The homicide trial of a nurse who accidentally killed a patient by providing the wrong medication is raising questions about the liability of healthcare facilities in similar cases — especially when they’re operating with less than ideal staffing levels of using technology to speed workflows.

An investigator in the case of former nurse RaDonda Vaught testified this week that Vanderbilt University Medical Center had a “heavy burden of responsibility” for a drug error that killed the patient in 2017. But investigators charged only Vaught with reckless homicide and abuse of an impaired adult, pursuing no penalties against the hospital.

Vaught does not deny she accidentally confused the drugs, according to trial coverage by Kaiser Health News. But she has pleaded not guilty to all charges in the death of Charlene Murphey, who died after being given vecuronium, a paralyzing drug, instead of Versed, the sedative she’d been prescribed.

Testimony from an agent with the Tennessee Bureau of Investigation seemed to support the defense’s argument that systemic failures at Vanderbilt contributed to the error. Combined with concerns Vaught’s team has raised about the way staff used technology to store and dispense drugs at Vanderbilt, the case shows long-term care providers have plenty to learn from this case.

‘Chilling’ effect on process improvement?

“The loss of this patient’s life should not be overlooked in this story, but we must acknowledge the failure of a broken system that allowed a nurse to work while being short-staffed, overworked and unsupported,” said Rebecca Love, chief clinical officer of IntelyCare, a nurse staffing firm. “Vaught’s case is representative of a systemic problem, not a nursing problem. Rather than criminally prosecuting a nurse, we should be cross-examining the healthcare system that under-staffs its floors and overworks its nurses, making room for tragedies like this to happen.”

The American Nurses Association also warned of a “chilling effect” on reporting and process improvement if medical errors begin to be routinely criminalized.

“Nurses are watching this case and are rightfully concerned that it will set a dangerous precedent,” the association said in a statement this week. “Healthcare is highly complex and ever-changing, resulting in a high risk and error-prone system. Organizational processes and structures must support a ‘just culture,” which recognizes that healthcare professionals can make mistakes and systems may fail.”

At trial, technology frustrations seen as contributor

Coverage of the homicide trial Thursday keyed in on the “widespread use” of technology overrides when it came to an electronic medication cabinet, the same type of automated dispensing tool increasingly in use at larger skilled nursing facilities.

Documents filed in the case show Vaught tried to access Versed stored in the cabinet by typing the letters “VE” into the a search bar. When the cabinet did not produce the drug as an option, Ms. Vaught triggered an override that unlocked more medication choices, then searched for “VE” again. The cabinet then gave her the option to access vecuronium.

Becker’s Hospital Review reports there is ongoing debate over whether the using an override to access medication cabinets should be viewed as reckless or an institutionalized practice, “given widespread use of IT workarounds among healthcare professionals.”

Vaught said that Vanderbilt directed its nurses to override the cabinet system in the face of delays and technical problems related to an EHR upgrade. She used at least 20 such overrides in three days caring for the patient who died, NPR reported.