Rapid Response Team

Dinith88 · Jun 3, 2005

My understanding of the purpose of this... is to;
1. free up the hands of a VERY busy floor nurse
2. lend an extra helping hand in assessing a pt. by a nurse more familiar with the "pt. crumping routine"
3. have that extra set of hands to hang drips, push meds.. maybe not allowed on a particular unit, look at an ekg, draw a blood gas... hook up to a portible monitor (which many floor nurses are not trained to read).. and get the whole picture to present to a doc.
4. That nurse can now call the primary doc and give an assessment (not that afloor nurse can't... but the stat nurse has additional skills to not only aid the doc on the phone in a diagnosis... but help treat emergent situations... that fllor nurses not only don't have the time for... but might not be allowed to provide.. regardless of their knowlege or skill level.
ie. your pt's crumping.. you call the stat nurse, they arrive.. you give them the MAR, chart and a quick report.... you can now attend to your other UMPTEEN pt's and let that nurse handle the crisis. You check in as frequently as possible. Your sick pt. now has an ICU nurse at the bedside... you aren't two hours behind and ALLLLLL the patients continue to receive care!
I would take each interaction as indepedent. A stat nurse with a crappy attitude twords you can be pulled aside post situation, or a note to their manager. Consider the learning possible if you actually have time to be in the room and assist in the process.
If this plan is presented in this way.... the way it SHOULD work... with and additional plan for ego's... you'll have immediate buy in by the floor nurse staff.
ps. this stat nurse CANNOT have patients in the ICU. they should be utilized for IV service, educational classes, and an ICU pair of hands during off need time. IF NOT, this is doomed for failure.
try to keep an open mind as how this can REALLY free you up and give the best care possible to all the patients.

I disagree. I feel it would be dumb for the RRT to 'free up a busy nurse'. That would 1)be dumping on the RRT 2) would not allow the floor nurse the 'experience' of handling a crisis, 3) could potentially screw things up if dealing with a doc (ie on the phone) because the floor nurse would know many details of this pt the RRT would not (especially if only a brief report, a look at the MAR's, and the floor nurse away attending other things)....

The purpose (in theory) is that the RRT will assist/collaborate and simply be a 'brainstorming group' (in conjunction with the floor nurse/nurses) with the capacity to 'take over' if the condition deteriorates into a code.

Your idea about a floaty-jack-of-all-critical-care-trades-iv-startin-code-goin-stud-nurse who's sole purpose is to be available and not take patients is a good one i suppose...but not realistic. At least in most hospitals (or the ones with a budget). In a code, the ICU nurse leaves her patients. IF a RRT is called, the ICU can leave her pt's...with the other nurses covering while she's out. If this seems impracticle(sp?), it's basically the same thing when a code is called...ICU nurse leaves and others pick up slack/assist.

The idea of insulting, demeaning, or underutilizing a floor nurse is a potentially big problem with an RRT. If this team (as you say) swoops in, takes over at the bedside, and Sends The Floor Nurse On Her Merry Way to look after her other patients, you'll be doing just that.

heart queen · Jun 8, 2005

perhaps I only inflamed your idea of an RRT, and did a poor job of trying to prove their benefit?? I'm sorry if I did. My friend, from a former hospital I worked now has a RRT in place... who's budget DOES allow this nurse to be all that... previously the busy ER staff went to codes... just the same theory as ICU staff. A nurse can't function collaboratively... when their legally responsible for a patient is on another unit... so their loyalties and needs are split... which is where the quick fix... leading to ego's rearing can happen! They, like you are then spread too thin.

There is NO dumping on a RRT... it's what they do... period... when crisis is over, on down time... their skills are utilized in appropriate areas to justify the cost to this position...they are fractioned from the budget from each ICU's and clock thier time on work sheets to prove the off hour needs of a free ICU hand even if it's being the transport nurse to cat scan.

No one is doubting your ability and expertise to relate to the MD the crisis. Think of how much valuable time is spent with one crumping patient... while you have 5-10 or more others. This is the point of the RRT (and no I don't work for your facility, seceretly trying to talk you into this). No one is trying to step on your toes....which are very capable ones at that.

You have a HR of 150, a RR of 30 with an spo2 of 86 a BP of 90/60 in a post surgical hip with CAD. Is it pneumonia? Is it PAT, SVT, AFIB, WPW? Is the respiratory compromise causing the increased HR and lower BP? or is the CAD causing the rapid HR and the RR is an intolerance of it?.

You're there to focus on mobility, warding off infection and pain controll, not manage a crisis ... and you need to be okay with this.... you don't have to do it all to provide the excellent care that you do!. The RRT with your help can assist the MD in either treating it as respiratory or cardiac..... what if you need to start pushing IV meds STAT in a non code... warding off code situation? The RRT can help the MD determine beta verse calcium channel blockers... has time to look up K and mag levels... draw abg's, read ekg's.... maybe stabalize the patient to go to tele instead of taking the last ICU bed... when another pt. is crumping on another unit who may need the bed more.

The reason I see your point, which you may not believe is that the wife of my friend that works that ICU with the RRT... works the floors. We've shared many breakfast post events where her night went to pot wih 8 patients and the one crumping set her two plus hours behind. That is what this should be about.... the patients NOT receiving care on your unit when You're tied up! Not that you aren't capable.

my goodness, you have a management that really wants to help you in this crisis and take some of the load off you to better care for the OTHER patients. This is not a dig about your abililty... it is about the time alloted to you, period.

I hope that I have tried to say, in way to many words... that you ARE capable... and you don't need the RRT.... but your remaining pt's do. This isn't about your skills (you manage a workload that I am envious of the ability to). This REALLY may be a legit solution. I understand your position, please at least evaluate that this might work...

I too am worried about the mannerisms and scathing comments that can come from the RRT (ICU nurses)... I am one... I've made the boo-boo's... and I've seen some scars made by others, maybe even myself. But we can learn as we go and give sincere apologies when we fail and work through this... cause the patients CAN benefit.... and that's why we're (I'm there). ((not trying to sound sappy)).... It may be that you've been burnt way too many times by your ICU team... to have trust in them?.....

I look foreward to talking about this more... ps, my spelling stinks if you haven't noticed. And I really DO care that you're worried about this and I'd, like many other nurses... NEVER send you on your merry way!

sue

I disagree. I feel it would be dumb for the RRT to 'free up a busy nurse'. That would 1)be dumping on the RRT 2) would not allow the floor nurse the 'experience' of handling a crisis, 3) could potentially screw things up if dealing with a doc (ie on the phone) because the floor nurse would know many details of this pt the RRT would not (especially if only a brief report, a look at the MAR's, and the floor nurse away attending other things)....
The purpose (in theory) is that the RRT will assist/collaborate and simply be a 'brainstorming group' (in conjunction with the floor nurse/nurses) with the capacity to 'take over' if the condition deteriorates into a code.
Your idea about a floaty-jack-of-all-critical-care-trades-iv-startin-code-goin-stud-nurse who's sole purpose is to be available and not take patients is a good one i suppose...but not realistic. At least in most hospitals (or the ones with a budget). In a code, the ICU nurse leaves her patients. IF a RRT is called, the ICU can leave her pt's...with the other nurses covering while she's out. If this seems impracticle(sp?), it's basically the same thing when a code is called...ICU nurse leaves and others pick up slack/assist.
The idea of insulting, demeaning, or underutilizing a floor nurse is a potentially big problem with an RRT. If this team (as you say) swoops in, takes over at the bedside, and Sends The Floor Nurse On Her Merry Way to look after her other patients, you'll be doing just that.

**canoehead, BSN, RN** · Jun 8, 2005

Assuming that you have experienced charge nurses that know the patient and the nurse that's working with him/her couldn't the charge nurse do the same thing as a second pair of eyes as the RRT member- and do it faster and better?

In that case you would need an extra pair of hands to cover patients that the charge and the patient's nurse have left. Someone who wouldn't leave the ICU without staff, wouldn't necessarily have to keep up ICU level skills, would be cheaper to maintain and easier to free up in a crisis.

But if you are talking about starting ICU drips and lines while the patient is still on the floor I can see why you'd want an ICU nurse.

For myself- I work the ER- having a second person to explain the whole situation to, who didn't know the patient, where anything was, or the unit paperwork, it would make things more difficult, not less. Give me someone who knows the unit's supplies and policies, (like a charge) and someone that I've been keeping up to date as the situation unfolded so she would be ready to jump in and help when I needed her.

and by the way- if administration REALLY wants to help out tell them an on-call scribe would be a HUGE help when the poop hits the paper.

Dinith88 · Jun 10, 2005

perhaps I only inflamed your idea of an RRT, and did a poor job of trying to prove their benefit?? I'm sorry if I did. My friend, from a former hospital I worked now has a RRT in place... who's budget DOES allow this nurse to be all that... previously the busy ER staff went to codes... just the same theory as ICU staff. A nurse can't function collaboratively... when their legally responsible for a patient is on another unit... so their loyalties and needs are split... which is where the quick fix... leading to ego's rearing can happen! They, like you are then spread too thin.
There is NO dumping on a RRT... it's what they do... period... when crisis is over, on down time... their skills are utilized in appropriate areas to justify the cost to this position...they are fractioned from the budget from each ICU's and clock thier time on work sheets to prove the off hour needs of a free ICU hand even if it's being the transport nurse to cat scan.
No one is doubting your ability and expertise to relate to the MD the crisis. Think of how much valuable time is spent with one crumping patient... while you have 5-10 or more others. This is the point of the RRT (and no I don't work for your facility, seceretly trying to talk you into this). No one is trying to step on your toes....which are very capable ones at that.
You have a HR of 150, a RR of 30 with an spo2 of 86 a BP of 90/60 in a post surgical hip with CAD. Is it pneumonia? Is it PAT, SVT, AFIB, WPW? Is the respiratory compromise causing the increased HR and lower BP? or is the CAD causing the rapid HR and the RR is an intolerance of it?.
You're there to focus on mobility, warding off infection and pain controll, not manage a crisis ... and you need to be okay with this.... you don't have to do it all to provide the excellent care that you do!. The RRT with your help can assist the MD in either treating it as respiratory or cardiac..... what if you need to start pushing IV meds STAT in a non code... warding off code situation? The RRT can help the MD determine beta verse calcium channel blockers... has time to look up K and mag levels... draw abg's, read ekg's.... maybe stabalize the patient to go to tele instead of taking the last ICU bed... when another pt. is crumping on another unit who may need the bed more.
The reason I see your point, which you may not believe is that the wife of my friend that works that ICU with the RRT... works the floors. We've shared many breakfast post events where her night went to pot wih 8 patients and the one crumping set her two plus hours behind. That is what this should be about.... the patients NOT receiving care on your unit when You're tied up! Not that you aren't capable.
my goodness, you have a management that really wants to help you in this crisis and take some of the load off you to better care for the OTHER patients. This is not a dig about your abililty... it is about the time alloted to you, period.
I hope that I have tried to say, in way to many words... that you ARE capable... and you don't need the RRT.... but your remaining pt's do. This isn't about your skills (you manage a workload that I am envious of the ability to). This REALLY may be a legit solution. I understand your position, please at least evaluate that this might work...
I too am worried about the mannerisms and scathing comments that can come from the RRT (ICU nurses)... I am one... I've made the boo-boo's... and I've seen some scars made by others, maybe even myself. But we can learn as we go and give sincere apologies when we fail and work through this... cause the patients CAN benefit.... and that's why we're (I'm there). ((not trying to sound sappy)).... It may be that you've been burnt way too many times by your ICU team... to have trust in them?.....
I look foreward to talking about this more... ps, my spelling stinks if you haven't noticed. And I really DO care that you're worried about this and I'd, like many other nurses... NEVER send you on your merry way!
sue

Hmm. Perhaps i misled you with my previous post. I'm an ICU nurse who is a member of our RRT if i'm 'on code'....not a floor nurse trying to disuade anyone from forming an RRT. And i still stand by my three main points. 1) a nurse who gives a quicky report and leaves the RRT to assume care IS dumping on the busy ICU-rn (and Respiratory therapist?) who may be involved. It would be wiser and more efficient to simply transfer the patient to ICU...rather than transfer an ICU to the patient (an ICU 'squad' that takes over). 2) The floor nurses NEED to experience handling a crisis...regardless if they're busy or not...for several obvious reasons..3)THe floor nurse will inevitably (ideally!?) know more about the patient than an RRT that was given a quicky report...so her presence would be invaluable.

Perhaps you work in a facility that has room in it's budget for a 'stand-by' RRT...but i can assure you that this is the exception...(a BIG exception).

In the VAST majority of hospitals, an ICU nurse is responsible for responding to codes...and other ICU nurses expected to hold the ship while she's away. SAme thing with the RRT. And if the patient is requiring pressors, etc. or otherwise crashing, he needs moved to ICU anyway...not a PRN 'ICU squad' that assumes the care of a patient on the floor.

The essence of a RRT isnt to assume care. It's to help trouble-shoot and stave-off an impending crisis...(ie. to prevent codes, stop unnecessary(sp?) tranfers to ICU, etc.) I cant say it enough..so i'll say it one last time... "if the patient is requiring ICU-type care...he needs to go to ICU...not have some icu-team insert itself on a unit".

And i still fully believe that your vision of an RRT (one that does not involve the floor nurse) would do less for morale/relations than would one that is more collaborative in nature.

heart queen · Jun 14, 2005

okay, now I got ya. From the point of an ICU nurse being pulled to handle an emergent crisis while being legally responsible for patients on another unit... is why I've stated this WON"T work... you're point exactly. A bit slow on the uptake here. so let me help you validate your point.

As I've stated with my knowledge of my pervious hospital... the RRT does NOT, NOT have a pt. assignment, shared in the budget by the ICU's, fractioned in the units with the "code". So in this situation... the ONLY situation that an RRT should be utilized will work.

my assumption is that some lunk-head manager has come across one piece of literature and has been given the go ahead to trial this with out the budget to ensure it's success. Regardless of ICU or ER nurse, there are critical patients going without care while you're butt is somewhere else, treating a patient that most likely will come to you... or in your scenerio... worse... goto step down... where you've now been tied up for an hour and have to pass off care to ANOTHER nurse..

So in you're situation, as I've stated from the beginning... this is NOT the theory behing the RRT, you're facility is half arsing it and screwing up the patient care.

gather all the literature you can... log your time away from patients as well as all the chaos going on in the unit you left... as well as basic care that was negligent.

I'm not flip flppping my response because you're ICU too, I'm recognizing the inability for this plan to work with the restraints they've tied you with.

as always, ya've got my support, this stinks like last weeks garbage.

codebluechic, ASN, RN · Jun 14, 2005

Try this link and click on the how to guide for rapid response teams.

http://www.ihi.org/IHI/Programs/Campaign/

JustMe · Jun 14, 2005

I work in a 9-bed Cardiac Intensive Care Unit. We were just notified yesterday that the hospital intends to institute the RRT. Guess who gets to go? The CICU nurse of course. Even though the charge nurse has 2 patients to take care of all by her lonesome. They're going to have to improve our staffing if they want us to go spend time out on the floors as well as doing our own jobs. We are also the code team leaders, so if one nurse is out of the Unit for RRT and a Code is called elsewhere in the house, what do we do??? Don't think it can't happen! :uhoh21:

Dinith88 · Jun 15, 2005

So in you're situation, as I've stated from the beginning... this is NOT the theory behing the RRT, you're facility is half arsing it and screwing up the patient care. .

No. NOt 'my' facility alone. Rather, most(nearly all!) facilities that have an RRT work this way. Look at CheriP's post as an example. So..either YOU're not getting the theory behind RRT, or everyone else has got it wrong :)

And unfortunately, the literature is very limited...But what's there has been scrutinized and disseminated(sp?) throughout the unit.

JustMe · Jul 7, 2005

To those of you who are using the Rapid Response Team: Who is on the team? Everyone mentions an ICU nurse and a respiratory therapist, but are some teams including a physician? We're just now getting our inservice for instituting the RRT but there is no mention of a doc. The ICU nurse is supposed to do an assessment and "make a recommendation" to the physician?? Since when did my license make it OK for me to make a medical diagnosis? Yeah, I know we all call a doctor and ask if we can do so-and-so. But as a member of the RRT, I don't think it's my place to suggest intervention to a physician. The form we're to fill out actually says "suggested intervention" on it, and we're very uncomfortable with that.

Lukestar · Jul 7, 2005

To those of you who are using the Rapid Response Team: Who is on the team? Everyone mentions an ICU nurse and a respiratory therapist, but are some teams including a physician? We're just now getting our inservice for instituting the RRT but there is no mention of a doc. The ICU nurse is supposed to do an assessment and "make a recommendation" to the physician?? Since when did my license make it OK for me to make a medical diagnosis? Yeah, I know we all call a doctor and ask if we can do so-and-so. But as a member of the RRT, I don't think it's my place to suggest intervention to a physician. The form we're to fill out actually says "suggested intervention" on it, and we're very uncomfortable with that.

First of all no one is having to make a Medical Diagnosis. The team member is doing what Nurses do everyday, assessing the patients and informing the physician of changes. The theory is that the more experienced Nurse that is a team member on the RRT assesses the patient and faciliates or helps the floor nurse in contacting the physician in charge of the patient. Where I work ICU nurses make suggestions or recommendations to the physicians every day and most if not all of the physicians are thankful and appreciative of this. What do nurses do where you work just pass pills and follow direction. It's called nursing judgement. If the Physician doesn't like your recommedation they aren't bound to have to follow it.

rstewart · Jul 10, 2005

Of course giving any attention to "failure to rescue" incidents will decrease patient mortality rates. However, I would submit that the underlying problem is not one of education but rather of grossly inadequate staffing levels.

Acuities have increased dramatically over the past 10-15 years. Many of the patients on med-surg floors today would have been in critical care units not so long ago. The perceived need for RRTs is a byproduct of the reality that aggregate staffing levels have not kept pace with increasing acuities.

Inadequately staffed facilities will no doubt extoll the value of RRTs. They (RRTs) will put out some fires simply because there will be more fires to be put out. Unfortunately, these "success" stories will find their way into the literature and give credibility/proof of the team's effectiveness. Similarly, glowing testimonials from floor nurses will be reported by hospitals. (Of course----what swamped nurse wouldn't welcome some extra sets of hands?)

Unlike RRTs, the effects of staffing levels on mortality/complications are already evident in the literature. One has to wonder why the Institute for Healthcare Improvement chose to select a new and largely unproven intervention model while failing to recognize the fundamental importance of nurse/patient ratios.

Sadly, I believe the answer is that implementing minimum staffing ratios costs money if you staff below minimums currently. On the other hand deployment of RRTs as recommended (no requirements as to the makeup of the team members etc.) can be done at no cost----assuming that no attention is given to the decrease in care received by the responding nurses's assigned patients while off the unit).

Lukestar · Jul 11, 2005

Of course giving any attention to "failure to rescue" incidents will decrease patient mortality rates. However, I would submit that the underlying problem is not one of education but rather of grossly inadequate staffing levels.
Acuities have increased dramatically over the past 10-15 years. Many of the patients on med-surg floors today would have been in critical care units not so long ago. The perceived need for RRTs is a byproduct of the reality that aggregate staffing levels have not kept pace with increasing acuities.
Inadequately staffed facilities will no doubt extoll the value of RRTs. They (RRTs) will put out some fires simply because there will be more fires to be put out. Unfortunately, these "success" stories will find their way into the literature and give credibility/proof of the team's effectiveness. Similarly, glowing testimonials from floor nurses will be reported by hospitals. (Of course----what swamped nurse wouldn't welcome some extra sets of hands?)
Unlike RRTs, the effects of staffing levels on mortality/complications are already evident in the literature. One has to wonder why the Institute for Healthcare Improvement chose to select a new and largely unproven intervention model while failing to recognize the fundamental importance of nurse/patient ratios.
Sadly, I believe the answer is that implementing minimum staffing ratios costs money if you staff below minimums currently. On the other hand deployment of RRTs as recommended (no requirements as to the makeup of the team members etc.) can be done at no cost----assuming that no attention is given to the decrease in care received by the responding nurses's assigned patients while off the unit).

I agree with you completely in that I have been in nursing for 16 short years and I am totally aware that the patients we see on the Med Surg floors today were in the Critical Care Units when I came out of nursing school. This is the world we live in, as a society we have decided that no one should die with dignity but we must keep them alive at all cost. This is saddly "in my opinion" the world we live in. The concept of RRT in my mind is all about: 1) The Patient 2) Nurses helping nurses. Should we scrap the idea of the system just because preceived staffing levels are not to our acceptance? If that is so only the patients and nurses will suffer.