A recent HSR has highlighted the contributions of Cassandra Shippee and how her actions identified a patient safety event, prompting a facility wide change. This resulted in the replacement of all the mattresses on all non-critical care units throughout the facility. A PSR placed by Mrs. Shippee for a consult she responded to within an hour of it being placed and just hours prior to patient discharge. Her detailed documentation and urgency in responding to the consult made it possible to identify a facility wide deficiency in patient bed conditions, prompting leadership to act quickly and replace all mattresses throughout 7 units (128 beds, apart from mother/baby, NICU, PICU). I would like to recognize Mrs. Shippee for her excellent work.