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Downstate Times

The Newsletter for SUNY Downstate
University Hospital of Brooklyn

Superstorm Sandy Sends Patients to the PIRR

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The PIRR team: nurses with heart (l. to r.) Sharon Ewart, RN 3, Pettal Cupid, RN 2.5, Agnes C. Adams, ADN, Normalee Mason, RN 2.5, and Denise Sarrabo, NA

by Agnes Adams, RN, nurse manager, and the PIRR nursing staff as told to Dianne Forbes Woods, RN, MA, NE-BC Deputy Nursing Director

October 29th, 2012, is a day the Post Interventional Recovery Room (PIRR) staff will never forget. At the height of Hurricane Sandy, we admitted five very sick, long-term care patients from a nearby facility that had to evacuate its patients. All five patients were on ventilators and had feeding tubes and urinary catheters. One patient had a pressure ulcer; another required isolation for an infection.

This was a far cry from the kind of patients we were used to having on our unit. PIRR is an ambulatory unit for patients after they undergo interventional radiology procedures. For these five new patients, however, we recognized that the care they needed was very different. Maintaining open airways and preserving optimal skin integrity were of the utmost importance.

In addition to frequent tracheotomy suctioning, pulmonary toileting, and oral care, we provided around-the-clock skin care. This meant repositioning patients every two hours, applying skin barrier creams, and promptly changing soiled linens to prevent pressure ulcers. We also washed their hair and gave them manicures and pedicures. On our own, we purchased the tools that were needed for the extra grooming.

By the end of the first week, we saw positive changes in our boarders. Their skin took on a healthy glow, they were more alert, and we were getting to know them as individuals and learning to anticipate their needs. Even the patient who had arrived with a deep pressure ulcer was showing signs of healing.

By week two, all urinary catheters were discontinued. One patient requested oral feedings instead of the feeding tube so she was evaluated and oral feedings were initiated. She tolerated the diet very well and ate with much gusto, so that marked the end of feeding tubes for her.

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"We all felt a sense of pride and accomplishment."

This same patient asked us to take her off the ventilator. The staff advocated on her behalf, collaborating with her medical team to attach a tracheostomy collar during the day and use the ventilator at night. By week three, we were able to completely wean her off the ventilator and she was breathing on her own. Week four brought our greatest accomplishment. The pressure ulcer had healed completely.

It was difficult to care for these five patients while also attending to our outpatient procedures. We couldn't have done it without the help of nurses who floated to our "Li'l Nursing Home," as it was affectionately called, during the weeks our boarders were here.

When it came time to say goodbye, we all felt a sense of pride and accomplishment knowing that we gave these patients our best care, along with lots of extra love and attention. They were transferred back to their long-term facility with skin intact, looking wonderful, and knowing they had occupied a special place in our hearts.