JKL33

See I think you should've slowly raised your hand, then uber-seriously and meekly replied, "....more pizza, maybe...?" Tip: Always carry a resignation letter in your bag, just leave the date blank so you can fill it in quickly if need be, like in case you just get fed up some day and pull a stunt like that ^

Trigger warning: Just say trigger warning every time you speak, to cover yourself.

You make a good point and I do think it is reasonable to believe that the order itself would have listed the generic name. She may still have searched VE but might have been jogged to try MI if her first attempt didn't bring up the med.

I hadn't noted anywhere that it said whether she looked at the order at any point or not. That issue is not addressed specifically unless I overlooked it; it kind of appears to me that they didn't ask her that specific question. But if she did start this whole process without looking at the order, it's another thing I can't fathom. I am familiar with different utilizations of the override function - not based on my own decision-making but because of the way its use has evolved over time.

Too bad they're stuck on the same boogeyman they've always been focused on: The Evil Physician. They act like there's nothing to watch out for on behalf of the patient except what those uncaring, greedy doctors might do. I think they missed the memo that, for the most part, doctors aren't the ones running the show now...

I think it is a plainly clear and common idea that a nurse might have every reason to believe a medication was entered as STAT when a patient is already in a procedure area waiting for the medication. If you would like to talk about whether it was literally emergent or not, I agree it clearly wasn't. No way. And I can't defend her actions. Just the same, the topic of whether it was actually emergent or not gets around to my assertion that fake emergencies (or imposed time pressures) have become a serious problem in acute care. I mean, that is this situation. We have several people up in arms about a downgraded ICU patient, unattended and off monitors, who needs something for anxiety right away in order to obtain an utterly non-urgent PET scan...

Was this reported to the BON upon her termination?

I don't know what to say. The whole quote regarding this is an ambiguous sentence or two from someone who may or may not ever touch patients or these machines, whose team performed an analysis. Okay. I'll just quote the report (quote is from the MAPST, Manager of Adult Patient Safety Team, p.22): My point is that we do not know the status under which the medication was ordered (STAT, NOW, Routine, PRN, etc). I have not been able to find that. She may have had reason to believe that it was entered as a STAT order since the patient was already down in radiology waiting for the med. But what we can't assume is that it wasn't entered STAT just because the situation was not in fact a dire emergency. It may indeed have been ordered STAT. She may have had reason to know that in such situations where the med is wanted sooner rather than later, it would be entered as STAT. You see what I mean? So the wrong med pops up, somewhere on the screen is the override button, which has a warning saying it is for STAT orders. Given the perversion of the use of STAT/NOW order status, she very well may have believed that it was a STAT order. Or she may have overlooked the 'red box' (whatever it was) like she overlooked everything else. The thing is, aside from RV, if you (we all) are interested in keeping patients safe, it does matter how override is commonly used, off the record, in that facility. Not how I use it or how some other nurse uses it, but what the tenor of its use is in that facility. This could be a situation that was utterly out of the ordinary with regard to the use of override, or it may be that she was doing a very common action and it went wrong only because of other serious mistakes she made. From a strictly patient safety standpoint, the minute details of this do matter. That's why it's a second, or third or fourth freaking crime that such things seem like they aren't even being looked into. You know - that, and well, the whole cover-up thingy.

Agree.

Where do they say it wasn't entered as a STAT order? There is more than one way to understand what they wrote about that in the report. You are assuming that the order wasn't entered as a STAT order, the machine knew that the order wasn't STAT, and that's why the warning came up. It's very possible that the warning comes up every time override is used. That's the way I read it. I don't think it is at all connected with the actual status of the order.

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)

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. 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.

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.

Override does not represent a lockbox where dangerous things are kept. The converse is also true, if a medication is on a patient's profile, it doesn't matter how dangerous it is, override is not required to obtain it - although other institution-specific safeguards may be in place.

Wrong. It said it should be used for STAT orders. Big difference, as I explained earlier in this thread or the other.