It is an honor to nominate Cindy LeCours for the DAISY Award. She is truly committed to the philosophy and values of the hospital, with an emphasis on positive patient outcomes. Her demeanor does not go unrecognized here in the Ambulatory Treatment Center. Cindy did an outstanding job caring for a challenging and complicated patient. The patient was a resident at a skilled nursing facility. Cindy was instrumental in coordinating her care and collaborating with various disciplines.
A nurse from the skilled nursing facility called ATC to schedule a blood transfusion of two units of PRBC's for the next day and sent a prescription slip via FAX for the blood order. Cindy called to inform the facility that we would need the blood order set completed by a doctor to proceed with the transfusion. The plan was to have the patient here early in the morning, obtain correct orders from the doctor, and continue with the transfusion.
The patient arrived as scheduled the next morning with two family members. Cindy worked diligently to contact doctor and completed the blood order set. Upon entering the orders, it was determined that doctor did not have ordering privileges at ASLMC. The doctor contacted another doctor, who was able to cover for him and completed the necessary blood transfusion orders. Cindy reached out to one of our Lead RN's and our CNS to help with this process.
During the process, Cindy was in contact with the patient and family in the waiting area to keep them updated on the progress. Once the orders were in place, the patient was admitted to the infusion area and here Type/Screen was sent. The Type/Screen was taking longer than usual. When Cindy called the blood bank to check on it, the blood bank stated that the patient had a "cold agglutinin antigen antibody". It would take longer to match her blood since this is a very rare antibody. When this was explained to the patient and the family, the daughter-in-law (who is an LPN), stated that the patient had this issue a few years ago when she got blood, but it was not present the time she needed a transfusion. The doctor was not aware of the history of this issue with the patient.
Upon hearing this information, Cindy began an in-depth information search about the antibody. She again collaborated with her CNS and other departments. Because the process was becoming quite lengthy, the patient was moved to a cart for comfort and lunch was provided. Cindy spoke to the blood bank, ICU, our CNS, and the MD director of the blood bank to determine the safest way to administer the blood to the patient. It was determined that a blood warmer should be used for the administration. Cindy and the CNS called around the hospital to find one to use. An RN from SNICU brought over a blood warmer for her to use and stayed to help with the setup. The patient needed premedication prior to the transfusion, which needed to be crushed and given in applesauce. The blood was given at a conservative rate due to the antibody and the patient had a significant cardiac history that required IV Lasix to be given between the units of blood.
During the day, the patient started to feel SOB and oxygen at 2L per NC was applied. With the process becoming too lengthy, the family asked about the patient being admitted to the hospital to receive the remainder of her blood. Eventually, the decision was made by the doctor to have the patient admitted for observation. The Hospitalist assessed the patient and decided to wait with the second unit of blood until a repeat CBC was done.
Late afternoon the patient was admitted. Cindy did an amazing job collaborating with a variety of disciplines, keeping the family members and patient updated on the situation, assessing the patient for any changes in status, and getting the patient the treatment she needed. Cindy's expertise was evident through her management of this patient. Her compassion was present during the entire visit in the way she cared for the patient and family. Her professionalism was shown through her extensive collaboration with a variety of disciplines and departments.
She did a great job handling this situation, which was beyond the typical care required for someone in our outpatient department.