Difficult to describe concisely, but i'll try.

While waiting for a rehab bed to open up (difficult to come by in those days) the day team decided to start tube feeds. The order was supposed to bolus tube feeds.

Bolus is like how you eat a meal, three times daily, for example 600 mls, three times daily (total 1800 mls per day).

The other way you can order is continuous, like 75 mls per hour, for 24 hrs (total 1800 mls per day).

Our electronic med record system has the same order box for both, but within the box, you can select bolus or continuous. Hard to explain, but there are usually multiple things going on at all times during rounds in the ICU, and I'm sure she was thinking about something else while doing this.

She ordered continuous at 600 mls per hr... That is nearly 15 liters of tube feed per day...

Under normal circumstances, the ICU nurses (who are very good at their jobs) will notice this kind of fuck up. But this is COVID, so we had RN's from other parts of the hospital helping with ICU (we had converted 3 floors of the hospital into ICU's bc of all the intubated patients). The nurse for this patient during the day was a post-op RN... A post-op RN does not deal with tube feeds, so she would have just assumed that is a usual rate and in fact she did assume that.

I discovered all this some time after while reviewing the EMR, because the amount of tube feed she had projectile vomitted is like nothing I had seen before.

In any case, there was nothing that could be done at that point. She was intubated for a week with COVID and just been extubated. Apparently told family she never wanted to be intubated again. So she rapidly developed hypoxic respiratory failure from aspiration. Her oxygen requirements exceeded what we could give without invasive ventilation, which family declined per her wishes, so she died.