I would like to share observations of the excellence in practice that Dayne Poulton demonstrates on an ongoing basis. Over the past several months, I can share some examples that demonstrate professionalism, excellent clinical assessment, critical thinking, and nursing judgment, diligent attention to details of professional clinical practice, and effective communication and teamwork.

A nonverbal patient with advanced dementia and aspiration risk who was medically stable and awaiting placement became mildly hypoxic on room air with blood oxygen saturation levels around 92%. Dayne noticed this value while charting the patient’s NEWS score and compared it to a trendline of the patient’s values over the previous five days. He noted this was a clinically significant change from a baseline. Dayne went to the patient’s bedside to assess the situation. After a thorough assessment, he paged the cross-cover provider to see the patient at the bedside ASAP. After an initial chest x-ray was negative for suspected aspiration pneumonia, a CT angiogram of the chest showed a large pulmonary embolus. Within two hours of Dayne’s initial observations, the patient was transferred to the SICU for higher-level care.

Dayne has, on numerous occasions, detected clinically significant changes that have resulted in patients being transferred to higher levels of care, treated for previously unrecognized acute conditions, and prevented situations that could have led to poor outcomes, including morbidity and mortality. Overall, Dayne’s unassuming yet exemplary practice is worthy of the DAISY Award, exemplifying extraordinary excellence in nursing care and caring for Veterans.