Rapid Response Team - page 4

by Lukestar

20,848 Views | 94 Comments

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


  1. 0
    Let me apologize in advance (although I could just edit out my previous remarks, I won't)

    I worked medical for 3 yrs before moving to ICU.

    I'm generally opposed to the arrogance some ICU nurses have: moving to ICU was a serious 2 yr learning curve for me before I felt anywhere near comfortable w/ pts on vents, etc. And I realize it's a different skill set. I respect floor nurses because I've been one and know what a job it is.

    Most ICU nurse have some serious experience under the belts, at least the ones that will be tapped for this RRT. And that should be the model: experienced nurses aiding inexperienced nurses.

    It's not that the ICU nurse responding is going to be a 'better' nurse by position of being in the ICU; it's that they are going to more than likely be a 'better' nurse by means of experience.

    And that's fine. That's what you need in an emergency: an experienced nurse that can pick up on things a more inexperienced nurse might miss (and by previous comment, I stated that the more experienced floor nurses aren't going to be likely to call someone to get in the way of what they already know to do).

    But a near code situation is not the time or place to play up the teaching aspects of nursing: do you want us all to feel good about an encounter, or do you want a pt taken care of, in short order.

    What rubs me wrong about this is that the RRT model everybody is working from stresses that this is a teaching opportunity, if only the ICU nurses will 'play nice' instead of 'showing off'. So lets pretend it's NOT about more experience being available in a close situation and instead it's about collaboration.

    And I bristle at that thought. If I have to take time from MY patients to respond, then let me respond and get back to my job: this whole touchy feely aspect of the RRT is going to be its downfall.

    And the model recognizes this but doesn't care: it just dismisses it with healthy doses of ivory-towered nursing 'theory' that we are all in it to advance each other. I'm surprised the nurses from both units aren't being advised to therapeutically touch each other. . .

    This model just encourages having your feelings hurt - why?: because you are smart enough to know you need help. And that's garbage. It's garbage for the floor nurse that needs the help and recognizes it, and is garbage for the ICU nurse that can provide the help.

    I'm not putting down the floor nurses by any means. I have a great respect for any nurse that knows when they need help and asks for it: it's the nurses that don't know when they need help that scares me.

    But the touchy feely design of this program is going to create bad feelings, on both sides of the coin. And that's what frustrates me. A near emergency is not the time nor place to play ivory towered games.

    ~faith,
    Timothy.
  2. 0
    Where I am at, the RRT are a group of ICU-experienced nurses who do nothing but RRT. They are available to help out with codes, patients on the floor who are crumping, visitors who get into trouble themselves, or help transport ICU patients to procedures if they have time. They can also assist with IV starts, pull sheaths if the unit nurses aren't qualifiied to do so, help out the unit nurses if they need help as well as floor nurses, etc.
    I think it's a great idea and a great asset to us. However, I could see big problems if it was staffed by ICU nurses who already have an assignment in the unit and also expected to do this too.
  3. 0
    Quote from conklip
    Please....the charge nurses are worthless, you need someone with critical care skills.
    If the patient needs critical care they should be on a critical care unit.

    If not...requiring some advanced education and knowledge of our charge nurses seems more realistic, and would benefit every unit on a 24/7 basis.
    Last edit by canoehead on Aug 4, '05
  4. 0
    Quote from justmanda
    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?
    I commend you for a job well done! That's exactly what you should have been doing--but I also understand that many floor nurses are badly understaffed to take the time with a really sick patient. Preventing a transfer to the ICU should have started with holding the BP meds if the BP was marginal to begin with. We do this in our Unit all the time, but then again we're taking VS q15-30 mins, something the floors don't have time to do. I'm not saying the RRT doesn't have its place, but it seems the hospital is throwing pennies at a bigger problem--enough ICU space and appropriate admissions to those limited beds.
  5. 0
    Quote from ZASHAGALKA
    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.
    I get it. And I understand it is management who is putting both of us (the floor nurses and the ICU nurses) in an awkward situation. Let me give you an example. A post cardiac cath patient suddenly has a bp of 210/110 (baseline 120/70). His urine output over the last 8 hours is minimal and he is has a fever of 102. My first thought would be he is in acute renal failure secondary to the cath dye. Do I call the doctor? No. I call you and you tell me that he is probably having a problem clearing the dye and you tell me to call the doctor. It's as if we have to clear it with the RRT before we actually do something. I think it is a waste of both of our time and it delays treatment. I mean, how many nurses does it take to screw in a light bulb? It also puts you guys in a precarious position, legally speaking. You don't know this patient. What if I charted that I called the RRT for assistance and the case goes to court? You know your name will be mentioned and you will have to get involved in the legal case. Perhaps the system needs a little tweeking like, say...have a team that's sole responsibility is to respond to these situations and, therefore, has the time to stabilize the patient for you. Even then, I would still be reluctant to hand over the care of my patient to someone else. I like handling a crisis and finding my way out of one. It's obvious that I just don't understand how it can be anything other than the hand-holding process you described.
  6. 0
    Quote from justmanda
    What if I charted that I called the RRT for assistance and the case goes to court? You know your name will be mentioned and you will have to get involved in the legal case. Perhaps the system needs a little tweeking like, say...have a team that's sole responsibility is to respond to these situations and, therefore, has the time to stabilize the patient for you. Even then, I would still be reluctant to hand over the care of my patient to someone else. I like handling a crisis and finding my way out of one. It's obvious that I just don't understand how it can be anything other than the hand-holding process you described.
    Most hospitals aren't going to shell out for a dedicated team. Mine isn't.

    Regarding liability:

    1.Part of it is liability: from both ends. If it's your patient, turning a problem over to a RRT isn't going to relieve you of responsibility (I can just see a defense lawyer: 'so you admit the hospital put you in a situation that you couldn't handle . . .')

    2. If you are the ICU nurse, then picking up a particular problem on the fly can mean you miss something significant about the whole picture (and this is why collaboration is important, but! the nurse that is out of his/her league w/ the particular problem might also be out of his/her league with understanding the ramifications of a particular treatment (for this problem that required assistance) on the whole patient - and only (s)he has knowledge of whole. But who's liability is it gonna be when the ICU nurse's problem oriented treatment creates worse problems for the patient as a whole?: a problem someone with the same level of experience AND knowledge of the whole patient would have avoided? Remember, this program is designed, I think, to be utilized by the inexperienced nurse and not the floor nurse with enough experience to handle a problem on his/her own.

    3. I'm sure this program IS about liability: it's a way for management to state that they were taking proactive measures to avoid 'failure to rescue'.

    I only have to hope that it's also about saving lives. Maybe I'm not quite so cynical to believe otherwise yet. And to the extent that it is about saving lives, I don't want to dismiss the idea in its entirety. But it's going to take a ton of tweaking before it's an effective idea.

    And this is why the ANA and the AACN demand bedside nursing input on such ideas from drawing board to implementation: to allow for those that must implement the program to critique and have a hand in tailoring it so that it ACTUALLY works in the trenches. . .

    But my biggest problem is still the concept that, because the patient hasn't coded quite yet, there should be enough time for the nurses to get together and have a happy hand-holding seance and make sure that everybody comes out of the experience emotionally enriched.

    As a floor nurse, you might be a little tweaked when an ICU nurse comes in and 'takes over' a code, but everybody knows that is the ICU team member's role. When you try to deliberately confuse roles, as is being done in RRT, it's gonna create confusion and hurt feelings.

    And I guess the thing that upsets me more than the liability dance being done is this 'We know you can't go talk to the floor nurses without being the rude ICU nurse you are, so here are the rules to make sure you 'be nice'.

    ~faith,
    Timothy.
  7. 0
    I can't understand a reason to have ICU nurses responsible for an assignment of one or more patients being forced to respond to impending or actual emergencies on another unit.

    Don't the ICU patients need a nurse at all times?

    I do think a RRT or what some local hospitals have as the "Code Team" consisting of a "crisis nurse". respiratory therapist, pharmacist, and nursing supervisor.
    The "crisis nurse" can be called to prevent "failure to rescue", to transport a patient off a monitored unit for a test (with ACLS equipment etcetera), or to admit a patient in an emergency.

    The "crisis nurse does not have an assignment. One hospital calls this position "Transport Team Nurse". They go pick up patients at hospitals without the facilities available at their hospital. SO they are not available to the rest of the units when on a run. Then one of the critical care charge nurses, who have no patient assignment except meal break relief, respond to a code.
  8. 0
    Quote from spacenurse
    I do think a RRT or what some local hospitals have as the "Code Team" consisting of a "crisis nurse". respiratory therapist, pharmacist, and nursing supervisor.
    The RRT is different than a code team. The RRT is an ICU nurse and an RT - they have a protocol they can act from: give neb tx, draw labs, get ekg, oxygen, etc. The point is that that either head off a code, or at least have handy labs and other stuff available before it gets to that point . . .

    The code team is utilized during an actual ACLS emergency.

    The RRT team is supposed to be for input when the nurse doesn't think things are 'right' but the patient isn't actually emergent - yet. The point is supposed to be to foster an earlier interaction than a code in order to head off some codes before they get to that point.

    There's been alot of effort to get us nurses to 'buy-into' this RRT recently.

    But you know, everytime I hear the phrase 'nurse buy-in' I have to be alert - 'buy-in' is management code for: how do we get them to BUY even more garbage. (we wouldn't HAVE to buy into something good for us).

    ~faith,
    Timothy.
  9. 0
    The rapid response team is not just a lamebrain management initiative. The rapid response team concept was born out of the IOM report on needless deaths in healthcare. The info below is right of the IHI website referred to by another poster:

    Institute for Healthcare Improvement
    The Institute for Healthcare Improvement (IHI) is a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. Health care is a highly complex system with many broken parts. The good news is that for every broken part in our system, there are remarkable examples of excellence — organizations that have overcome enormous obstacles to redesign the way patient care is delivered.
    Unfortunately, these examples are too few. As the Institute of Medicine (IOM) declared in 2001, in words that still ring true, “Between the health care we have and the care we could have lies not just a gap, but a chasm.” Health care does not yet reliably transfer best-known science into action, and processes frequently fail, despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, too often does just the opposite — leading to unintended harm and unnecessary deaths at alarming rates.

    100,000 Lives
    IHI and other organizations that share our mission are convinced that a remarkably few proven interventions, implemented on a wide enough scale, can avoid 100,000 deaths over the next 18 months, and every year thereafter. The Centers for Disease Control and Prevention estimate that two million patients suffer hospital-acquired infections each year. ( And guess what....most of these are from healthcare workers who do not wash their hands or follow appropriate aseptic technique) The US spends the most money on health care of all (advanced) industrialized nations [1], but it performs more poorly than most on many measures of health care quality [2].

    The 100,000 Lives Campaign aims to enlist thousands of hospitals across the country in a commitment to implement changes in care that have been proven to prevent avoidable deaths.

    Deploy Rapid Response Teams…at the first sign of patient decline
    Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack
    Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
    Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle”
    Prevent Surgical Site Infections…by reliably delivering the correct perioperative care
    Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”
    =========================
    Very similar to the Leap Frog Group, this group is trying to guide healthcare providers to adopt strategies with a basis in scientific methods and proven outcomes. Basically, this group has studied practice in facilities who are generating better outcomes than the rest of us to determine what is it they are doing to make a difference. In turn, they are asking all of us to implement these initiatives.
  10. 0
    Quote from ZASHAGALKA
    ...There's been alot of effort to get us nurses to 'buy-into' this RRT recently.

    But you know, everytime I hear the phrase 'nurse buy-in' I have to be alert - 'buy-in' is management code for: how do we get them to BUY even more garbage. (we wouldn't HAVE to buy into something good for us).

    ~faith,
    Timothy.
    I work registry sometimes and talk to the agency nurses who come to our hospital. I don't think this has come to LA (yet).

    CCU Nurse posted this about, I think Oklahoma University Hospital. It seemed like a good idea at the time. I didn't know the nutses would also have a patient assignment.
    The "crisis nurse" can be called by any nurse on any floor for help or advice. It is always an experienced critical care nurse. If there is a conflict the shift supervisor decides where to send the Crisis nurse".

    I am thinking, "What about a clinical nurse specialist? At least on weekday shifts they are a wonderful resource.


Top