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Pediatric nurse speaks up, exemplifies Trusted Care

Capt. Kelsey Pilcher, 48th Medical Group pediatric nurse practitioner, listens to a newborn’s heartbeat during a check‐up at Royal Air Force Lakenheath, England, Oct. 24. Recently, during a check‐up with one of her patients, Pilcher spoke up when she noticed that the lab test results differed from what she observed during her examination. (U.S. Air Force photo/Senior Airman Malcolm Mayfield)

Capt. Kelsey Pilcher, 48th Medical Group pediatric nurse practitioner, performs a check‐up on a newborn at RAF Lakenheath, England, Oct. 24, 2017. Recently, during a check‐up with one of her patients, Pilcher spoke up when she noticed lab test results differed from what she observed during her examination. Pilcher’s actions exemplified one of the nine principles of trusted care emphasized by the Air Force—the duty to speak up. (U.S. Air Force photo by Senior Airman Malcolm Mayfield)

Capt. Kelsey Pilcher, 48th Medical Group pediatric nurse practitioner, listens to a newborn’s heartbeat during a check‐up at Royal Air Force Lakenheath, England, Oct. 24. Recently, during a check‐up with one of her patients, Pilcher spoke up when she noticed that the lab test results differed from what she observed during her examination. (U.S. Air Force photo/Senior Airman Malcolm Mayfield)

Capt. Kelsey Pilcher, 48th Medical Group pediatric nurse practitioner, listens to a newborn’s heartbeat during a check‐up at RAF Lakenheath, England, Oct. 24, 2017. Recently, during a check‐up with one of her patients, Pilcher spoke up when she noticed lab test results differed from what she observed during her examination. Pilcher’s actions exemplified one of the nine principles of trusted care emphasized by the Air Force—the duty to speak up. (U.S. Air Force photo by Senior Airman Malcolm Mayfield)

ROYAL AIR FORCE LAKENHEATH, England (AFNS) -- Trusted Care is a core component of Air Force medicine. There are nine principles, one of which is speaking up.

This critical principle was exemplified by 48th Medical Group attending pediatric nurse practitioner Capt. Kelsey Pilcher in the case of two newborns recently brought into her care.

The babies, both less than a week old, came into the clinic for their newborn visits within 20 minutes of each other. While at the clinic, both had standard bloodwork drawn to check their bilirubin levels at the medical labratory. High bilirubin levels can lead to jaundice and if not treated can have long-term consequences including brain damage.

When the test results came back, Pilhcer thought something was wrong.

"When I got the results,” she said, “I realized it didn't quite match the clinical picture."

The first baby, who was visually showing all the signs of having high bilirubin levels, had normal test results. The second baby, who showed signs of having normal levels, had test results indicating high bilirubin levels.

"It made me question if the bilirubins were actually associated with the right baby," she said.

Pilcher trusted her instincts, spoke up, and had the tests redone.

"In the medical field it's so necessary (to speak up),” Pilcher said, “If something goes unnoticed, or if your technician or nurse notices that something doesn't seem quite right, but they don't say anything, there can be consequences, both long-term and immediate."

In this case, not speaking up would have resulted in the baby who actually needed additional medical care being sent home. The second lab results matched what Pilcher had observed in the babies, and resulted in the correct baby being admitted to the hospital.

“Captain Pilcher's great catch highlights just how important it is for all Airmen, regardless of positon, to speak up if they recognize something that they feel may jeopardize patient safety and to stand by that conviction until a satisfactory explanation or solution is presented,” said Capt. Adam Hotz, 20th Medical Operations Squadron medical director of pediatrics.

The duty to speak up fosters a mindset that values alternative perspectives. It helps Air Force medical leaders build deeper organizational trust, remove barriers and reinforce a mutual respect.

“At the heart of duty, to speak up is the recognition that we all are human and capable of making errors, and none of us wants one of those errors to adversely affect the patients we are working so hard to help,” Hotz said. “It empowers everyone involved in a patient's care to advocate for that patient's safety and ensures there are no barriers to that end.”

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