Rachel was the bedside nurse for an LVAD patient who was well-known to the unit and to Rachel. This patient, unfortunately, had frequent hospitalizations related to her heart failure and LVAD. She is a very feisty patient who always keeps the staff on their toes. Around lunch time Rachel was in at the bedside ambulating the patient to the bedside commode and then got her settled in the chair. As Rachel was about to leave, she noticed that the patient was acting a bit strange. The patient was saying bizarre things, and then patted on the couch next to her as if to signal Rachel to come sit next to her. Knowing this was not the patient’s baseline, Rachel went over and sat next to her. As she continued to speak to her she noticed a very minor facial droop on her left side. Rachel conducted a neuro exam and noticed that her grip on her left hand was also weaker than a few moments ago, when she helped her to ambulate. Rachel immediately called a rapid response overhead. When the Rapid Response team responded, she was able to quickly inform the team of her concerns, and the patient’s history of strokes in the past. Rachel also made it a point to inform the team that the patient was admitted with a subtherapeutic INR. A stroke alert was called overhead. The patient was returned to her bed, where Rachel quickly checked the LVAD batteries and prepared the patient for transport. The Stroke team, SWAT nurse and Rachel transported the patient to CT, then emergently to IR for a clot retrieval. She ensures that all back-up equipment traveled with us, and the LVAD coordinator was updated throughout the process. In IR, Rachel took charge of the LVAD and kept checking the patient’s MAP and educated the IR staff to safe patient positioning. The CVICU Charge RN eventually came down to relieve the Stroke team, where Rachel was able to provide a full patient report and transfer of accountability. After a successful clot retrieval, the patient discharged a week later with no residual deficits from her stroke.

This patient’s outcome was a direct result of the amazing care that Rachel provides to her patients. It would have been easy in this situation to help her patient into the chair and move onto the next task. But Rachel always takes the time to build relationships with her patients and understand their personalities and needs. That extra effort helped her identify the smallest change in behavior, which ultimately affected this patient’s outcome and quality of life.