Last night I was working as team leader in the emergency department.
It was a busy shift with multiple patients who were seriously unwell.
A 35 year old, Mrs M, had arrived several hours before. She had a complex medical history including mental health problems. She had been assessed, stabilised, and was now awaiting the allocation of an inpatient bed on the wards.
As we approached 9PM (handover time), we were having a ‘storm’ of multiple high priority arrivals, including two paediatric traumas. I was attempting to move patients around within the department to open some bed capacity for these new arrivals when one of our clerical staff approached me.
She informed me that she had just been over to get Mrs M to sign her admission papers. She was refusing to do so.
“She just wont talk to me…….she just stares at me angrily and refuses to sign.”
“What do you want me to do?”
I was already trying to sort out a pile of more important things.
“OK. Ill go over and talk to her in just a moment. She will definitely need to be admitted, so put the paperwork through unsigned and I will sort it all out ASAP”.
My first thoughts were:
I knew this lady had been waiting for a bed all day. I knew she had a mental health history. The clerk had told me that she seemed angry and uncooperative. I decided I would go and explain the situation to her as soon as I had sorted out the beds for these inbound paediatric traumas.
I actually walked past Mrs M’s bed on my way out to Triage.
I glanced at her monitor screen. All looked well. She was indeed staring angrily over at the clerical staff.
The nurse looking after Mrs M was well and truly caught up applying skin traction to another trauma patient.
10 minutes later, the same clerk came over to me.
“Ian, the nurse in bed 3 is asking for some help.”
Mrs M was completely unresponsive. Eyes open, staring angrily.
The nurse had just performed a capillary blood sugar which was 1.1.
The nurse looking over at Mrs M had come to check on her. She immediately knew that something was very wrong.
We quickly administered some IV glucose, followed by some oral glucose paste as she woke up.
Mrs M made a rapid recovery to be alert, oriented, very pleasant, and more than happy to sign her admission papers.
So. I learned some important lessons here.
- Listen twice.
What exactly was the clerk trying to tell me? Did I really hear the message she was trying to give me?
- Be open to potential.
I already had a handful of important problems I was trying to sort out. Did I shut down to the potential for yet another problem to be just as important?
- Don’t always trust your gut.
I had some small amount of information about Mrs M. Based on that, I jumped to a conclusion.
It was my gut feeling.
It was wrong.
The nurse who had been looking after Mrs M all shift knew she was a pleasant lady who had been interactive all shift. She had far more information and made the correct call.
- Dont put your patient in a box.
Did you see how the label mental health history kept coming up in my mind? Did you see how it contributed to my assessment? I should be better than that.
- DO NOT (place all your) TRUST (in) THE MACHINES.
If I had taken the few extra seconds to walk right up to the bedside and interact with Mrs M, I would have made a very different clinical assessment of the situation.
- Communication: Communication. Communication.
I should have informed the nurse caring for Mrs M of the clerks initial concern. It was her patient.
- Be Busy = Be Vigilant.
The busier (and more stressed) you are, the more likely something is going to go wrong around you. Its Sods Law.
Pay attention, and think about what (and why) you are thinking about.
So, as it turned out, this event was but a small blip in the overall craziness of the shift.
But it could have been worse. For Mrs M. No thanks to me.
The important thing to gain from reflecting on incidents such as this, is to make lessons learned…lessons practiced.