Kayla was the ICU charge RN that responded to a Rapid Response (RRT) for a patient on an acute care [unit]. The nurses on the acute care unit felt that the patient needed an RRT as he had a rapidly growing hematoma and they were concerned about him maintaining an airway. The RRT was canceled overhead prior to Kayla arriving. She followed her training and the ICARE values and ensured she followed through to the acute care unit to check that the patient and nursing staff were safe.

Upon arrival Kayla assessed the situation and was able to determine that an RRT was appropriate as the patient had just had a drain removed and was developing a rapidly growing hematoma that would require emergent surgery. Kayla refused to leave the veteran and nursing staff even when informed by the MD that she was not needed; she informed the MD that the RRT should not have been canceled and that she would remain at the scene until the patient was moved to the OR for surgery to ensure he was prepared and to be available to help if the situation decompensated.

Kayla was able to identify that the MD was holding pressure on the hematoma but was requesting many nursing tasks such as inserting 2 IVs, obtaining emergent labs, and emergent transfer that would require additional assistance the MD could not provide at that time. After the patient was emergently transferred to the OR, Kayla followed up with the acute care unit manager to debrief and with the ICU management. She then forwarded her concerns to the code board and resuscitation committee. The committee was able to validate the policy and decisions that Kayla made and forward this information to all parties involved to ensure everyone was aware of the facility policy and best practices.

Her actions allowed the patient to be at the center of all cares and will ensure practice improvement for all involved. Integrity—by maintaining the trust and confidence of the patient by being present, coordinating cares and ensuring he was transferred safely. She also maintained the trust and confidence of the nursing staff by encouraging them that they had made the right call by activating the RRT for this patient and she stood by them in their efforts to ensure the patient’s safety. Commitment– by serving the Veteran and honoring the VA mission. Advocacy—by continuing to go to the RRT call even after it was canceled. Staying at the scene after she assessed that the patient was not safe, and the MD needed additional assistance. Reaching out to management to share her concerns which allowed the entire team to review the policy and debrief on the situation. Respect –by providing dignity ad respect to everyone she encountered. She was able to remain at the scene and use effective communication during a critical situation to ensure the right people were present and available for the patient without demoralizing any staff or their decision at the moment. Excellence– by striving for the highest quality and continuous improvement by speaking up when something was not right, following through to ensure all parties were informed of what happened, management of nursing and MDs were informed so they could guide their staff to debrief and reeducate to ensure great outcomes.

Kayla, thank you for all you do to keep our Veterans safe and ensure that we are all striving for excellence every day.