Samantha assumed care of a patient, Mrs. R., while working in the PCU. It was observed that the patient was in severe distress. She had just been placed on respiratory support for concerns about increasing respiratory distress. She was acutely ill, and her overall condition had significantly deteriorated since her admission.
Upon rounding that evening, I was informed that we had a very sick patient on the unit. I entered the room where Samantha has just finished receiving the report and had immediately jumped into action. Samantha, having critical care/emergency trauma experience, recognized the urgency in the matter. We partnered with Dr. B to determine which lifesaving measures could be initiated, considering the current circumstances. He felt that airway management and utilization of multiple critical drips would not be appropriate, as the patient was a DNR/DNI status.
While Samantha initiated a head to toe assessment, it was discovered that Mrs. R's neurological status was completely intact. She was alert, oriented and responsive to questions. We proceeded to have a candid conversation with her about her current medical condition, our concerns and that we believed that more could be done to help save her life. However, there were limitations based on her DNR/DNI election. During this conversation, Mrs. R agreed to allow the team to transfer her to another facility, where critical care services could be provided to her.
We also wanted to consider a location in close proximity that would be commutable for her elderly husband, who was actively involved in her care. Next, to ensure all parties were in agreement and aware of Mrs. R's wishes, we proceeded to call Mr. R. They spoke lovingly to one another and agreed this would be the most appropriate course of action that could help stabilize Mrs. R's condition. Over the course of this phone conversation, Mrs. R rescinded her DNR/DNI status.
Following this new revelation, we proceeded to update Dr. B on the patient's declining condition and her revised code status. Upon assessment, he agreed to upgrade her admission status to ICU and facilitated transferring her to a sister facility. Samantha took charge of receiving and initiating physician orders for critical care management. She hung and titrated critical drips, initiated multiple blood transfusions, closely monitored the patient's cardiac rhythm and vital signs.
When the flight team arrived, Samantha provided a meticulous report, to ensure safe continuity of care. She followed with a thorough report to the receiving facility as well. She provided exceptional care to Mrs. R. Samantha displayed confidence, accuracy, empathy, compassion, and urgency with gravity. Each step taken was with purpose, deliberation, and exactness, so to ensure no step was left unturned.
Needless to say, this was emotionally taxing on Samantha and the team. It truly took a village to manage Mrs. R's care, within the confines of our facility. Nonetheless, the team rallied and safely delivered Mrs. R to a sister facility that offered a higher level of care.
It was later learned that Mrs. R. was in fact discharged from the hospital about two weeks later. Had it not been for Samantha and her willingness to advocate for this patient and engage in a crucial conversation regarding Mrs. R's condition and limitations with code status, the outcome of this admission might have ended very differently for Mr. and Mrs. R. I truly believe her commitment to nursing excellence and quality patient care was evident and life-altering for Mrs. R.