7/30/2019 at 8:18 PM, KalipsoRed21 said:

I probably would have reviewed with my supervisor and if s/he said it was okay I would have assisted in this order. I do fundamentally agree that these orders are more in the doctor’s realm of decisions than mine. And when a I disagree with both the doctor and the supervisor I do attempt to pull family aside and express my personal concerns.

2000mcg Fentanyl would require breaking open 20 glass ampoules of Fentanyl (in the smaller size) so that's a red flag.  Don't need a supervisor to tell you that and if he/she went along with it raise your arms high and scream.  This should have been taken up the medical chain of command.

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