I would like to take a quick moment to tell you about an amazing catch by one of our med/surg nurses that may have potentially saved the patient’s life or at most extreme morbidity. The nurse’s name is Candice.

I had a patient who came to my office with low blood pressure and not feeling well. He is normally hypertensive and has chronic gout pain. He is a frequent flyer to our ER along with the rest of his family. I sent him to the ER where he was evaluated and together with the ER attending, we came to the decision to admit the patient at least for observation in the ICU given that his blood pressure was consistently low, his creatinine was 3.0 which was above his baseline of 1.4. His ICU course was unremarkable, his blood pressure improved, and his creatinine level decreased. He was transferred to the Medical/Surgical floor for an overnight observation due to high blood pressure as well as to titrate his meds appropriately. On the day of discharge, the patient told me he was feeling great, he was walking, using the restroom, and was ready to go home. I did not question this, nor did I have a PT/OT consult because he had walked into my clinic and has never had any ambulation deficits in the past.

This is where Candice stepped in. She was hesitant to allow the patient to be discharged and informed me that he was not ambulating but instead he was a two person assist from the bed to the chair. I was extremely surprised to hear this and ordered a PT/OT consult which was confirmed by therapy. As we were planning on potential discharge locations it was observed that the patient was experiencing stiffness in his neck which was a new complaint. At this time, CM and Candice contacted me again and we started to think about meningitis as part of his differential diagnosis. Anesthesia was called since this was the weekend, and a lumbar puncture was performed. Within an hour, the result was confirmed to be viral meningitis. Overall, he did well for the rest of that day and got a dose of antibiotics and steroids prior to the LP results populating.

He was seen by Neurology the next morning for disposition. Overnight however it was observed that the patient had developed some confusion which slowly progressed to a mild case of encephalitis. Treatment started with IV acyclovir for 10-days to ensure full recovery. The patient started walking again and was ambulatory with a walker and was then sent for inpatient rehab with the help of CM insistence to the insurance company.

This is an amazing example of multi-disciplinary teamwork which started with Candice having the courage to stand up for her patient against a physician’s discharge orders. I am very proud of her and would encourage every nurse to feel empowered to ask questions when advocating for the best interest of his/her patients. I am very proud of being a part of this institution and happy to see how well everybody can work together in a very quick timeframe.