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RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?

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tnbutterfly - Mary is a BSN, RN and specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

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What do you think the verdict will be for RaDonda Vaught?

By now, most nurses have heard about RaDonda Vaught, a former Vanderbilt University Medical Center nurse who was charged with reckless homicide and patient abuse as a result of administering the wrong drug that killed a patient in December 2017. You are reading page 6 of RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?. If you want to start from the beginning Go to First Page.

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1 hour ago, Jory said:

A nurse practitioner discovered her error, not RV.  Her charges do not include a malicious factor...only negligent, which we all agree on.  

Here is food for thought....the fact she was able to pull a paralytic doesn't matter.  It truly doesn't matter what drugs they keep/don't keep in the Pyxis.  The Pyxis isn't the problem.  There was an appropriate warning/packaging in place.  It was all ignored.  

What if she pulled a different medication?  One she had an anaphylactic reaction to? One with a fatal combination with something else the patient was on?   You wouldn't be blaming the Pyxis, you would be placing more blame on the nurse for not looking at the vial.

So we need to stop putting the blame on the paralytic...it is hardly the issue.  

Her testimony to CMS is that RN #2 informed her that the med was vecuronium not Versed, and that she (RN #1/RV) immediately informed the providers, including the NP, of such.

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LilPeanut has 8 years experience as a MSN, RN, NP and specializes in NICU/Neonatal transport.

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Honestly, I don´t think she had much choice - She was informed she gave vec not versed in the patient room with all the providers there, and obviously another nurse knew.  It's not like she had a chance to hide it even if she wanted to. 

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Radonda was the help all nurse and was asked to give the Versed  by the patient's RN because Radiology was threatening to cancel the test due to a time issue. After reading the CMS report, not guilty. This was not solely her fault, but a systematic error.

1) I still don't understand why Versed was the drug of choice for anxiety for a scan. I have always given a small dose of Ativan or Valium, but not Versed.

 

First, many here seem to forget that they are all the same class of drug. Second, Versed has a shorter half-life which is desirable for neuro patients. Just because you haven’t used it doesn’t make it wrong  

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2) If the primary RN (which was not Radonda) was familiar with Versed and that it required close monitoring, she should have; questioned the doctor's order, made sure the correct monitoring equipment was connected to the patient prior to them going to the scan, or accompanied her own patient to the scan and monitored them.

The dose ordered was the anxiolytic dose and does not require sedation monitoring. It does, however, require the same kind of assessment any IV push medication does. You wait a few minutes to asses for response or adverse reactions. This is nursing 101. In fact, the original order was for 1mg to be repeated x1 if needed. This clearly implies that the ordering physician expected RV to stay and assess the patient. Instead, she slammed the entire 2mg and booked. I know this because I’ve given  Vecuronium many, many  times and it acts within just a few seconds. 

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3)  The Pyxis allowing someone to override a paralytic when most paralytics are kept in a separate lock box or hand delivered

Every ICU/ED I’ve worked in or from keeps paralytic readily available on the unit because they are used in EMERGENCIES! There often isn’t time to wait for it to come from pharmacy or for someone to find the keys to a lockbox. 

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4) no scanner being available in the department 

All scanning systems have an override feature. RV had already overrode several safety mechanisms and ignored basic standards of practice. Plus, even though computers were available she did not even document on the MAR. 

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5) Radonda's error.

Lastly, when Radonda became aware of her mistake, she admitted it to the doctors immediately. It was Vanderbilt who failed to report the incident to the state to try to cover their butt. When errors like this happen in a hospital, a root cause analysis is supposed to take place. The hospital is then supposed to take steps to implement changes to improve systems to ensure it won't happen again. However, Vanderbilt had no intentions of changing anything until their Medicare funding was threatened.  I am not saying Radonda is blame free. She made a tragic tragic mistake and she will live in Hell probably the rest of her life. Her actions were negligent, but not malicious. If she's charged and sent to jail; imagine what this will do to the nursing field. 

 

RV did not realize her mistake. It was pointed out by another staff member. Shortly thereafter a “Code Blue” was called overhead and RV telephoned the scanner to see if it was the patient she had medicated. Because, you know, they weren’t busy doing something else or anything. When she was asked how much medication she gave she said she “didn’t know”. This was a bald-faced lie. She couldn’t have possibly not known. She thought she had reconstituted the vial to 1mg/1ml because those were the directions on the vial that she pulled but she couldn’t “remember” how much she pushed. Too bad she also didn’t label the syringes she took with her. One had 8ml left and one had 2ml left. Even I can do that math. She either gave 2mg or 8mg. So the lying started the very day it happened.

What Vanderbil did or did not do after this incident (although I agree they were wrong to cover it up) has no bearing on what RV did. It’s being used to divert attention away from the person who is entirely at fault  because we don’t want to admit that there are those among us who do terrible things. 

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6 minutes ago, LilPeanut said:

Honestly, I don´t think she had much choice - She was informed she gave vec not versed in the patient room with all the providers there, and obviously another nurse knew.  It's not like she had a chance to hide it even if she wanted to. 

That is not what the report says.

There is plenty else to condemn.

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1 hour ago, Jory said:

At my hospital, routine overrides without a valid reason in a non-critical unit for a non-critical reason will have you getting a first warning, second warning, and then you are terminated.  There were at least one or two nurses in almost every unit that CONSTANTLY were overriding/not scanning medications.  When everyone else is at 3 to 7% and yours is at 70 to 80%?  The problem is you...not the system.  When brought in for counseling they all had the same flippant attitude of "I don't have time".  Well...everyone else does?  Why don't you? 

I think that's part of the problem here that we don't yet know about (or maybe we do - I'm trying not to get behind in the convo) -

This was  CC unit.

We do not know the status of the order (STAT/NOW/Routine), but we do know that she should have made a nursing judgment that it was not an "emergency" regardless of the timing/urgency status of the order itself - at least I believe she should have been able to correctly prioritize that this was not a hair-on-fire emergency. [I also believe such prioritization decisions are currently being made under duress in many places - but I have accepted that that is an issue for a separate discussion.]

I agree outlier-level activity shouldn't be tolerated with regard to whatever it is - wastes, overrides, etc.

I will say for some people it is difficult to initially see how one is going to "have the time" to do things a new way - - I've noticed it being about 50/50 between those who are flippant/lackadaisical types and those who are the ultra-thorough types. For the latter types, it does require accepting the fact that compromise is necessary. Some of these people are just slow - but some of the people who have the hardest time making time for new processes are those who struggle with the concepts surrounding "being more efficient." IOW, being less thorough = being more efficient and there are people who genuinely have a problem with that. I don't personally feel that was the case here - but I like to point these things out lest we make unfair judgments and stereotypes our rule of thumb. [There is a lot about all of our healthcare changes that never gets discussed and the definition and the very ethics of current "efficiency" is one such thing - IMVHO 🙂]

1 hour ago, Jory said:

I'll tell you what WILL come out in this investigation...RVs history of overriding non-critical meds and her history of whether she scanned them or not.  If her practice is out of sync with her co-workers, that is going to be even more damning.  My guess is that you'll find out that is the case because she even had an orientee....and made no effort to set an example. 

I wonder how that's going to work though, politically-speaking. Not only did she do this, but she did what she frequently does and no one cared up until now?

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Where can I find the information about the BON's discussion of RV? Is this available publicly?

@juan de la cruz I went through quite a few of the minutes from the link you posted. I didn't see her name but may have overlooked it.

 

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

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4 minutes ago, JKL33 said:

Where can I find the information about the BON's discussion of RV? Is this available publicly?

@juan de la cruz I went through quite a few of the minutes from the link you posted. I didn't see her name but may have overlooked it.

 

I actually posted those minutes to show that her name is nowhere to be found on those meeting minutes leading me to believe previously that her case was never reported to the BON...that until this new "revelation" from her lawyer that the BON never gave any sanctions implying some form of investigation on the BON's part.

Also, her name didn't show up in the monthly report of disciplinary actions by the Board of Nursing...which incidentally lists nurses whose licenses were suspended for non-payment of student loans (Jan 2018, April 2018). https://www.tn.gov/content/tn/health/health-professionals/health-professionals-boards-disciplinary-actions.html

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Jory has 10 years experience as a MSN, APRN, CNM.

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14 hours ago, Luchador said:

I'm shocked-- shocked-- to find out that the Tennessee BON is protecting Vanderbilt's reputation by not taking action against a demonstrably dangerous and reckless nurse. 

 

I cannot find a single word on the BONs website since the CMS report came out, where RV was even discussed at a meeting....do you have a specific date?  Maybe I missed it.

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Jory has 10 years experience as a MSN, APRN, CNM.

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11 minutes ago, juan de la cruz said:

I actually posted those minutes to show that her name is nowhere to be found on those meeting minutes leading me to believe previously that her case was never reported to the BON...that until this new "revelation" from her lawyer that the BON never gave any sanctions implying some form of investigation on the BON's part.

Also, her name didn't show up in the monthly report of disciplinary actions by the Board of Nursing...which incidentally lists nurses whose licenses were suspended for non-payment of student loans (Jan 2018, April 2018). https://www.tn.gov/content/tn/health/health-professionals/health-professionals-boards-disciplinary-actions.html

This....is my thought.  If Vanderbilt wasn't going to report the death, they sure as heck are not going to report an RN made a med error on that same case.  

I will personally be writing to my state representatives if she is not brought before the BON and I will tell you why:

I think we can all agree it is RIDICULOUS that a nurse can lose her license b/c she can't pay her student loans, but can kill a patient by negligence and have an unblemished license.  

That...is complete bull****

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31 minutes ago, juan de la cruz said:

I actually posted those minutes to show that her name is nowhere to be found on those meeting minutes leading me to believe previously that her case was never reported to the BON...that until this new "revelation" from her lawyer that the BON never gave any sanctions implying some form of investigation on the BON's part.

Ok - thanks.

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Do you think it might be possible that the Board suppressed information about the investigation and findings for any reason? Definitely not saying this happened but one would think that an incident such as this would garner more urgent attention than what we can find in the documentation. 

Of course I recognize the information came from her defense attorney. He could have inside access to it but I think we all know that there is also an equally good or better chance he pulled that out of his behind. I’m not sure which is worse. The board not revoking her license after investigating or the delay in investigating such a horrible event. 

I must tell you how relieved I am to know that those nurses who have defaulted on student loans aren’t practicing anymore. They are the true threat to patient safety. 

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If she goes to jail; then all of the unsafe politics in hospitals needs to stop. Hospitals better start going on a hiring frenzy because there are many hospitals, who put their nurses in unsafe situations daily! Being mandated, working 16 hour shifts, high nurse to patient ratios, taking unsafe assignments. Yet if you speak up to administration, they throw it under the rug, but if a nurse dares refuses to work in unsafe conditions, they can be slapped with patient abandonment. This could have easily been me making this error on one of my MANDATED 16 hour shifts! 

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