This letter is written to highlight the exceptional actions of Christine Kirby, a nurse whose clinical expertise and commitment to patient safety embody the High Reliability Organization (HRO) principle of "Preoccupation with Failure." This principle emphasizes anticipating risks and taking steps to mitigate them, which Christine demonstrated with unwavering dedication.

As an Oncology Certified Nurse (ONC), Christine consistently demonstrates her extensive clinical expertise in assessing patient stability prior to treatments such as chemotherapy. Her unwavering commitment to patient safety reflects her professionalism, which was recently highlighted in the story below.

“Recently, I had the privilege of working alongside Christine while covering a hospitalist shift. Christine was the Charge Nurse on 4E and the chemotherapy-certified nurse responsible for my patient’s care. The patient, whose condition had drastically deteriorated over the past few weeks, had been admitted earlier in the week and was in critical condition.

This patient had been scheduled for chemotherapy the previous evening, but the treatment was postponed following a rapid response due to acute mental status changes and hypoxia. When I rounded on the patient the next morning, Christine informed me that the patient was currently undergoing dialysis and was slated to begin chemotherapy once he returned to the floor.

Christine, utilizing her extensive experience and clinical judgment, wisely questioned whether the patient was stable enough to proceed with chemotherapy, particularly in light of the rapid response the night before. After consulting with another involved provider, the patient was deemed stable to proceed with Chemotherapy. Christine monitored the patient's condition closely during treatment, communicated concerns promptly, and ensured the family was well-informed.

Christine played a crucial role in initiating chemotherapy, adhering to protocols while also utilizing her expertise to anticipate potential challenges. Throughout the treatment, she closely monitored the patient's condition, observing slight drops in blood pressure. She proactively communicated any concerns, ensuring that we were prepared to manage any adverse effects promptly.

Christine also kept the patient’s family informed every step of the way, ensuring they understood the treatment process despite the patient’s critical condition. As the infusion continued and the rate was increased, Christine observed subtle clinical changes and acted immediately, ensuring all providers involved in the patient's care remained informed so we could adjust as needed.

Thanks to Christine’s clinical acumen, experience, and attention to detail, we were able to prevent further clinical deterioration. Her timely actions, including pausing treatment, reassessing the patient, and stabilizing him, ensured that potential rapid responses and adverse outcomes were avoided.

In the midst of a high-pressure situation, Christine remained composed and focused. She not only provided exceptional care but also mentored the primary nurse, guiding them through the critical steps required for the patient’s stabilization. She skillfully prioritized and delegated tasks, ensuring that critical interventions—such as pausing chemotherapy, administering medications, and providing respiratory support—were completed efficiently.

Despite the escalating stress, Christine’s professionalism and leadership never wavered. Her ability to maintain a calm, clear-headed approach ensured that the patient received the highest quality care in a stressful, high-stakes environment.”

Christine exemplifies the HRO principles through her safety-focused approach, teamwork, and leadership. It is an honor to present her with the DAISY Award in recognition of her outstanding contributions and dedication to patient care.