Greg Henry, Phlebotomist: You were going to tell me about the Count you met on your cruise.
Edna Everett, Patient: My cruise? Oh dear, I need to get my cat Hobbes to the vet.
Greg: Is there something wrong with your cat?
OK. All done. I'll see you tomorrow.
(To himself)
That was weird. She was acting awfully strange. It's almost like she's bumped her head. Maybe I should say something.
Greg: Sheri, do you know who's taking care of Edna tonight?
Sheri Wilson, Clerk: Um, tonight, that'd be Amy.
Greg: Would you mind paging her for me? Tell Amy that I want to talk with her about Ms. Everett. She appears confused. If I'm not here at the station, I'll be in room 3 drawing labs for Mrs. Perkins.
Sheri: Will do, Greg. You need to talk to Amy about Ms. Everett, and you'll either be here or in room 3?
Greg: Yes, I'll be in room 3.
Amy Allen, RN: Hey,Greg. You wanted to talk to me about Ms. Everett?
Greg: Yeah. I wanted to let you know that Ms. Everett is acting weird. I've been drawing her blood for the past couple of days and she's always seemed normal. Last night we talked about her cruise, and tonight she doesn't seem to remember it at all. I think you should check on her.
Amy: Well, you know I just checked her vitals about an hour ago. She was napping but she seemed fine to me. Think you got her just as she was waking up?
Greg: No, Amy, Ms. Everett always recognizes me and even jokes about my being Dracula. I asked her about her cruise and she started talking about her cat and the vet. She wasn't sleepy, but she looked very confused.
Greg: I'm not a nurse or a doctor, but I really think something might be wrong. She's acting as if she's bumped her head or something. I'd really feel better about it if you'd go see her.
Amy: Hmm. From what you're telling me, sounds like I should check on her. Thanks, Greg
Amy: Hi, Ms. Everett, I'm back again. I was in just about an hour ago checking your blood pressure. Greg's a little worried about you and asked me to come check on you, so I'm just going listen to your lungs and ask you some questions?
Amy: Sheri, can you page the doctor on call for Ms. Everett?
(Phone rings)
Sheri: Two West, this is Sheri.
I have Dr. Feldman for you.
Amy: Hi, Dr. Feldman. This is Amy from Two West. I'm taking care of Ms. Everett. She's an 82-year-old woman. She was admitted three days ago with DVT. She's on Heparin, telemetry, and oxygen. She's been alert and pleasant with no problems other than urinary retention, and she has a Foley in place.
Amy: But tonight, she appeared to be confused. She's awake and oriented to person, but she hinks she's at her aunt's house and that Ronald Reagan is president.
Amy: I checked with her nurse from the last few nights and confirmed that she doesn't sundown and is usually very sharp. Her heart rate has increased to 110; her blood pressure's down to 110/60. Her systolic usually runs 150.
Amy: Her temperature's 37 Celcius. She looks pale, but not uncomfortable. Her coag studies are within the parameters, and her blood gases normal. All other A.M. labs are normal. She's not putting out much urine, and it looks cloudy to me.
Amy: I'm worried about her. I think she needs to be seen. Would you like me to order some labs? Maybe send her urine for culture?
Dr. Kerry Feldman: Yes. Sounds like she could be getting septic. Send a urinalysis with culture, chemistries, and a CBC. Thanks for calling. I'm on my way but I need to know if she has any changes immediately.
Greg: I'm glad you're feeling better. Well, take care, Mrs. Everett.
Ms. Everett: Thanks, bye.
Dr. Feldman: I'm Kerry Feldman, Mrs. Everett's doc. I just wanted to say you did a great job with the heads up on Ms. Everett the other night. Amy said she might not have realized that Edna was getting so sick if you hadn't spoken up.
Greg: Sure thing. Thanks.
Dr. Feldman: Amy mentioned that there's a nurse managers meeting next week. I thought what you did would be a great example of effective communication and teamwork to spread across our units here. Would you mind talking to the group about what you did?
Greg: Not at all, Dr. Feldman. Not at all.