For those of you who are following the Radonda Vaught case, she was a guest on the podcast Good Nurse Bad Nurse on January 18, 2022. (For those not familiar with this case, search for Radonda Vaught and read the threads on the case. It was discussed extensively.)
I stumbled across the podcast when searching for when her trial starts.
Spoiler alert - she's the "Good Nurse" featured on the podcast.
The host gives a version of the case starting about 30 minutes 30 seconds. Radonda starts speaking around 40 minutes.
I'm surprised her lawyer would allow her to speak publicly.
Were you by yourself when you gave vec? Vec shouldn't be administered with just a nurse at the bedside. There should be someone who can intubate and run a code if something goes wrong.
Yes I was, both in the unit as well as in the back of an MICU and a helicopter with another nurse or a medic. Outside of the initial intubation you do not need someone at the bedside who can intubate to administer vec because the patient is already intubated and, in my case, did not need a physician to be present at all. If you did it your way you would need a physician to sit at the bedside of every sedated and paralyzed patient in every ICU across the country.
21 minutes ago, ThePrincessBride said:
Of course not, but vec is not an every day med like insulin with a much less room for error.
Yes I was, both in the unit as well as in the back of an MICU and a helicopter with another nurse or a medic. Outside of the initial intubation you do not need someone at the bedside who can intubate to administer vec because the patient is already intubated and, in my case, did not need a physician to be present at all. If you did it your way you would need a physician to sit at the bedside of every sedated and paralyzed patient in every ICU across the country.
Vec is an everyday med in the ICU.
That is...scary.
Is Vec normally given just for scans in radiology? Why was it so readily available in rad? In the ICU, I'm sure you have access to multiple resources (and are not just chilling by yourself giving a paralytic without backup...that just doesn't seem safe).
I just don't think it should be so easy to get a med...in my baby ICU, we have to have two people present in order to pull morphine, so the idea of one person being able to override safety functions to get something arguably more dangerous that morphine is just, well, frightening. And it makes me wonder how often does a mistake like RV's happen in the U.S.
Is Vec normally given just for scans in radiology? Why was it so readily available in rad? In the ICU, I'm sure you have access to multiple resources (and are not just chilling by yourself giving a paralytic without backup...that just doesn't seem safe).
I just don't think it should be so easy to get a med...in my baby ICU, we have to have two people present in order to pull morphine, so the idea of one person being able to override safety functions to get something arguably more dangerous that morphine is just, well, frightening. And it makes me wonder how often does a mistake like RV's happen in the U.S.
Do you give paralytics to your ventilated, high flow/high rate neonates in the NICU?
Why? I'm an educated and prudent nurse who uses good nursing judgment and follows policy. I can safely but cautiously administer vecuronium in any situation where it is appropriate. When I was flying should we have landed the aircraft at any random hospital every time we needed to give it so a physician was there? Flown with a pharmacist?
6 minutes ago, ThePrincessBride said:
Why was it so readily available in rad?
It wasn't in radiology it was pulled from the system in the Neuro ICU
8 minutes ago, ThePrincessBride said:
I just don't think it should be so easy to get a med.
You would think differently if your patient was thrashing about risking extubation or worse.
9 minutes ago, ThePrincessBride said:
And it makes me wonder how often does a mistake like RV's happen in the U.S.
Apparently not that often given the availability of information on the internet. Most nurses practice at a much higher level than RV demonstrated.
Do you give paralytics to your ventilated, high flow/high rate neonates in the NICU?
Well, those are few and far between (thankfully), but if a baby is being paralyzed, you have multiple people (NNP, 2 bedside RNs) present in the room. You cannot pull a med like vec by yourself and it is double checked. I'm surprised adult ICU doesn't operate like this.
Well, those are few and far between (thankfully), but if a baby is being paralyzed, you have multiple people (NNP, 2 bedside RNs) present in the room.
If you have a baby being paralyzed in all likelihood the reason for all of that staff is because the kid is crumping badly not because of the medication being ordered.
Why? I'm an educated and prudent nurse who uses good nursing judgment and follows policy. I can safely but cautiously administer vecuronium in any situation where it is appropriate. When I was flying should we have landed the aircraft at any random hospital every time we needed to give it so a physician was there? Flown with a pharmacist?
It wasn't in radiology it was pulled from the system in the Neuro ICU
You would think differently if your patient was thrashing about risking extubation or worse.
Apparently not that often given the availability of information on the internet. Most nurses practice at a much higher level than RV demonstrated.
High risk meds should require a dual check. I'm surprised it isn't like this everywhere.
Even if she pulled in the Neuro ICU, I am surprised it didn't require two RNs to pull out and that there were overriding capabilities.
Anyway, my point is, there are so many ways this could have been avoided. RV was definitely reckless in practice, but this also presents a system failure as well. I don't think the answer is to lock her up and throw away the key. If we did that every time a nurse or MD made an error, there would be few people at the bedside.
If you have a baby being paralyzed in all likelihood the reason for all of that staff is because the kid is crumping badly not because of the medication being ordered.
We typically stay away from paralytics in the NICU. It is very, very rare (and I work at a Level III NICU). Usually, if a baby is thrashing, we give pain medications.
But still...if a paralytic is given, it is policy that there is someone there for airway (NNP in my facility) and 2 RNs to pull the med (can't even pull the med from the pyxis without another RN) and 2 RNs to scan the med and double check it at bedside.
If we did that every time a nurse or MD made an error, there would be few people at the bedside.
She didn't make an error. She willfully neglected to follow established and expected prudent nursing practice more than 10 times in this one patient encounter. Who gives a medication without looking at the vial?
But still...if a paralytic is given, it is policy that there is someone there for airway (NNP in my facility) and 2 RNs to pull the med (can't even pull the med from the pyxis without another RN) and 2 RNs to scan the med and double check it at bedside.
First, if she had given the medication she was supposed to give there would have been no need for an airway. Not sure why you keep belaboring that point. Nobody gives Vec to a patient without expectation or presence of an adjunct airway but she wasn't supposed to be giving Vecuronium in the first place. Second, just because your hospital does things the way they do does not necessarily make them the right or better way.
She didn't make an error. She willfully neglected to follow established and expected prudent nursing practice more than 10 times in this one patient encounter. Who gives a medication without looking at the vial?
I'm not arguing that she was negligent...she clearly was. But I believe when she gave that med, she fully believed that she was giving versed and had no intention of harming Charlene, let alone killing her. Intent matters when facing criminal charges (hence why there is 1st degree murder vs. 2nd, 3rd degree, etc). She practiced in a manner that was not only common but encouraged at her facility (again, not right, but it just speaks on the fact that this was a system wide problem).
Why she forgot to double check the med...maybe short staffing, rushed, stressed, I don't know, doesn't excuse her poor practice.
She has already been punished. She will never work as a nurse ever again and her livelihood is gone. Why do you think she should be punished as a criminal? She's not a criminal...she's just a terrible nurse who is no longer a threat to the public as she has been stripped of her title.
First, if she had given the medication she was supposed to give there would have been no need for an airway. Not sure why you keep belaboring that point. Nobody gives Vec to a patient without expectation or presence of an adjunct airway but she wasn't supposed to be giving Vecuronium in the first place. Second, just because your hospital does things the way they do does not necessarily make them the right or better way.
If there was no way to override to get vec, this couldn't have happened in the first place. But you would rather go out on a witch hunt than come up with a solution to prevent something like this from possibly happening ever again.
Wuzzie
5,238 Posts
Yes I was, both in the unit as well as in the back of an MICU and a helicopter with another nurse or a medic. Outside of the initial intubation you do not need someone at the bedside who can intubate to administer vec because the patient is already intubated and, in my case, did not need a physician to be present at all. If you did it your way you would need a physician to sit at the bedside of every sedated and paralyzed patient in every ICU across the country.
Vec is an everyday med in the ICU.