Before shift turnover, RN Eguez noticed a Provider come out of a patient's room. She informed Provider that she would be taking over care for his patient and if, based on his assessment in the room, were any changes to the plan of care. Provider mentioned performing another NIH on the patient and that it had increased to a score of 13 from the previous score of 2-3. Provider at that time also stated that there were no changes to orders or the plan of care when asked.
During turnover staff began giving report on this patient and that she had presented to the ED with signs of a stroke. At the time of her presentation to the ED, she was out of the window to receive anti-thrombotic such as TPA. CT in ED was negative for hemorrhage. The patient went in town for MRI, which revealed Ischemia. The patient was a civilian visiting family in Japan and subsequently admitted to MSU until a flight home could be arranged. Report continued with the previous nurse's assessment and findings. RN Eguez knew that this patient needed to be at a facility that could appropriately care for a stroke patient if interventions were needed. She then spoke with the Nurse of the Day about her concerns and then they called the Provider regarding the appropriateness of this patient's admission. The Provider stated that he had asked the patient and she preferred to stay here. RN Eguez again stressed her concern regarding the NIH now being 13 which was a significant increase from previous, the report from night shift's assessment of the patient having right-sided weakness, and expressive dysphasia.
They went into the room together to conduct another assessment driven by RN Eguez. The patient was able to state her name, however, unable to disclose her birthday, the current year or name the President of the United States. The patient had a very difficult time verbalizing as well (expressive dysphasia). This furthered the nurse's concern as to what she was able to even comprehend. She did not present competent to make any decisions based on her care. Upon performing the neuro assessment, RN discovered the patient had right-sided hemiplegia rather than weakness and more so severe than moderate dysphasia. RN Eguez then notified the patient that we are not a stroke center and are not able to perform interventions if she needed them. She also informed her of her declining assessment (Provider at the bedside during this time and concurring with information) and that we are not able to appropriately care for her with her condition. RN Eguez then asked her if she would be more comfortable at a host nation hospital where they could perform interventions that she may need. She then stated she would rather be in a Host Nation Facility. RN Eguez then contacted the patient's son so that he could be notified of the recent assessment and findings and explained everything to the patient, his mother, and he as well agreed on the decision to go to Host Nation Facility. The provider then reached out to a Japanese fellow and they were able to coordinate a transfer within 1.5 hours of taking over the shift.