Knock knock

My patient P was at the hospital last week for meningitis which may have explained his cranky and paranoid behavior the last time I saw him. I took in his am meds and found that the crankiness and paranoia were alive and well. P was really upset about other people he claimed were coming into his room and rifling through his things. He went on for a while and my preceptor did a really good job of listening to him and calming him down. His ankle looks worse; he was diagnosed with cellulitis a couple of weeks ago and has been on antibiotics. He’s still getting IV antibiotics and I helped my preceptor connect his PIC line to the IV pump.

P wasn't in his room – or so I thought – for most of the morning and through the early afternoon. I knocked on his door several times and used the intercom to see if he was in the room. When he didn’t respond, I respected his wishes and didn’t enter the room. Finally, after he missed his 1400 antibiotics and the time for his 1600 IV antibiotics was coming close, I entered his room uninvited. The patient was lying in the bed, hard to rouse and disoriented and absolutely drenched with sweat. His temp was 102.9F and I called my preceptor in. We called the doctor and were instructed to send the patient to the hospital – he may have endocarditis or bacteremia. I really should have gone into the patient’s room much sooner. The other staff had also assumed he was out on an errand or out smoking; who knows how long he might have been in there.