The HUC called on Caitlin to come and talk to a patient that was at the HUC station who was very upset and tearful. Caitlin interacted with this patient in a compassionate manner to find out what she was upset about. The patient indulged to Caitlin that she was very unhappy and upset about the way she was spoken to, she said she did not like the way she was told to get dressed and that she had to leave because she had an order for discharge. Caitlin quickly reviewed her chart to see that she did have an active discharge order but did notice she had not received her discharge papers as of yet. Caitlin asked the patient if she could go back to her room and talk in private, the patient refused, stating, "no, just give me my papers". Caitlin printed the discharge paperwork and asked the patient to walk with her to the waiting room, so they could talk in private, she agreed. By being a compassionate listener and giving the patient time to express herself to Caitlin was able to find out that the patient still did not feel well but since she was discharged she was going to have to leave.
The patient was still very tearful during this discussion and refused to talk any more about the situation. Caitlin called the provider and asked about the ARC appointment that was listed in the AVS but was not ordered for the patient and reported to the provider the patient is still complaining of dizziness. The provider came to the waiting room to see the patient. The patient opened up to Caitlin and told her she felt she was being rushed out the door even though she said she still felt dizzy and because she was told she had to leave she wants to go now! The provider did not want to discharge the patient if the patient was still complaining of dizziness, the discharge order was canceled.
Through active listening techniques, such as being attentive to what the patient was saying, not interrupting, making eye contact with the patient, Caitlin was able to convince the patient to stay. She apologized to the patient for what she experienced and promised her if she would stay she would care for her. The patient agreed to go to another room; Caitlin walked with this patient to her new assigned room where she volunteered to take over the patient's care. Caitlin ensured the patient was comfortable and let her know what she was doing the entire time. She spoke to the attending about the patient and the attending went to assess the patient. Based on the attending's assessment the patient required further treatment which was medication and nebulizer treatment. After these interventions, the patient reported she felt significantly better and agreed to an ambulation trial which she passed. The patient felt she was ready to go home, she was cleared for discharge and Caitlin educated her AVS and answered all of her questions.
Even though this sounds like what an RN should do, it was really above and beyond for Caitlin. She took the time to listen to the HUC, actively listen to the patient, intervene and stopped the patient from leaving when clearly this did not appear to be a safe discharge at that time. Caitlin ensured the provider came to speak to the patient which resulted in a canceled discharge and even got the attending involved. She made sure the patient felt safe by providing her a new room and volunteered to be her nurse. She kept the patient updated on the plan of care and ensured the patient was involved in the plan of care.
This patient was very thankful and appreciative of all of this and expressed it before leaving. By Caitlin's quick response, actions and serving as an advocate for this patient the results were a safe discharge and a satisfied patient, which really is the ultimate goal for all of us. The provider and attending were very pleased with Caitlin’s actions as well.
After further investigation, it was identified this was more than likely miscommunication between the patient and her original caretaker who was on their 1st day off of orientation. Not only was the patient safe and satisfied, but this resulted in an educational and learning experience for the new nurse, a win-win situation.