Lauren Nunnally

Lauren Nunnally

Lauren Nunnally, RN

Glen Allen Internal Medicine
Bon Secours Virginia Medical Group
Glen Allen, Virginia
United States
Lauren was reviewing the patient's EMR as the patient had been readmitted. It became apparent to Lauren that the patient's collective symptoms of drooling, seizures, tremors and weight loss may be related to a drug the patient was taking.

Lauren Nunnally, RN, Nurse Navigator for BSMG is an exceptional nurse. This exemplar demonstrates Lauren's caring, professional and thoughtful work. Lauren is also a talented preceptor and Respecting Choices Facilitator.

Lauren was working with a patient diagnosed with end-stage renal disease, anorexia, many years of laxative abuse and schizophrenia. Initially, the patient was guarded to receiving Lauren's help. The patient had been admitted six or more times within one year and Lauren had followed her throughout each admission. She was managed by a Primary Care Physician, Nephrologist and Psychiatrist who was not in the hospital system and did not communicate with the patient's primary physicians regarding psychiatric care.

The patient was admitted for sepsis at one point and began having new-onset seizures. She was seen by neurology and was started on anti-seizure medications. Over the next eight months, the patient looked sicker. She began drooling, lost weight, and became tremulous. It was assumed that her symptoms were attributed to her anorexia, dehydration and laxative abuse as she weighed 100 pounds. The patient's Primary Care Physician visited the patient at his office and discussed the possibility of Hospice and the patient requested a DNR order.

Subsequently, Lauren was reviewing the patient's EMR as the patient had been readmitted. It became apparent to Lauren that the patient's collective symptoms of drooling, seizures, tremors and weight loss may be related to a drug the patient was taking, Clozaril, a drug for schizophrenia that is so potent a physician must be specifically licensed to prescribe it. Lauren looked back at all of the patient's admissions and realized that the patient had never been tested for a Clozaril level. The patient's providers assumed that the Psychiatrist at the other hospital system had been checking Clozaril levels regularly as this is standard of practice. Rather than seeing her psychiatrist, the patient was frequently seen by Residents and that lack of continuity may be the reason the levels were never checked.

Lauren called the inpatient Hospitalist and recommended the patient's Clozaril level be checked as over time her symptoms may be due to toxicity. Sure enough, the patient's Clozaril level was at a deadly toxic rate of five times the normal level.  The patient's Clozaril was properly adjusted. A month later during a follow-up appointment, the patient walked into Lauren's office a bright and well woman and told Lauren she had saved her life because "she was dying." 

The patient was able to stop all seizure medications and no longer needed to visit her Neurology provider as the seizures were directly related to Clozaril toxicity. Acquiring patient trust and caring for this patient as an RN Navigator over a six month period Lauren was able to critically think, figuring out what was causing the patient harm. Lauren believes that having the ability as a Navigator to take a deeper dive into patient care is beneficial in helping the team put the pieces together and facilitate positive patient outcomes. This patient was grateful as her life was given back to her. We are grateful for Lauren's outstanding service.