A 93-year-old Veteran was seen for his Primary Care appointment at the Lima Community-Based Outpatient Clinic. Kaitlynn Brown, LPN, completed a thorough intake and provided hand-off information to the Primary Care Provider, Nurse Practitioner, Renee Kirwan. During his appointment, it was identified that he could have a deep vein thrombosis in his leg. The NP Kirwan instructed the Veteran to go immediately to the Emergency Department, which is across the street from our clinic. The report was called to the ER for notification and Veteran information.

The veteran’s friend/caretaker brought him to this VA clinic and was present during this visit. The friend took great care and responsibility of this Veteran and ensured he got to the ER as instructed by NP Kirwan.

This Veteran was discharged from the ER with a diagnosis of Left Thigh Deep Vein Thrombosis. The Veteran did not receive any treatment for this while in the ER; instead, an e-Script for the blood thinner Eliquis was sent to a local Wal-Mart pharmacy. The friend was taken home to rest after discharge from the ER.

Shortly after 4 pm, the friend returned to the Lima VA Clinic to inquire about the prescription process. He asked how the “Eliquis starter pack” prescription sent to Wal-Mart by the ER was going to be covered by the VA and how to get a “long-term” prescription for the needed medication. NP Kirwan contacted Wal-Mart and was told they did not have the medication. The LPN, Kaitlynn, contacted the local CVS Pharmacy but could only leave a voicemail and provided her cell phone number because it was past her Tour of Duty.

NP Kirwan then provided the friend with a new prescription for 7 days, along with a Community Pharmacy Voucher, to be filled immediately at CVS. She also ordered a 30-day supply for the VA Pharmacy to send to the Veteran’s home. She also placed an Anti-Coagulation Consult for follow on therapeutic care. LPN Kaitlynn instructed that if he could not get this medication filled, he must take the Veteran back to the Emergency Department.

During the LPN Kaitlynn Brown’s drive home, she pulled over to take the call from a CVS pharmacist, in which she was told they had the medication. Kaitlynn also notified the pharmacist that he will be using a VA Voucher and verified that they accepted and understood the VA voucher process. A short time later, Kaitlynn pulled over for a second phone call with the CVS pharmacist and was told there was an issue with the prescription. Kaitlynn contacted NP Kirwan by text and asked if it was okay for her to give the pharmacist her cell number. She gave CVS the provider’s cell number and then called NP Kirwan to explain the situation. NP Kirwan received a call from CVS directly and resolved the issue immediately.

In this case, the ER could have given the Veteran a 7-day Starter pack of this vital medication that needed to be started immediately, but did not. LPN Kaitlynn Brown and NP Kirwan stayed late to ensure the friend received the crucial medicines promptly. The attention to detail, extra time and effort, and non-stop follow-through in working this time-sensitive situation demonstrate the ICARE values and dedication to serving our Veterans.

LPN Kaitlynn Brown and Provider Nurse Practitioner Renee Kirwan had this Veteran’s care on high alert and were adamant to continue to work this situation, no matter what. This showcases how invaluable they were in preventing treatment delays and directly contributed to this veteran’s positive outcome. Through highly focused assessment skills in identifying potential life-threatening problems, directing immediate advanced care, and adaptive problem-solving to coordinate across several layers of civilian pharmaceutical needs, they are both worthy of the DAISY Award.