Nurse Deteriorating Patient Reflection: Driscoll

What?

During a night shift, I was caring for a post-operative patient whose observations were within acceptable limits - the early warning score did not mandate escalation. But the patient seemed subtly different: more withdrawn, slightly confused about the time, and 'just not right'. I increased the frequency of observations, and an hour later the score had risen by two points. I called the on-call doctor using the SBAR format and said explicitly that I was worried about deterioration despite the modest score. The patient was reviewed promptly, sepsis screening was initiated, and treatment began within the hour. The patient was later moved to a higher level of care and recovered.

So what?

The significant learning is about the relationship between track-and-trigger tools and clinical judgement. The scoring system, used alone, would have delayed escalation. What made the difference was acting on the 'soft signs' - new confusion and withdrawal - by increasing observation frequency, which generated the objective evidence for escalation. I also learned the value of stating my concern plainly: saying "I am worried about this patient" in the SBAR call changed its urgency in a way the numbers alone would not have. I felt some anxiety about being seen as over-cautious when I first called, which I suspect deters escalation more often than we admit. The prompt, respectful response from the doctor reinforced rather than punished the escalation, and I want to remember that feeling when I am the more experienced person taking the call.

Now what?

I will continue to treat 'not right' as a clinical finding that warrants action - increased observations at minimum - even when scores are reassuring. I plan to share this case at our unit's education session to reinforce soft-sign recognition with newer staff. I have also resolved to respond to escalations from colleagues, especially junior ones, in the way that doctor responded to me: taking the concern seriously and thanking them for calling, so that the next escalation is never delayed by fear of seeming over-cautious.