Reminder why the seven rights are important

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Well, this source has posted the CMS investigatory report.

*V had instituted "World's Best Performance-Timing-and-Statistic-Producing EMR" within the month prior to this event. If you have ever been through this at an institution the size of V, you know why it is significant. [beside the point and irrelevant "fun fact": There's no way a system this size spends less than $billion(s) on acquiring and rolling out across the system.]

*The nurse was performing a roving/"help-all" role. S/he was asked to go to a completely different area and medicate someone else's patient, which was to be accomplished prior to (or on the way to) going to a second completely different area to do something for another patient. **Now she is accused of failing to monitor the patient in PET scan after giving the med. This is an important take-home point for every nurse who could ever find themselves doing things like this as part of teamwork or helping others. Raise your hand if you have ever gone somewhere to medicate someone else's patient (I have). Raise your hand if you were relieved of all of your other duties/expectations so that you could stay put in a different department for an hour to monitor a stable patient after you administered a med. Right. It's not even an expectation. The mere idea of it is something that would be ridiculed as laziness or wanting to get out of work.

*The patient's actual primary nurse could not leave the department to go medicate her own patient because she was watching yet another nurse's patients - - that nurse was on lunch break.

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It never fails to boggle my mind at how much money hospital systems are prepared to spend on technology in an effort to try to avoid spending more than the bare minimum on staffing.

I'm not defending the nurse's actions because she clearly failed in her due diligence when administering this medication.

But I also believe many of us are being set up to fail. The pressure to get things done quickly. The pressure to take on more patients. The pressure to be a "team player" and just put your head down and get on with doing whatever has been asked.

I really think California has the right idea with mandatory staffing ratios. I know we are pressed to take our meal breaks so as to cut down on "unapproved overtime," but if we've all got 6 patients on a busy med-surg floor, is there anyone in his or her right mind who thinks a nurse can adequately watch 12 patients while her co-worker is on break? Would you want to be one of those patients? At best, you're going to have delays in care, and at worst...well, this poor patient found out what can happen.

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Specializes in Tele, ICU, Staff Development.
I work in an ICU and over-ride the med cabinet very frequently when emergencies are going on. I know my meds well enough to know that a bottle of Versed looks very different from a bottle of Vecuronium. I honestly find it pretty tough to make excuses for this nurse, as it doesn't even sound like this was an emergency situation where adrenaline is running high and there's pressure to hustle with the med. I am usually the last person to hop on the nurse-blaming band-wagon because I know horrible things happen, mistakes get made, and it's not typically reflective of the nurse's competency. In this case, however, I can't help but wonder what on earth was going through this nurse's head.

She didn't seem to be familiar with either drug at all. She wasn't the pt's nurse (she was working that day as a "help all nurse") and she should not have been the one sent to administer Versed.

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Specializes in Tele, ICU, Staff Development.
I know where you're coming from, but I see it a little differently (the following comments are in no way directed personally, Pixie): There is only one thing that could have stopped this cold that wasn't done, which was conscientiously looking at the label. People are in the habit of not doing that now because the usual practice has become scanning. Not looking at the vial isn't my MO, but I see it enough where the reason to really look at the label is if/when there is a problem with scanning. I see all of this as having happened in a setting of the usual and accepted chaos (constant change, new EMR, constantly orienting, "covering" others' patients, and floating all over the dang place being a good team member/keeping that bottom line efficient).

My interest in this is that I believe the benefits (or overall usefulness) of technology-related safety measures have been oversold or not kept in perspective while at the same time the reasons given for this have mainly been "look what happens when we rely on humans" (accompanied by examples that border on mockery and are very condescending). Well guess what. The bottom line here despite shameful billions spent, is still human beings - - but all we have done to enable best human functioning is tell people they're so fallible they can't and shouldn't be relied upon.

They're also blathering on (implied) about the fact that nurses shouldn't be able to access meds that haven't been verified by pharmacy. Well, that verification process is something that also once fell into nursing realm (it is largely accounted for in the "Rights") - - but we've long since been told we were not adequate to perform that, either, so all of that question-asking and evaluating that was done by a professional nurse as part of the medication administration process has gone by the wayside. I will argue anyone regarding my belief that hospitals' dumbing down of the RN role so that they can employ a revolving door of novices and their spreading of everyone as thin as possible matters overall - including in situations like these. Meanwhile, things that hospitals must do to enable safety is a conversation that has never been anything but disingenuous. For example: What is their contingency plan for a nurse being on break? Someone else who has their own assignment "watches" those patients. What is their contingency plan for a nurse who must leave the unit to administer a med to a patient off the unit and then monitor that patient according to professional nursing standards that CMS will refer to when they are investigating a death?>>> NONE. There is no plan or allowance for that. It is not efficient and therefore it is ignored.

I will go on record as being 100% "put up or shut up" with regard to safety. It is not acceptable to wring your hands and point fingers about what a professional nurse would/should do, when acute care nurses spend all of their time in a setting that flat out ignores and a good deal of time prevents RNs from easily accomplishing much of what a professional nurse should do.

This. Thank you.

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It never fails to boggle my mind at how much money hospital systems are prepared to spend on technology in an effort to try to avoid spending more than the bare minimum on staffing.

I'm not defending the nurse's actions because she clearly failed in her due diligence when administering this medication.

But I also believe many of us are being set up to fail. The pressure to get things done quickly. The pressure to take on more patients. The pressure to be a "team player" and just put your head down and get on with doing whatever has been asked.

I really think California has the right idea with mandatory staffing ratios. I know we are pressed to take our meal breaks so as to cut down on "unapproved overtime," but if we've all got 6 patients on a busy med-surg floor, is there anyone in his or her right mind who thinks a nurse can adequately watch 12 patients while her co-worker is on break? Would you want to be one of those patients? At best, you're going to have delays in care, and at worst...well, this poor patient found out what can happen.

Brilliant! Right on, turtlesRcool! It's unbelievable to me too how much spending on construction and nurse specialists but when it comes to the actual hands on caregivers there's just not incentive for management to hire enough help! Why? Patients suffer daily due to understaffing. What gives?

Get rid of some of the technology and hire and retain knowledgeable, experienced nurses and respect the ones who help the new ones. Give the ones who are teachers and approachable to new nurses, as a resource, incentive and bonuses, etc. Like a salesperson would get commission.

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Specializes in Pediatric Critical Care.

I've never heard of the drug and didn't mind the article pointed out what its uses include. It was educational for me.

Maybe. But it would have been more relevant to the topic (and just as educational) to describe the drug as something being used to chemically disable muscle movement when needed, in very limited circumstances involving critically ill patients on breathing machines.

In August Tennessee executed their first inmate in a decade and used a new cocktail that included midazolam, vecuronium, and potassium chloride. There were more news stories about how the prisoner suffered and how barbaric this was. Readers of the Tennessean already would have been familiar with these drugs in relation to the August Execution and lawsuits from other death row inmates.

If they were interested in education rather than sensationalism, they might have mentioned that midazolam is also sometimes used in lethal injection.

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^ Yes. It was no educational effort. These are sick attempts at pretending to be a "journalist." The direct intent was to associate the nurse's mistake with a situation that others largely associate with intentional cruelty.

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Specializes in Pediatric Critical Care.
^ Yes. It was no educational effort. These are sick attempts at pretending to be a "journalist." The direct intent was to associate the nurse's mistake with a situation that others largely associate with intentional cruelty.

Imagine my surprise when zDoggMD used the same attempt at education when he made a video about the story.

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Brilliant! Right on, turtlesRcool! It's unbelievable to me too how much spending on construction and nurse specialists but when it comes to the actual hands on caregivers there's just not incentive for management to hire enough help! Why? Patients suffer daily due to understaffing. What gives?

Get rid of some of the technology and hire and retain knowledgeable, experienced nurses and respect the ones who help the new ones. Give the ones who are teachers and approachable to new nurses, as a resource, incentive and bonuses, etc. Like a salesperson would get commission.

The consequence of inadequate staffing: a certain level of patient dissatisfaction, med errors, patient harm and even the occasional sentinel event, is a risk the hospital willingly accepts because it is outweighed by the benefit of higher profits.

And technology is bling bling.

Risk management, lawyers, number crunchers...It's not like they just don't understand what nurses need to provide good, safe care, they are just running the cost benefit analysis that shows it costs less to deal with the negative consequences of inadequate staffing. In the meantime, demand more from the nurses, convince them they are to blame when patients complain, and when errors occur it's because they haven't followed correct procedure or whatever.

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