Lana Piedra
May 2021
Lana
Piedra
,
RN
Infusion Procedural Center
University of Virginia Health
Charlottesville
,
VA
United States
But overall what stood out to me most was how Lana reassured the patient we were going to keep a close eye on her nausea, come up with a good plan, and communicate to her outpatient doctors.
On Sunday afternoon, Lana was staffing in the infusion center caring for a stem cell transplant patient that had been recently discharged from the hospital. The patient had been struggling with severe, intractable nausea since discharge. Lana worked with the covering LIP on Sunday afternoon to get some additional anti-emetics ordered (IV Emend and oral haloperidol).
As the covering pharmacist in the infusion center, I reviewed these orders but wanted to speak with Lana to determine what was going on with the patient. When I called Lana she provided an amazingly detailed assessment of the patient's severe nausea. Lana described the specific patterns of nausea (what worked, what didn't work, potential exacerbating factors for nausea, etc.). After speaking with Lana for a few minutes I prepared the medication for the patient. After getting one of the anti-nausea pills from the main hospital pharmacy I stepped out into the infusion center to give it to her and to discuss in more detail. Lana then shared with me how she had advocated for Ms. M over the last few days - she had recognized the severity of the patient's nausea and the impact it was having on her nutrition and overall quality of life (including the severe weakness she was experiencing). Lana advocated for optimizing electrolytes and fluids (consistent with the post stem cell discharge protocols) but also encouraged additional fluids and anti-emetics. She worked with the covering LIP to optimize the infusional therapies. Lana also took the time to understand what the patient had been instructed to do for her nausea at discharge; Lana provided tips to the patient on using certain medications in more optimal ways (scheduling ondansetron around the time of meals rather than taking PRN). Lana also help expedite a new prescription for haloperidol to be sent to our UVA pharmacy. This was filled and picked up by the patient's husband.
Finally, to ensure we had a good plan for the patient's nausea Lana asked if I could discuss the haloperidol with the patient. Lana and I agreed on what made the most sense for the schedule and we both ensured the patient we had more anti-nausea medications in our toolbox if we needed to try something else. But overall what stood out to me most was how Lana reassured the patient we were going to keep a close eye on her nausea, come up with a good plan, and communicate to her outpatient doctors. I think this lessened the anxiety component of the patient's nausea as well. Lana approached this situation with a caring heart and was a wonderful communicator and advocate for the patient. (As a follow-up the next day, I spoke with our stem cell transplant pharmacist who said the patient's nausea was a little bit better controlled and was feeling overall better).
As the covering pharmacist in the infusion center, I reviewed these orders but wanted to speak with Lana to determine what was going on with the patient. When I called Lana she provided an amazingly detailed assessment of the patient's severe nausea. Lana described the specific patterns of nausea (what worked, what didn't work, potential exacerbating factors for nausea, etc.). After speaking with Lana for a few minutes I prepared the medication for the patient. After getting one of the anti-nausea pills from the main hospital pharmacy I stepped out into the infusion center to give it to her and to discuss in more detail. Lana then shared with me how she had advocated for Ms. M over the last few days - she had recognized the severity of the patient's nausea and the impact it was having on her nutrition and overall quality of life (including the severe weakness she was experiencing). Lana advocated for optimizing electrolytes and fluids (consistent with the post stem cell discharge protocols) but also encouraged additional fluids and anti-emetics. She worked with the covering LIP to optimize the infusional therapies. Lana also took the time to understand what the patient had been instructed to do for her nausea at discharge; Lana provided tips to the patient on using certain medications in more optimal ways (scheduling ondansetron around the time of meals rather than taking PRN). Lana also help expedite a new prescription for haloperidol to be sent to our UVA pharmacy. This was filled and picked up by the patient's husband.
Finally, to ensure we had a good plan for the patient's nausea Lana asked if I could discuss the haloperidol with the patient. Lana and I agreed on what made the most sense for the schedule and we both ensured the patient we had more anti-nausea medications in our toolbox if we needed to try something else. But overall what stood out to me most was how Lana reassured the patient we were going to keep a close eye on her nausea, come up with a good plan, and communicate to her outpatient doctors. I think this lessened the anxiety component of the patient's nausea as well. Lana approached this situation with a caring heart and was a wonderful communicator and advocate for the patient. (As a follow-up the next day, I spoke with our stem cell transplant pharmacist who said the patient's nausea was a little bit better controlled and was feeling overall better).