(LtoR) Glenda Feliciano, RN, Kim North RN, James Baldwin, RN, ACNO and Kay Ashworth, RN, Nurse Manager - not present Rachel LaFon RN and Becky Taylor, RN
May 2021
4 Doan SICU
Surgical Intensive Care Unit
The Ohio State University Wexner Medical Center
Columbus
,
OH
United States
Kim North, BSN, RN
Glenda Feliciano, BSN, RN
Rachel LaFon. BSN, RN
Becky Taylor, RN (no longer with OSUWMC)
Glenda Feliciano, BSN, RN
Rachel LaFon. BSN, RN
Becky Taylor, RN (no longer with OSUWMC)
For over 48 hours these nurses worked tirelessly to save this patient, who was able to receive a liver transplant and transfer out of the ICU!
These nurses not only had to handle such a unique patient situation as having to keep a patient alive without a liver, but they also had to navigate the challenges associated with physicians new to OSU and unconventional treatment options. For over 48 hours these nurses worked tirelessly to save this patient, who was able to receive a liver transplant and transfer out of the ICU! Without the hard work, collaboration, and experience of these dedicated nurses, the patient would have suffered an adverse outcome.
The Ohio State Wexner Medical Center has seen its share of complicated medical cases throughout the years. Nurses in the Surgical/Trauma/ Burn ICU have been exposed to varying degrees of acuity and stress in caring for the patients that enter their unit. You would think that the experienced nurses would have “seen it all” and be prepared for anything that comes their way. However, there is never a dull moment in the ICU setting. The primary nurse received report that she was to recover a patient coming from the OR following a liver transplant. The new liver was nonviable, and the patient came to the unit in an extremely unstable condition. The patient required multiple continuous medications to keep his blood pressure, heart rate, and pH in a normal range. Multiple coolers of blood products were administered because the new liver was nonfunctioning, and the patient would be unable to clot his blood and hence bleed to death.
In addition, his kidneys were suffering from an acute injury requiring continuous renal replacement therapy (CRRT) at the bedside. The transplant doctors decided to take the patient back to the OR to remove the dead organ. The patient was too unstable to stop any treatment. Therefore, our ICU RN’s had to go into the operating room with the surgeons and anesthesiologists to manage the care of the patient and continue the CRRT therapy during the surgery procedure. The nurses then had to take care of the patient postoperatively a second time. The patient who now has no liver required mass transfusions and numerous medications to keep him alive in hopes that a new liver would become available in the near future. The nurses had to collaborate with various personnel in order to care for this acutely ill patient.
The charge nurse and nurse manager allocated staffing so that two nurses were at the bedside at all times for multiple days. The nurses worked closely with the respiratory therapists, pharmacists, nursing assistants, unit clerks, and various ancillary staff to facilitate care. The transplant doctors and the SICU team consisting of residents, fellows, and attending doctors were constantly working with the nurses to treat this patient. The nurses had to navigate the challenges associated with physicians new to OSU and unconventional treatment options, and they had to collaborate with the director of the SICU in order to determine the best plan of care for this unique situation. The nurses at the bedside worked tirelessly for over 4 days to keep him alive until the patient was able to receive a newly transplanted liver. The two primary nurses worked as one to accomplish their goals.
One nurse stated, “We didn’t discuss what roles we would perform or how to go about the tasks; we just knew what needed to be done and just did the work.” Fortunately, the patient was able to receive a newly transplanted liver and was eventually transferred out of the ICU! Without the hard work, collaboration, and experience of these dedicated nurses, the patient would have suffered an adverse outcome.
The Ohio State Wexner Medical Center has seen its share of complicated medical cases throughout the years. Nurses in the Surgical/Trauma/ Burn ICU have been exposed to varying degrees of acuity and stress in caring for the patients that enter their unit. You would think that the experienced nurses would have “seen it all” and be prepared for anything that comes their way. However, there is never a dull moment in the ICU setting. The primary nurse received report that she was to recover a patient coming from the OR following a liver transplant. The new liver was nonviable, and the patient came to the unit in an extremely unstable condition. The patient required multiple continuous medications to keep his blood pressure, heart rate, and pH in a normal range. Multiple coolers of blood products were administered because the new liver was nonfunctioning, and the patient would be unable to clot his blood and hence bleed to death.
In addition, his kidneys were suffering from an acute injury requiring continuous renal replacement therapy (CRRT) at the bedside. The transplant doctors decided to take the patient back to the OR to remove the dead organ. The patient was too unstable to stop any treatment. Therefore, our ICU RN’s had to go into the operating room with the surgeons and anesthesiologists to manage the care of the patient and continue the CRRT therapy during the surgery procedure. The nurses then had to take care of the patient postoperatively a second time. The patient who now has no liver required mass transfusions and numerous medications to keep him alive in hopes that a new liver would become available in the near future. The nurses had to collaborate with various personnel in order to care for this acutely ill patient.
The charge nurse and nurse manager allocated staffing so that two nurses were at the bedside at all times for multiple days. The nurses worked closely with the respiratory therapists, pharmacists, nursing assistants, unit clerks, and various ancillary staff to facilitate care. The transplant doctors and the SICU team consisting of residents, fellows, and attending doctors were constantly working with the nurses to treat this patient. The nurses had to navigate the challenges associated with physicians new to OSU and unconventional treatment options, and they had to collaborate with the director of the SICU in order to determine the best plan of care for this unique situation. The nurses at the bedside worked tirelessly for over 4 days to keep him alive until the patient was able to receive a newly transplanted liver. The two primary nurses worked as one to accomplish their goals.
One nurse stated, “We didn’t discuss what roles we would perform or how to go about the tasks; we just knew what needed to be done and just did the work.” Fortunately, the patient was able to receive a newly transplanted liver and was eventually transferred out of the ICU! Without the hard work, collaboration, and experience of these dedicated nurses, the patient would have suffered an adverse outcome.