Leah Thibeault
August 2023
Leah
Thibeault
,
BSN, RN
Stress Lab
Northeast Georgia Medical Center
Gainesville
,
GA
United States
You are my angel (Leah). I am so glad you are here. Will you stay with me while they do the cardioversion?
This summer, Nurse Leah Thibeault was going through the future schedule for TEEs and cardioversions. She noticed a patient was scheduled out farther than usual with earlier openings available. She called the patient to see if he wanted to come in on an earlier date and to inquire as to why he may have been scheduled so far out. In talking with him, it wasn’t clear as to why he was scheduled so far out but he told her that he had not been feeling well since being discharged from the hospital the week prior.
In conversation over the phone, she noticed he seemed short of breath, and she asked if he had been feeling bad. He said it was getting progressively worse and he could barely walk from one room in his home to the next. She asked his permission to comb through his chart to see if there was a documented reason for the procedures to be pushed out as far as they were. She also asked the patient if he was on any blood thinners, what they were, and if he had missed any doses. He stated he was on Eliquis and had never missed a dose. He asked that while looking through his chart, see if he had received every dose while he was in the hospital as he tried to keep up with what he was getting but it was difficult with all the commotion that happens when someone is in the hospital. She asked one final question which was if there was an option to move his procedure earlier, would he be able to get to the hospital. He said he would be able to get there any time she told him. She let him know she would be back in touch with him that same day no matter what.
In surveying his chart, it was noted that he had been discharged from the hospital within the same week prior and was scheduled for outpatient cardioversion, but no indication as to why it was pushed so far out. She looked through his medication history and saw that no doses of his blood thinners had been missed. There was no clinical documentation indicating a need to wait an extended period of time. The patient had undergone an ablation at our organization three months prior but was through the latent period. She also saw that the patient had a newly discovered PFO.
All of these findings increased her concern for a patient in AFib. She sent a secure chat message to the patient’s primary cardiologist to review the chart and see if he knew of any indication as to why the patient should wait. The day progressed and she had not heard back from the cardiologist, so she decided to contact him directly. While waiting for his response, she decided to go ahead and call the patient.
He answered the phone still sounding very short of breath. She asked him if he had a means of checking his blood pressure and heart rate. He could not check his blood pressure, but he had a monitor that he put on his finger that would tell him his heart rate. He said it was in the 50s. She knew that typically someone with that degree of shortness of breath would have an increased heart rate so that concerned her more. As she was talking with the patient, the cardiologist texted her back. He saw no reason for the patient to have been scheduled that far out for the cardioversion. She let the physician know the patient had grown increasingly symptomatic and she was very concerned for his heart rate and shortness of breath, and suggested the patient come to the ED. The cardiologist supported her decision and thanked Leah.
Leah explained her concerns to the patient and highly advised him to come to the ED. She gave him her cell number in case he had any further questions. After hanging up with the patient, Leah called the charge nurse in the ED and gave her a run-down of the patient’s history and why he was coming in for treatment. About 30 minutes later, Leah’s cell phone rang, and it was her patient. He had arrived at the ED and wanted her to talk to the triage nurse to explain why he was there. He couldn’t remember everything to tell her, and he was feeling bad. Leah explained why she asked the patient to go to the ED and the triage nurse quickly ushered the patient to a room to be evaluated.
A couple of hours later, the patient called Leah back and said in a panic that they were going to send him home. He said he was afraid to be home and didn’t know what to do. Leah said she would speak with the ED provider as well as the cardiologist and would call him back with a plan. She reached out to the cardiologist who agreed to take over the patient’s care and have him admitted and a midlevel would be arriving shortly to see him. Leah called the patient back to let him know the plan. He cried with relief.
The next morning, Leah was back at work and saw that the patient was scheduled for cardioversion in her department that day. As soon as he arrived in her department, she went to the room and introduced herself. The patient stated, “You are my angel. I am so glad you are here. Will you stay with me while they do the cardioversion?” Leah assured him she would.
While another nurse was getting the patient prepped for the procedure, she explained how the patient’s heart rate had dropped into the 20s during the night and how a rapid response was called. She said the night nurse told her they “almost lost him.” While in the procedure room, his heart rate was in the 30s. The low heart rates are a concern for any patient, but for someone with AFib and a known PFO, it complicates things even more. As the patient was given sedation for the procedure, he held Leah’s hand and thanked her for being there for him.
The cardioversion was performed and was successful, but the patient’s heart rate remained very low. Leah requested the patient have an EP consult for a pacemaker. The cardiologist spoke with one of the EP providers and the patient was seen right away. The next day the patient had a pacemaker placed and was evaluated for PFO closure as his risk for stroke was high. Leah kept in contact with the patient throughout his stay in the hospital, which extended for more than a week.
At every stage of this process, any number of the 7 C’s were materialized by Leah. She followed her intuition with a patient she had never met and was willing to cross any barriers to get him the treatment he needed at the time he needed it. Sister Simone Roach would be proud of Nurse Leah for humanizing the theory she so thoughtfully taught and sums up in her quote, “A need to care for others is what called you into the profession, and it’s what will sustain you through the joys, conflicts, and challenges you will experience.”
In conversation over the phone, she noticed he seemed short of breath, and she asked if he had been feeling bad. He said it was getting progressively worse and he could barely walk from one room in his home to the next. She asked his permission to comb through his chart to see if there was a documented reason for the procedures to be pushed out as far as they were. She also asked the patient if he was on any blood thinners, what they were, and if he had missed any doses. He stated he was on Eliquis and had never missed a dose. He asked that while looking through his chart, see if he had received every dose while he was in the hospital as he tried to keep up with what he was getting but it was difficult with all the commotion that happens when someone is in the hospital. She asked one final question which was if there was an option to move his procedure earlier, would he be able to get to the hospital. He said he would be able to get there any time she told him. She let him know she would be back in touch with him that same day no matter what.
In surveying his chart, it was noted that he had been discharged from the hospital within the same week prior and was scheduled for outpatient cardioversion, but no indication as to why it was pushed so far out. She looked through his medication history and saw that no doses of his blood thinners had been missed. There was no clinical documentation indicating a need to wait an extended period of time. The patient had undergone an ablation at our organization three months prior but was through the latent period. She also saw that the patient had a newly discovered PFO.
All of these findings increased her concern for a patient in AFib. She sent a secure chat message to the patient’s primary cardiologist to review the chart and see if he knew of any indication as to why the patient should wait. The day progressed and she had not heard back from the cardiologist, so she decided to contact him directly. While waiting for his response, she decided to go ahead and call the patient.
He answered the phone still sounding very short of breath. She asked him if he had a means of checking his blood pressure and heart rate. He could not check his blood pressure, but he had a monitor that he put on his finger that would tell him his heart rate. He said it was in the 50s. She knew that typically someone with that degree of shortness of breath would have an increased heart rate so that concerned her more. As she was talking with the patient, the cardiologist texted her back. He saw no reason for the patient to have been scheduled that far out for the cardioversion. She let the physician know the patient had grown increasingly symptomatic and she was very concerned for his heart rate and shortness of breath, and suggested the patient come to the ED. The cardiologist supported her decision and thanked Leah.
Leah explained her concerns to the patient and highly advised him to come to the ED. She gave him her cell number in case he had any further questions. After hanging up with the patient, Leah called the charge nurse in the ED and gave her a run-down of the patient’s history and why he was coming in for treatment. About 30 minutes later, Leah’s cell phone rang, and it was her patient. He had arrived at the ED and wanted her to talk to the triage nurse to explain why he was there. He couldn’t remember everything to tell her, and he was feeling bad. Leah explained why she asked the patient to go to the ED and the triage nurse quickly ushered the patient to a room to be evaluated.
A couple of hours later, the patient called Leah back and said in a panic that they were going to send him home. He said he was afraid to be home and didn’t know what to do. Leah said she would speak with the ED provider as well as the cardiologist and would call him back with a plan. She reached out to the cardiologist who agreed to take over the patient’s care and have him admitted and a midlevel would be arriving shortly to see him. Leah called the patient back to let him know the plan. He cried with relief.
The next morning, Leah was back at work and saw that the patient was scheduled for cardioversion in her department that day. As soon as he arrived in her department, she went to the room and introduced herself. The patient stated, “You are my angel. I am so glad you are here. Will you stay with me while they do the cardioversion?” Leah assured him she would.
While another nurse was getting the patient prepped for the procedure, she explained how the patient’s heart rate had dropped into the 20s during the night and how a rapid response was called. She said the night nurse told her they “almost lost him.” While in the procedure room, his heart rate was in the 30s. The low heart rates are a concern for any patient, but for someone with AFib and a known PFO, it complicates things even more. As the patient was given sedation for the procedure, he held Leah’s hand and thanked her for being there for him.
The cardioversion was performed and was successful, but the patient’s heart rate remained very low. Leah requested the patient have an EP consult for a pacemaker. The cardiologist spoke with one of the EP providers and the patient was seen right away. The next day the patient had a pacemaker placed and was evaluated for PFO closure as his risk for stroke was high. Leah kept in contact with the patient throughout his stay in the hospital, which extended for more than a week.
At every stage of this process, any number of the 7 C’s were materialized by Leah. She followed her intuition with a patient she had never met and was willing to cross any barriers to get him the treatment he needed at the time he needed it. Sister Simone Roach would be proud of Nurse Leah for humanizing the theory she so thoughtfully taught and sums up in her quote, “A need to care for others is what called you into the profession, and it’s what will sustain you through the joys, conflicts, and challenges you will experience.”