Rapid Response Team - page 3

by Lukestar

Is anyone here a part of or does your hospital participate in a Rapid Response Team. Our hospital sent me to a conference a couple of weeks ago and now I am supposed to come up with criteria for a team. The RRT will be members of... Read More


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    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.
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    Quote from CheriP.
    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.
    francoml likes this.
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    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).
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    Quote from rstewart
    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.
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    [
    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.

    Please....the charge nurses are worthless, you need someone with critical care skills.
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    There was an article about the Rapid Response Team idea in US World and News Report this past week. It's in the issue with the Top 50 Hospitals rankings.
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    Quote from CheriP.
    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.
    Our hospital just started the RRT (We call it a Stat Team). I never use them unless the house supervisor makes me when I call for an ICU bed. It seems they only exist (in our hospital anyway) to prevent unnecessary transfers to the ICU. I work on Cardiac Tele and we maintain cardiac drips. I usually call the doctor when I need someone to give me orders, not another nurse. The nurses in our ICU are grumpy (because they have to leave their patients) and all they do is ask silly questions that any nurse would have already considered. Patient is hypotensive (did you give them any BP meds lately?) duh! They are in rapid a-fib with a bp of 80/40 (due to the HR) they need to be started on Cardiziem or the like. Why do I need to call another nurse down to tell me to call the doctor? Doesn't that just delay treatment? The nursing supervisor called the Stat team to our unit the other day--different patient. (I was charge) and we had already talked to the doctor, given 2 fluid boluses and started the pt on dopamine. ***** But, on the ICU nurse's behalf, they are probably feeling silly asking us silly questions. I understand they are just doing what they were assembled to do. One ICU nurse, after she was given a verbal request on the phone to come down for a patient who had been having seizures on and off for a few hours, told us to pad the side rails. Didn't we learn that in week 2 of nursing school? Also, we had already given the meds the doctor ordered and gotten an order to transfer to ICU...so what is the purpose of the STAT team?
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    Quote from heart queen
    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!
    If someone expected ME to be their bail out monkey, I'd be the ICU nurse w/ an 'tude.

    RRT is supposed to be a collaboration. But. It will end up being the ICU nurse swooping down to save the day. I'm sorry, it will.

    It's another management 'tool' that never had the input of bedside nurses before being handed down from on high (oh and did I mention the vaunted ANA demands such input - fat lot of good their 'demands' are).

    The nurses on the floor that can handle their own in a crisis won't use the RRT: the nurses that need bailing out will. So what is this time stressed ICU nurse with his/her own patients in ICU (and the RT w/ 60 nebs txs due) gonna do? Spend 2 hrs holding the floor nurse's hand? Or fix the problem so they can get back to their own patients?

    We are working up a RRT. I (an ICU nurse) expect to avoid duty whenever possible, and go 'save the day' so I can get back to my own patients whenever necessary.

    I'm sure this will be a good program. I'm sure it'll save lives. I'm glad about that.

    I just don't like all this 'you ICU nurses have to play nice and go hold hands' mentality. I'll agree ICU nurses are assertive by nature, otherwise they wouldn't have gravitated to critical care. But when you initiate a hand holding program for the floor nurses, don't be surprised if all you end up doing is ingraining stereotypes - on both sides.

    oh btw, first night of RRT: we coded the same 2 patients we otherwise would have, they just got them to ICU (unannounced) first: so, a code situation with no code team. Seems like RRT is more like dump and run.

    ~faith,
    Timothy.

    p.s. reread before you comment: I'm not opposed to the RRT - I'm opposed to creating circumstances that will absolutely and consistently cause bad feelings between the floor and ICU nurses with just a casual 'be nice' thrown in for good measure.
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    Quote from ZASHAGALKA
    If someone expected ME to be their bail out monkey, I'd be the ICU nurse w/ an 'tude.

    RRT is supposed to be a collaboration. But. It will end up being the ICU nurse swooping down to save the day. I'm sorry, it will.

    It's another management 'tool' that never had the input of bedside nurses before being handed down from on high (oh and did I mention the vaunted ANA demands such input - fat lot of good their 'demands' are).

    The nurses on the floor that can handle their own in a crisis won't use the RRT: the nurses that need bailing out will. So what is this time stressed ICU nurse with his/her own patients in ICU (and the RT w/ 60 nebs txs due) gonna do? Spend 2 hrs holding the floor nurse's hand? Or fix the problem so they can get back to their own patients?

    We are working up a RRT. I (an ICU nurse) expect to avoid duty whenever possible, and go 'save the day' so I can get back to my own patients whenever necessary.

    I'm sure this will be a good program. I'm sure it'll save lives. I'm glad about that.

    I just don't like all this 'you ICU nurses have to play nice and go hold hands' mentality. I'll agree ICU nurses are assertive by nature, otherwise they wouldn't have gravitated to critical care. But when you initiate a hand holding program for the floor nurses, don't be surprised if all you end up doing is ingraining stereotypes - on both sides.

    oh btw, first night of RRT: we coded the same 2 patients we otherwise would have, they just got them to ICU (unannounced) first: so, a code situation with no code team. Seems like RRT is more like dump and run.

    ~faith,
    Timothy.

    p.s. reread before you comment: I'm not opposed to the RRT - I'm opposed to creating circumstances that will absolutely and consistently cause bad feelings between the floor and ICU nurses with just a casual 'be nice' thrown in for good measure.
    I don't understand the "play nice" remark. I understand the hand-holding comment...most of us don't want that either...but play nice?
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    Quote from justmanda
    I don't understand the "play nice" remark. I understand the hand-holding comment...most of us don't want that either...but play nice?
    Because ICU nurses can be intimidating to floor nurses, we aren't supposed to direct the RRT situation, but instead, 'advise'. It was stressed that we had to 'play nice' and not be the assertive nurses that we tend to be.

    So, I have to suggest solutions and 'collaborate' and explain what is being done and why. It's a happy teaching circle, hold hands and find your happy spot.

    That's what I mean when I say the directives to the ICU nurses regarding the RRT has been to 'play nice'. We wouldn't want to seem like we are responding because we know what to do, that wouldn't be 'collaboration' (and that might hurt some feelings). Instead, we'll 'play' like we're putting our heads together to come up with a mutual plan of action.

    (in reality neither the ICU nurse nor the Med/Tele/Etc nurse is going to have time for a happy 'advance the nursing profession' confab - it's gonna end up being a Rapid Response for Transfer to ICU team.)

    It's the same ivory tower crap that leads to banning dodge ball because somebuddy might get their little feelings hurt . . .

    I am normally appalled when ICU nurses act haughty and arrogant. But I won't get away from this thread without being tagged as being what I oppose: but my complaint is that this whole deal seems designed to create and sustain that stereotype.

    So stereotype me. It's what I expect from the RRT and what I expect from being a realist on a RRT thread.

    You put an ICU nurse in a position where they are supposed to be an ICU nurse without acting like an ICU nurse, and poof, hurt feelings and bad mojo abounds.

    And saying 'play nice' isn't going to make it nice.

    ~faith,
    Timothy.


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