Nurse kills patient by giving vecuronium instead of versed

[nimbus]

Inter professional equivalency for some of the mistakes we've seen made? (Obviously not talking about the dead pt)
A surgeon mistakes a kidney for a tumor. How can this happen?

Interesting that the general surgeon who did the approach was allowed to operate without malpractice insurance. Only in Florida.

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[Ezekiel2517]

It's terrible that he worked with a surgeon that made him too afraid to speak up and a patient got hurt as a consequence. I would say this is another systems error.

Agree. It's amazing to me how many people in "leadership" positions across all kinds of professions don't realize that people perform at their absolute best when they are relaxed. You need to be able to create that culture and environment.

 

[MoMoGesiologist]

How do people here approach crotchety old surgeons? What do you say or do when they start speaking loudly, or talking down to the CRNA or resident? What if they're trying to dictate your plan? What are tactics that you have found effective? If other attendings or the division or department chair don't speak up, how do you as an individual say something?

 

[okayplayer]

How do people here approach crotchety old surgeons? What do you say or do when they start speaking loudly, or talking down to the CRNA or resident? What if they're trying to dictate your plan? What are tactics that you have found effective? If other attendings or the division or department chair don't speak up, how do you as an individual say something?

Doesn’t happen at my hospital.

 

[Mr.S]

How do people here approach crotchety old surgeons? What do you say or do when they start speaking loudly, or talking down to the CRNA or resident? What if they're trying to dictate your plan? What are tactics that you have found effective? If other attendings or the division or department chair don't speak up, how do you as an individual say something?

There are no tactics that will be effective. You can go toe to toe with the surgeon but they will likely win. Why? He or she has mroe power than you. And they have created that differential.
Department chair? thats a laugh. You think the dept.chair is worried about your stupid battles? He/she is sitting in the office relaxed. He/she has reached the promise land. You think he/she will sacrifice that for your squabbles? your squabbles and problems on the front lines are exactly that. Your problems to deal with. You go to him/her with those problems, he will make them your problems. That goes for any other problems you have with staff, pacu nurses, crnas etc etc etc.
That is the game as i see it.

 

[deleted875186]

The Protamine on pump is also avoidable with a system change. At my hospital, protamine is only carried by the perfusionist. I don’t have it within reach on the room, when we are off pump, I have to ask the perfusionist for the appropriate dose. I do think it makes me less likely to have it “drawn and ready”.

 

[MoMoGesiologist]

There are no tactics that will be effective. You can go toe to toe with the surgeon but they will likely win. Why? He or she has mroe power than you. And they have created that differential.
Department chair? thats a laugh. You think the dept.chair is worried about your stupid battles? He/she is sitting in the office relaxed. He/she has reached the promise land. You think he/she will sacrifice that for your squabbles? your squabbles and problems on the front lines are exactly that. Your problems to deal with. You go to him/her with those problems, he will make them your problems. That goes for any other problems you have with staff, pacu nurses, crnas etc etc etc.
That is the game as i see it.

Hmm I think my experience in residency was very different. My department chair was very good. Strong leader, resident advocate, put his foot down when needed. He reached out to residents to make sure they were ok if something went wrong. He would take small issues of disrespect seriously.

Even then some surgeons just r so rude.

 

[T-burglar]

The Protamine on pump is also avoidable with a system change. At my hospital, protamine is only carried by the perfusionist. I don’t have it within reach on the room, when we are off pump, I have to ask the perfusionist for the appropriate dose. I do think it makes me less likely to have it “drawn and ready”.

In a service that uses residents, the protamine needs to be hidden from them. There will always be residents in there with no motivation to learn on their own and have no clue about cardiac OR safety. In my training program protamine wasn't drawn by perfusion until the surgeon ordered it. And residents were not allowed to go into the perfusion drug cart. There are all kinds of opportunities to kill someone in the cardiac room outside of anti-coagulation management. High concentration pressors, high concentration potassium bottles... insulin is hung for every case and can easily be misprogrammed by a newbie or even a veteran to run in very fast (have seen this, and it caused hypoglycemia with patient harm) ... TEE trauma .... the list goes on.

Of all the places in the OR, the cardiac room benefits the most from fostering a team approach. It is beyond easy to kill and maim in there. Good riddance that all the older surgeons will be gone soon.

 

[Apollyon]

Interesting that the general surgeon who did the approach was allowed to operate without malpractice insurance. Only in Florida.

Alabama, Alaska, Arizona, Arkansas, California, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington and West Virginia. These are all states that do not require malpractice insurance. However, hospitals or hospital systems might require it or insurance carriers. But, if you are at a small/troubled place, you can probably "go bare" without issue.

 

[Man o War]

How do people here approach crotchety old surgeons? What do you say or do when they start speaking loudly, or talking down to the CRNA or resident? What if they're trying to dictate your plan? What are tactics that you have found effective? If other attendings or the division or department chair don't speak up, how do you as an individual say something?

Pick your battles. Best advice I can give. Also goes for supervising CRNAs. Only fight the battles that are really worth fighting.
Our chair does not take any crap from anyone, but he has a way of telling people no without ruffling too many feathers. High EQ is an essential skill in anesthesiology IMO. Especially for the really good private practice jobs. Lots of managing different personality disorders.

 

[chocomorsel]

When you have a surgeon riding your ass, making the OR super tense, feeling time pressure that doesn't need to exist, it's very understandable a resident wouldn't hear things correctly (also scared to ask surgeon to repeat himself), and would fumble things and not perform at their best. I bet if the resident was asked outside the OR what the consequences of giving protamine on pump were, he would know.

Some surgeons are just so nasty to work with. If the attendings arent saying anything, no way a resident will.

I'm not defending the resident, but I can understand why such a big no-no happened. We have all made mistakes in the OR we never thought possible. Just usually it's stuff that really doesn't matter.

One of the reasons I left the OR and plan on limiting my time there in the future. Not good for my mental health dealing with toxic people frequently.

 

[chocomorsel]

Hmm I think my experience in residency was very different. My department chair was very good. Strong leader, resident advocate, put his foot down when needed. He reached out to residents to make sure they were ok if something went wrong. He would take small issues of disrespect seriously.

Even then some surgeons just r so rude.

You are lucky and probably in the minority.

 

[deleted171991]

One of the reasons I left the OR and plan on limiting my time there in the future. Not good for my mental health dealing with toxic people frequently.

You ain't seen toxic passive-aggressive younger generations of ICU nurses yet. The kind who thinks she must be smart because she went to college to learn to wipe someone's butt, and whose every pore and body language exudes attitude and lack of respect, BECAUSE SHE KNOWS YOU CAN'T DO **** ABOUT IT. The kind you won't find in a good academic place (like the one you're doing your fellowship at), simply because there is too much work.

One problem with American healthcare is that doctors are not in control of all the hiring and firing of the underlings they have to work with on a daily basis. Like it used to be. Too much misunderstood egalitarianism. People with bad character respect just one thing: power.

 

[chocomorsel]

You ain't seen toxic passive-aggressive younger generations of ICU nurses yet. The kind who thinks she must be smart because she went to college to learn to wipe someone's butt, and whose every pore and body language exudes attitude and lack of respect, BECAUSE SHE KNOWS YOU CAN'T DO **** ABOUT IT. The kind you won't find in a good academic place (like the one you're doing your fellowship at), simply because there is too much work.

One of the problem with American healthcare is that doctors are not in control of all the hiring and firing of the underlings they have to work with on a daily basis. Like it used to be. Too much misunderstood egalitarianism. People with bad character respect just one thing: power.

Hasn't been my experience at all. Sorry this is yours. Will keep you updated. Nurses I have dealt with in my years of PP from the OR to the ICU were very easy to get along with. Academic nurses are the ones that seem to have ego, bully behavior, and or passive aggressive problems in my opinion. I have worked at three academic institutions and 15 or so private hospitals. But I haven't worked in big hospitals either. Typically smaller hospitals were the nurses are just happy to have a physician to help who's competent and not a jerk. With the bigger places, seems like out West there was still more respect for us than out in the east IMO.
I will deal with those nurses any day than the toxic personalities of some surgeons. No thanks. You can have them. Another reason I can't do academics. Too many egos of all varieties in the MECCA.

 

[deleted171991]

 

[drmwvr]

People with bad character respect just one thing: power.

bingo

 

[deleted171991]

Pick your battles. Best advice I can give. Also goes for supervising CRNAs. Only fight the battles that are really worth fighting.
Our chair does not take any crap from anyone, but he has a way of telling people no without ruffling too many feathers. High EQ is an essential skill in anesthesiology IMO. Especially for the really good private practice jobs. Lots of managing different personality disorders.

Can't like this post enough. This should be posted as a sticky in every career advice thread about anesthesiology. Because it's way more important than anything else. It's also becoming true about the rest of medicine, unfortunately, but anesthesiology has a special place in this hell. There is no place for ego or conscience in anesthesiology. The more you have of either, the more you'll suffer.

We are seen as replaceable cogs, techs, servicepeople. We are less and less respected as individuals, as professionals. They need somebody "to put the patient to sleep". Gods forbid you contradict the almighty well-connected surgeon! And that continues also in the SICU, by the way.

Whoever owns the patient owns you.

 

[Cryc_to_the_point]

I dont understand why that dynamic exists in the SICU. I've been told that's not the case in other countries.

 

[chocomorsel]

Can't like this post enough. This should be posted as a sticky in every career advice thread about anesthesiology. Because it's way more important than anything else. It's also becoming true about the rest of medicine, unfortunately, but anesthesiology has a special place in this hell. There is no place for ego or conscience in anesthesiology. The more you have of either, the more you'll suffer.

We are seen as replaceable cogs, techs, servicepeople. We are less and less respected as individuals, as professionals. They need somebody "to put the patient to sleep". Gods forbid you contradict the almighty well-connected surgeon! And that continues also in the SICU, by the way.

Whoever owns the patient owns you.

Get out of academics FFP. You will likely end up happier.

 

[chocomorsel]

I dont understand why that dynamic exists in the SICU. I've been told that's not the case in other countries.

In other countries anesthesiologists command a lot more respect and work in more than just the OR and even the ICU.

 

[deleted171991]

Get out of academics FFP. You will likely end up happier.

It's not just the academia, although I have worked in PP only as an anesthesiologist. The surgical butt-kissing is even worse in PP, the land of rubber-stamped cardiac clearances, robotic surgeries in 95 year-olds etc., anything that doesn't endanger the group's contract.

I am sorry to say, but most anesthesiology departments, whether in PP or academia, are more concerned about PR or keeping the surgeons happy than about anything else. Anesthesiologist job satisfaction and happiness is very low on the list. Surgical ICUs are not much different when about intensivists.

The secret of a happy job is to be as irreplaceable as possible. Go to a place where they need your expertise, there is nobody else like you, and it would take them a long time to find a replacement. THEY will kiss YOUR butt.

 

[Planktonmd]

You ain't seen toxic passive-aggressive younger generations of ICU nurses yet. The kind who thinks she must be smart because she went to college to learn to wipe someone's butt, and whose every pore and body language exudes attitude and lack of respect, BECAUSE SHE KNOWS YOU CAN'T DO **** ABOUT IT. The kind you won't find in a good academic place (like the one you're doing your fellowship at), simply because there is too much work.

One problem with American healthcare is that doctors are not in control of all the hiring and firing of the underlings they have to work with on a daily basis. Like it used to be. Too much misunderstood egalitarianism. People with bad character respect just one thing: power.

My friend ... you are again 100% right!
But this is what health care in this country is going to be , it's about cutting cost by using cheaper "providers"

 

[chocomorsel]

It's not just the academia, although I have worked in PP only as an anesthesiologist. The surgical butt-kissing is even worse in PP, the land of rubber-stamped cardiac clearances, robotic surgeries in 95 year-olds etc., anything that doesn't endanger the group's contract.

I am sorry to say, but most anesthesiology departments, whether in PP or academia, are more concerned about PR or keeping the surgeons happy than about anything else. Anesthesiologist job satisfaction and happiness is very low on the list. Surgical ICUs are not much different when about intensivists.

The secret of a happy job is to be as irreplaceable as possible. Go to a place where they need your expertise, there is nobody else like you, and it would take them a long time to find a replacement. THEY will kiss YOUR butt.

You are correct on the anesthesia aspect. I was thinking in line more for CCM in a closed unit.

 

[dhb]

In other countries anesthesiologists command a lot more respect and work in more than just the OR and even the ICU.

Very untrue

 

[chocomorsel]

Very untrue

Really? Are you just as disrespected as we are? I have no first hand knowledge just read about their scope and talked to a few people from Europe. It depends on the country I am sure but based on the responsibilities they have out of the OR, it’s gotta come with more respect. Hopefully?

 

[dhb]

Are you just as disrespected as we are?

Fo shizzel.
If you're not bringing in the $ (patient)...

 

[mmag]

Pharmacy tech (mostly likely since they call the person a pharmacy worker and not pharmacist) puts roc into IV bag instead of another drug. Fire alarm goes off right after ED patient gets medicine. No one notices until it's too late.

Hospital says "No single caregiver is responsible for Loretta Macpherson's death. All of us feel a sense of responsibility and deep remorse."

Wrong drug put in IV bag led to fatal Bend hospital error

 

[Psai]

Pharmacy tech (mostly likely since they call the person a pharmacy worker and not pharmacist) puts roc into IV bag instead of another drug. Fire alarm goes off right after ED patient gets medicine. No one notices until it's too late.

Hospital says "No single caregiver is responsible for Loretta Macpherson's death. All of us feel a sense of responsibility and deep remorse."

Wrong drug put in IV bag led to fatal Bend hospital error

Sure sounds like the responsibility of a single caregiver

 

[jwk]

Pharmacy tech (mostly likely since they call the person a pharmacy worker and not pharmacist) puts roc into IV bag instead of another drug. Fire alarm goes off right after ED patient gets medicine. No one notices until it's too late.

Hospital says "No single caregiver is responsible for Loretta Macpherson's death. All of us feel a sense of responsibility and deep remorse."

Wrong drug put in IV bag led to fatal Bend hospital error

Although very sad, I'm impressed that the hospital publicly released a very detailed description of what happened.

"The vials of rocuronium and the IV bag that was labeled "fosphenytoin" were reviewed without the error being noticed." That would give me the impression that if a pharmacy tech mixed the IV, that a pharmacist is the one who reviewed it. I know in our place a pharmacist has to personally review IV admixture preparations with the tech.

 

[LineAndBerry]

This would not have happened if brand names were also programmed in the Pyxis machine. Goes to show how the purists with their elitist attitude result in patient deaths. Most likely this nurse will be fired and the elitist pricks on the pharmacy committee will still not program brand names into the system, because I’m sure we have all heard the idiots say only generic names are allowed.

The Pyxis, the JCAHO, the EMR, and the current state of top-heavy bureaucratic Admin result in hundreds, if not thousands, of pt. deaths each year.

 

[LineAndBerry]

Prob

Have you ever reconstituted versed?

Have you ever seen vec that didn’t need reconstituted?

It’s hard to imagine mistaking versed for vec and vice versa for that reason alone.. that’s why folks think there might be more to the story..

Both probably were in red labelled syringes. The Vec was already reconstituted and lying there (this is what boggles the mind - why was Vec there in the first place?). Nurse grabbed the first syringe she saw. She probably had no clue what Vec even is. I can easily imagine this scenario.

 

[LineAndBerry]

its hard to blame the system when at least a little part of the system relies on someone who knows how to read
The only similarities between versed and vecuronium is that the first two letters of those two words are the same.
At some point people have to be held accountable and not the system.. If we hold the system accountable every single time then our rule book will be one million pages before long.

Yes and no. The system can be so messed up (current state of EMR in many hospitals - ex: Canopy EMR is unbelievably horrible, distracting, etc.) that it just facilitates errors.

 

[LineAndBerry]

What boggles my mind is that this nurse, obviously unfamiliar with both drugs, would sit there and read the (fine print) instructions for reconstitution, but not see the “VECURONIUM” on the front. To me this goes beyond simple malpractice and borders on criminal negligence.

It had to be already reconstituted.

 

[Mman]

Prob

Both probably were in red labelled syringes. The Vec was already reconstituted and lying there (this is what boggles the mind - why was Vec there in the first place?). Nurse grabbed the first syringe she saw. She probably had no clue what Vec even is. I can easily imagine this scenario.

why would Versed be in a red labeled syringe? It should be orange if anything.

 

[LineAndBerry]

Don’t the bottles also say “paralyzing agent” on them? I have to say though I dont think those words stand out very well . I think the bottle should have “LETHAL PARALYZING AGENT” on it in massive lettering with a skull and crossbones. And only in very small letters somewhere does it read which drug it is.

Yes. It should say something like: "THIS DRUG WILL RESULT IN THE MOST EXCRUCIATING TORTURE IMAGINABLE UNLESS USED PROPERLY"

 

[Mman]

It had to be already reconstituted.

from the report linked in this thread, it was not a prefilled syringe...

RN #1 stated, "I reconstituted the medication and measured the amount I needed"​

 

[LineAndBerry]

Because some patients just won’t hold still in the scanner damn it!

I've honesty encountered this thought numerous times. It's incredible that there is not better education amongst ED and ICU personnel As a resident at Mercy in Pittsburgh, PA, they gave all new residents the opportunity to be given a paralytic without sedation. I knew enough about this to decline - those who did it will never misuse a paralytic agent and became evangelists for the dangers of using these drugs without heavy sedation or other improper ways.

 

[DM27]

That makes it even more confusing. After googling a bit I found that Pharmedium sells prefilled reconstituted Vec syringes so I assumed that had to be the case.

Having to reconstitute the med...I would’ve assumed at one point the nurse would have stopped to wonder “why am I reconstituting this?”. I am not sure how it works at most hospitals but I am not aware of any medications that our floor nurses physically reconstitute, instead it is done in the pharmacy and coming up in a syringe or bag.

 

[LineAndBerry]

The nurse was looking for versed in the Pyxis but the stupid thing was programmed for midazolam only. The she went for the closest to versed.

Don't know any drugs with 5 names but if there is one they all should be programmed into the pyxis.

And who the heck thinks monitoring after 2 mg of versed is mandatory? Every other patient I take care of is on xanax po at home. Do they need to be monitored at home?

".....the stupid thing was programmed for midazolam only...."
Exactly, the idiot sitting in an office writing these programs should be liable. Waaaaaay too many folks sitting in offices controlling health care, and it's only getting worse by the day.

 

[LineAndBerry]

We were called to the ED as a resident to be "on standby" for a "potentially difficult intubation." The second my attending and I step into the room the ED fellow or attending or whatever it was pushes 200mg of sux and before giving 20mg of etomidate. It was the most bizarre scene I had ever seen, the patient looked like he was having a full body seizure on the bed before he went unconscious. My attending shouted some deservedly choice words at the ED staff before we went back into our safe space in the operating room. Hospitals are dark dangerous places outside of the OR.

Being a patient caught in the system is getting increasingly scary. Like being caught in the current dysfunctional legal maze but worse.

 

[LineAndBerry]

why would Versed be in a red labeled syringe? It should be orange if anything.

Close enough to red if the nurse was harried. Just a speculation.

 

[LineAndBerry]

from the report linked in this thread, it was not a prefilled syringe...

RN #1 stated, "I reconstituted the medication and measured the amount I needed"​

OK, thanks.

 

[Mr.S]

".....the stupid thing was programmed for midazolam only...."
Exactly, the idiot sitting in an office writing these programs should be liable. Waaaaaay too many folks sitting in offices controlling health care, and it's only getting worse by the day.

the problem is.. even the clinical people who are the point people dont have good intentions...

Have you been to an OR lately. You can hardly recognize it. Unless you have 3-4 username/passwords you cant do anything.
This does NOTHING for patient safety and just pisses me the F off on a daily basis and will make retire early thats for sure.

 

[LineAndBerry]

the problem is.. even the clinical people who are the point people dont have good intentions...

Have you been to an OR lately. You can hardly recognize it. Unless you have 3-4 username/passwords you cant do anything.
This does NOTHING for patient safety and just pisses me the F off on a daily basis and will make retire early thats for sure.

I'm not sure what you mean when you say we don't have good intentions.

Yes, I've supervised over 110 cases this week and was in the OR again today. I've spent many, many hours just logging into the health record. Gotta get all 10 characters, the capitals, the numbers, and don't forget at least one punctuation mark. One mistake and it's back to square one - and that's just getting in. Asked to log in again for some strange reason. Takes about 10 illogical steps to try to place an order. Nowhere to just write a simple progress note - have to choose from a list of 5000 options, none of which really denote what I could have said in 5 seconds with a pen and paper.
Multiply that by 600 and that's a typical day in my busy OR. I treated the computer who got the bulk of my attention. Miss one jot or tittle and someone in the bowels of the hosp. will find out and I'll have to fix it in all my spare time. That could not be increasing the cost of health care could it? Obama pushed really, really hard for this. Follow the money trail and you'll have your story.

I agree 110% about what you say about the current state of electronic health records and how seriously they interfere with patient care. I've remarked in a comment above that the EHR is implicated in very serious patient morbidity and mortality. Humans cannot give full attention to treating the damn computer whilst also giving full attention to the patient. Something has to give, and since the only thing that we ever get dinged on is documentation (ie: billing for insurance companies and recording a billion useless pieces of data for lawyers) the computer is more valued than the patient. Somebody's got to care about the patient. The pressure on nurses is over the top. We need to be mad and we are overdue for a revolution, hosp. admin., health insurance exec's, and lawyers be damned....

 

[IlDestriero]

We have reconstituted Vecuronium that the pharmacy makes for us with it’s robot. 1mg/ml, 5cc syringe. They may have something similar.
Horrible error, but it exposed serious problems with their system. No monitoring of patients when they are given sedatives, overriding meds in Pyxis, not knowing or checking genetic names, etc.

 

[woopedazz]

It boggles my mind that the US uses trade names and people do not know the drug name. I just don't see how people can learn 5 different drug names for every drug and then internally translate it continuously.

In Australia I could say "can we load this patient with 300mg of aspirin?" And the nurse would respond "of course." Then go get whatever brand name our hospital bought for cheap that month... it'll probably change the month after as we constantly bid to keep prices down.

In the US I can only imagine I say "can we load this patient with 300mg of Bayer Aspirin?" And the nurse would respond "sorry doctor, we don't have that drug."
Then I would say "oh, how about 300mg of Ascriptin?" Nurse "no..."
Then I would say "Ecpirin?" Nurse "no... I'm so sorry..."
Then I would say "perhaps Easprin?" Nurse "I'm so sorry sir... I don't know what any of these drugs are... Are you wanting me to give versed?"
Then I would say "What about Norwich Aspirin?" Then the nurse would say "Oh, of course... why didn't you just say that? I'll get it right away!"

Surely you have several trade names for each drug? Otherwise, your costs would be astronomical with the monopoly companies would have over their brand name. I don't get it.

 

[Cryc_to_the_point]

We have reconstituted Vecuronium that the pharmacy makes for us with it’s robot. 1mg/ml, 5cc syringe. They may have something similar.
Horrible error, but it exposed serious problems with their system. No monitoring of patients when they are given sedatives, overriding meds in Pyxis, not knowing or checking genetic names, etc.

They in fact did not have something similar. You can read above. She reconstituted it. A large portion of this error is that she is either a massive ***** or never bothered to apply the intelligence she does have to this case.

 

[MirrorTodd]

It boggles my mind that the US uses trade names and people do not know the drug name. I just don't see how people can learn 5 different drug names for every drug and then internally translate it continuously.

In Australia I could say "can we load this patient with 300mg of aspirin?" And the nurse would respond "of course." Then go get whatever brand name our hospital bought for cheap that month... it'll probably change the month after as we constantly bid to keep prices down.

In the US I can only imagine I say "can we load this patient with 300mg of Bayer Aspirin?" And the nurse would respond "sorry doctor, we don't have that drug."
Then I would say "oh, how about 300mg of Ascriptin?" Nurse "no..."
Then I would say "Ecpirin?" Nurse "no... I'm so sorry..."
Then I would say "perhaps Easprin?" Nurse "I'm so sorry sir... I don't know what any of these drugs are... Are you wanting me to give versed?"
Then I would say "What about Norwich Aspirin?" Then the nurse would say "Oh, of course... why didn't you just say that? I'll get it right away!"

Surely you have several trade names for each drug? Otherwise, your costs would be astronomical with the monopoly companies would have over their brand name. I don't get it.

Nurses actually say sorry in Australia?

 

[Mr.S]

I'm not sure what you mean when you say we don't have good intentions.

Yes, I've supervised over 110 cases this week and was in the OR again today. I've spent many, many hours just logging into the health record. Gotta get all 10 characters, the capitals, the numbers, and don't forget at least one punctuation mark. One mistake and it's back to square one - and that's just getting in. Asked to log in again for some strange reason. Takes about 10 illogical steps to try to place an order. Nowhere to just write a simple progress note - have to choose from a list of 5000 options, none of which really denote what I could have said in 5 seconds with a pen and paper.
Multiply that by 600 and that's a typical day in my busy OR. I treated the computer who got the bulk of my attention. Miss one jot or tittle and someone in the bowels of the hosp. will find out and I'll have to fix it in all my spare time. That could not be increasing the cost of health care could it? Obama pushed really, really hard for this. Follow the money trail and you'll have your story.

I agree 110% about what you say about the current state of electronic health records and how seriously they interfere with patient care. I've remarked in a comment above that the EHR is implicated in very serious patient morbidity and mortality. Humans cannot give full attention to treating the damn computer whilst also giving full attention to the patient. Something has to give, and since the only thing that we ever get dinged on is documentation (ie: billing for insurance companies and recording a billion useless pieces of data for lawyers) the computer is more valued than the patient. Somebody's got to care about the patient. The pressure on nurses is over the top. We need to be mad and we are overdue for a revolution, hosp. admin., health insurance exec's, and lawyers be damned....

Who are you?
Are you an Anesthesia Chief?
If you are then make it F in stop
Someone, somewhere with power (anesthesia chief) said, yes this is ok. Bringing this freakin monstrosity into the OR to take attention away from patients is a good idea.

I would have said, "over my dead body" are you bringin this **** into my OR.
Yea, make just jotting vitals down into a 80 billion dollar business.
Oh why is healtcare so ****ing expensive again?

 

[precisiongraphic]

They in fact did not have something similar. You can read above. She reconstituted it. A large portion of this error is that she is either a massive ***** or never bothered to apply the intelligence she does have to this case.

Nurse was arrested this week. Article states charged with reckless homicide and patient abuse.