Frances demonstrated extraordinary care during her recent interaction with a veteran in the Interventional Radiology (IR) department. A patient, B, arrived to IR for a tunnel catheter placement. During her assessment of the patient, Frances noted an extremely large area of profound erythema, edema, and excoriated skin around the veteran's portacath on his left anterior chest area. There was a tegaderm dressing over the portacath and another tegaderm dressing just above the port, holding a dry dressing in place. The extreme erythema and skin break down extended over his entire left chest and into the left axilla. B concurred that the area was very painful, such that Frances was not able to remove the tegaderm dressing without the veteran experiencing great discomfort.
Even though B was coming to IR for a totally unrelated issue, Frances's concern for the veteran's skin condition and discomfort motivated her to inquire about the cause and ensure the proper treatment of it. Frances took initiative and contacted the wound care nurse for expert evaluation. The wound care nurse saw the veteran while in IR and concurred that it appeared to be a severe allergic reaction to the tegaderm dressing. Frances also contacted the PICC line RN to get recommendations on optional dressings that could be used following the tunnel catheter placement, so she could avoid using tegaderm dressing on the veteran.
To follow up, Frances contacted the nurse practitioner on the veteran's medical team the next day to follow up on his care. Unfortunately, B returned to IR, at a later date, to have the portacath removed due to infection. On a positive note, this also allowed her to follow up and see the obvious improvement in the patient's skin that resulted from her actions. Out of concern for the veteran, Frances completed an incident report to have the occurrence further reviewed.
Frances was sincerely concerned for the veteran's well-being and her actions improved his quality of life by taking the initiative to have his condition urgently addressed. Her actions exemplified going above and beyond, as well as serving as a role model for her colleagues as to what veteran-centered care is all about.