Speak up when it doesn’t feel right

You are your patient’s last line of defense.  Whether it’s meds, bedside procedures, trips off the unit, or just care in general, you are the person that can potentially save a patient.

I know, medical shows would have you believe that doctors are the saviors. Doctors are the last hope. Doctors save the world! Yeah, most of the doctors I know can’t start an IV sooo…

You are the one at the bedside for 12 hours. You are the one that has had them for three shifts straight and don’t even need report anymore. You are the one that knows that patient. You are the one that may notice something wrong.

Perhaps you come in for your shift and notice that Mr. B, who is typically trying to crawl out of the low bed and get back to his “bus”, it far too chill. His vitals have been great all day. The team doesn’t order labs for him daily anymore but the ones from two days ago look fine. In your gut you know something isn’t right. You talk to the doc, who isn’t impressed. You give it all you got and at least convince the doc to order a set of labs for now. You get those labs and anxiously wait to see if they can help you figure out why Mr. B hasn’t tried to kick you in the face tonight.

And then the lab results come back AND THEY ARE A SHIT SHOW! His WBC’s are almost 30. His H&H has dropped by 3. His BUN and creatinine are climbing. All of his electrolytes are out of wack. But once again, his vitals have been good all day.

You just saved your patient. You knew something wasn’t right, even if you couldn’t pinpoint it. By being a patient advocate you may be the reason he’s alive.

Maybe it’s less dramatic than that. Maybe they have ordered a medication for your patient that seems like it just might be contraindicated at this point. His platelets are low. His INR is going up, not down. One of the teams wants you to give heparin. You aren’t comfortable with that, especially since the primary team (or doc) purposefully stopped it because of his labs. You try and talk to the ordering provider and rather than listen he yells “just do it!“.  Do NOT just do it. Healthcare was not designed by Nike and that rarely works out. You can take another step. You can talk to the primary team or doc about a consulting team or doc restarting what they’ve stopped. So you do just that. Primary agrees with your hesitation and they talk to the consult to let them know heparin has been discontinued and why. Turns out, consult didn’t actually look at any labs before ordering it.

Looks at you walking around saving the day, like you have an “S” on your chest! You know what you are doing. You know when something isn’t quite right. You know your patient. Trust yourself and speak up when you feel like it is necessary.