December 2015
Kaitlin
Holt
,
RN
ER
VA Palo Alto Health Care System
Mountain View
,
CA
United States

 

 

 

Katie Holt prevented an inappropriate and unsafe discharge and advocated for one of our veteran's safety and the safety of the community, all against the doctor's plan and the patient's plan.
A patient came to the ER with an acute on chronic SAH with a midline shift. When the patient insisted on leaving AMA the MD was ready to discharge him as such. Katie rightly did not think this was safe as the patient's plan was to drive himself home and was exhibiting subtle neuro deficits and obviously had the capacity to become much worse with his diagnosis. Katie persevered for what she thought was right for this patient and for the community even though it was a difficult and legally confusing road. The patient was eventually placed on a hold and admitted to the MSICU. He was taken into surgery that night and the patient is doing much better now.
This is a fantastic example of one of our nurses being aware of subtle changes in mental status and being confident in her assessment; enough to advocate for what was best for the patient, even if it was initially unpopular. Katie very likely saved someone's life that day; either the patient's or another driver's or both.