Changing the Outcome

Speaking Up for Patient Safety

An important part of maintaining a safety culture is feeling empowered to express concern when something doesn’t feel quite right.

Mishael Appling, RN, who works in the Specialty Resource Unit, recently changed the outcome for a child admitted from the Emergency Department to A3 North with urinary stones. She was scheduled for surgery the following morning.


Although the patient was alert and interactive when she arrived on the unit around 3:30 pm, Appling, who was there to assess her, had a hunch that this child was at risk for sepsis. The patient had persistent fevers and tachycardia, declining blood pressure, slow capillary refill and cool extremities. Appling reported his assessment and raised his concern to the care team several times, but they did not immediately agree. Appling persisted, however, and finally called the Medical Response Team (MRT).

The MRT evaluated the patient and determined that she was indeed at risk for sepsis and needed to go to surgery immediately. By 7:30 that evening, the patient was on her way to the operating room. There, the doctors discovered and removed an infected stone and significant drainage.


Appling’s keen assessment skills, his confidence built from ICU experience and his willingness to speak up and call the MRT made a huge difference for his patient.


Said Victoria Hickey, RN, clinical director, A3 North, “Mishael serves as an excellent role model for all nurses and demonstrates how training and ICU experience promote a strong voice for patient safety on a surgical unit.”

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