Working at a hospital we see a variety of different cases that are difficult to understand. Here is a case that was submitted as a nomination that is particularly difficult as it involves a young man of only 24 years of age, who was the son of one of our own nurses here at Los Robles. This young man suffered from a hereditary chronic disease, and was in the CCU on a ventilator until the family made a decision for compassionate extubation and comfort based care.

This brave family was promised (as all of our families are) that we would do everything possible to keep him comfortable. No matter how much medication was needed he would be sure to get it. One day Tiffany Terry felt frustrated, and wanted help fixing an issue that came up. She had received new orders to go up higher on her patient's PCA continuous pump, but the machine would not let her go higher. She called the pharmacy, and the first person she spoke with had told her that the drip could not go any higher. Tiffany did not take "NO" for an answer and called for further assistance.

Tiffany and a co-worker began to trouble-shoot, and made sure the pump was on the "Palliative Care" dictionary that would allow the higher doses, which it was. They called and worked with pharmacy and they figured out that it doesn't matter what the dictionary shows, if 1/3 of the vial will be infused within the first hour, the pump will not let it run. In order for it to work, they had to change from a 20cc syringe to a 60cc syringe, then the dose was no problem.

Throughout the process, Tiffany remained calm, reassured the parents that this would be fixed and made sure she provided the patient with medications to treat his symptoms.

I am so proud of Tiffany for taking it to the next step to make sure her patient received the care he needed.