Rapid Response Team

Specialties CCU

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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 Critical Care that will go thru out the hospital to the various floors and areas when a nurse has a patient that they are feeling uncomfortable with. Either the patients vital signs are declining or just that the floor nurse feels uncomfortable with the patient and wants an extra set of experienced eyes to look at a patient before the patient crashes. It is supposed to be more of a nurses helping nurses type of program rather than the unit nurses coming to take over. Anyone with any expeirence with a program like this. I am wondering how the nurses involved respond to this. Do the floor nurses feel like they are looked down on if they have to call for help or do the nurses on the RRT feel put out for having to go help. Any input will be appreciated.

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.

Specializes in Critical Care.
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.

:) 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. :balloons:

...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.

Specializes in Critical Care.
:) 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:

I never said it's a lamebrain management initiative: I said it's a management initiative brought on high by the ivory tower'd types that don't know how to implement something on a unit level. They go to a meeting or read a magazine and adopt the ideas over some luncheon wholesale without input and then are amazed that the nurses don't just latch on. But you know those bedside nurses, we have to force them to 'buy in' to our wise on high proposals.

As much as I hate to quote the ANA, since we're quoting:

From ANA Position Paper: Restructuring, Work Redesign, and the Job and Career Security of Registered Nurses

"when work redesign decisions affecting RN practice are being made, ANA insists that the registered nurses from the affected workplace be at the table as a full partner so that the decisions will be justified in terms of both cost and effect on important patient outcomes, including mortality, length of stay, patient satisfaction, and adverse outcomes."

What I have said is that it might be a great idea, once all the tweaks are worked out but in it's current condition, without bedside nursing input, it's insulting (you ICU nurses must 'play nice' because we know you won't unless we tell you to) and will just lead to interunit problems.

~faith,

Timothy.

Specializes in CCU/CVU/ICU.

What I have said is that it might be a great idea, once all the tweaks are worked out but in it's current condition, without bedside nursing input, it's insulting (you ICU nurses must 'play nice' because we know you won't unless we tell you to) and will just lead to interunit problems.

~faith,

Timothy.

Timothy, other than being expected to be nice, do you feel your team is doing a good job or helping? Or are you way too wound-up in your management's presumption that 'icu nurses aren't nice'? Yeah, sometimes it's hard to be nice. BUt that's ok, if you're saving lives then who needs NIce. In fact, it's a silly concept! Hey, where's the meanies when you need' em? Though mostly i personally think nice is kinda nice.

Go get'em tiger!..grrrrr!!

Here is the previous thread on RRT:

https://allnurses.com/forums/showthread.php?t=92059

From article about Austin Hospital (Heidelberg, Victoria, Australia) and Baptist Memphis Hospital (Memphis, Tennessee, USA) using Rapid Response Teams. - http://www.ihi.org/IHI/Topics/Improvement/MoveYourDot/ImprovementStories/BuildingRapidResponseTeams.htm

The MEDICAL EMERGENCY TEAM (MET) is designed to intervene to prevent cardiac arrest. - http://www.metproject.org.uk/html/the_met_project_book.html

The work of the In-Hospital Cardiac Arrest Prevention project is now being carried forward collaboratively by the Royal Centre for Defence Medicine and the Council for Professionals as Resuscitation Officers. - http://www.metproject.org.uk/html/the_met_project_team.html

Specializes in Critical Care.
Timothy, other than being expected to be nice, do you feel your team is doing a good job or helping? Or are you way too wound-up in your management's presumption that 'icu nurses aren't nice'? Yeah, sometimes it's hard to be nice. BUt that's ok, if you're saving lives then who needs NIce. In fact, it's a silly concept! Hey, where's the meanies when you need' em? Though mostly i personally think nice is kinda nice.

Go get'em tiger!..grrrrr!!

It hasn't been around enough to tell: so far, the result has been that we coded the same people we otherwise would have, they just got to ICU first and therefore the ICU nurse ended up doing a code without a code team being there to help.

And I hear you, but I'm a big boy; it's more than about just the presumption that I'm not nice . . .

Look, if the model is to get an experienced nurse to help an inexperienced nurse head off an emergency, that is great. But if I'M the experienced nurse (and if I have my own patients on my own unit, and in most cases that will be true), then let me go lend my experience and the get back to my job.

The concept that the inexperienced nurse will be offended because the experienced one can help, or that the experienced nurse must be a 'mentor' not an 'intervener' in order not to come off as not being rude is garbage - from both sides. If I needed help, I'd think I'd be grateful for the help, and if I could give help, I think it would be more fruitful to give specific information instead of playing 'what do you think?' games.

I understand that this is envisioned as not just avoiding codes, but as a teaching tool to teach inexperienced nurses how to deal with crisis. BUT. If I have my own patients as an ICU nurse, and this floor nurse has 5-6 other patients somewhere else, the thought that this is going to be some happy teaching circle just doesn't take reality into account: It's management's dream: that since those lazy nurses don't have enough to do with their primary jobs, they ought to have plenty of time to interact over the bedside of a near emergency.

I think the RRT can be beneficial, but only if you cut out the happy horse stuff.

You expect an ICU nurse to come to a code and be the assertive nurse they tend to be. Most nurses that fear codes actually like someone there that can give them snap instructions if needed (and some nurses would freeze up without someone much more familiar with ACLS giving verbal guidance).

Why wouldn't you expect the same thing from a RRT?

If you read the first part of this thread, the comments were along the lines of 'this will be great, as long as the ICU nurse doesn't play mighty mouse (here I come to save the day!).'

And my comments is: what else would you expect from somebody that has their own patients in ICU - they are going to try to fix things quickly, or initiate a transfer to ICU quickly - and then get back to their own jobs.

And even if you have a dedicated RRT nurse, it won't be much better. The limits to that happy teaching circle is still going to be the floor nurse that has 5-6 other patients. They aren't going to want to waste time 'being mentored'; this nurse has probably to this point spent an hour or more on 1 patient and wants nothing more than to address his/her others. A dedicated RRT nurse is more than likely gonna be a turf and run nurse, as was said before:"This is what's going on, here's the chart and MAR, I'm outta here".

Teaching and mentoring is nice but there's a time and place for everything, and this will not be it. And my point about telling the ICU nurse to be nice is that the formulation of this idea (it's a group hug not pointed advice from a more experienced nurse) is just going to stereotype the idea that ICU nurses are arrogant and institutionalize bad feelings. (And 3 yrs from now, after all this bad mojo abounds, management will be wondering why there isn't more 'buy-in' to getting floor staff to want to move to ICU.)

Shaking my head about how management always seems to take a good idea and warps it into something unwieldy and unfriendly. (I suspect the how has to do with not following the ANA and AACN's advice and let the bedside nurse actually participate in the planning of such ideas instead of just implementing them from 'on-high'.)

Sorry so long,

~faith,

Timothy.

Somewhat related to the topic of this thread;

I responded to a near arrest in med-surg. An RN in orientation was quite upset when the physician intubated the patient.

She told me she's been an RN for a long time, just returning from raising a family. She said she never experienced a patient being intubated before going to the unit. She said she has never cared for an intubated patient.

The patient had been restless, SOB, agitated, and confused. Tachycardic with a sat of 58%, and rales to the scapulae. She wanted them to transport before intubation. That would have meant an elevator ride.

I imagine and hope she'll be OK when orientation is done. her preceptor was surprised because she seemed so competent until the intubation.

Do you think I should follow up? Talk with her or her preceptor? I think she'll be fine. I just want her to know that.

Somewhat related to the topic of this thread;

I responded to a near arrest in med-surg. An RN in orientation was quite upset when the physician intubated the patient.

She told me she's been an RN for a long time, just returning from raising a family. She said she never experienced a patient being intubated before going to the unit. She said she has never cared for an intubated patient.

The patient had been restless, SOB, agitated, and confused. Tachycardic with a sat of 58%, and rales to the scapulae. She wanted them to transport before intubation. That would have meant an elevator ride.

I imagine and hope she'll be OK when orientation is done. her preceptor was surprised because she seemed so competent until the intubation.

Do you think I should follow up? Talk with her or her preceptor? I think she'll be fine. I just want her to know that.

One of the things we nurses are remiss in doing is debriefing after a traumatic event. I've only seen it done one time and it was really helpful. This might be the time to bring it up. As you probably know, a debriefing session would allow the participants to summarize the events, let them ventilate, ask questions, try to think how they could have done something different. This should NOT be a session for pointing fingers, rather for learning from each other and supporting each other in what we do. It can be especially helpful for new employees whether seasoned old-timers, returning-to-work moms or new grads.

Specializes in M/S/Tele, Home Health, Gen ICU.

We are going to be starting up a RRT in our small (48 beds) community hospital. Since staffing everywhere is governed by ratios how do you get around this? We really could not afford, nor have the need to have an FTE for a nurse to respond on the RRT. Thanks for any input : :)

Specializes in Med-Surg, Long Term Care.
We are going to be starting up a RRT in our small (48 beds) community hospital. Since staffing everywhere is governed by ratios how do you get around this? We really could not afford, nor have the need to have an FTE for a nurse to respond on the RRT. Thanks for any input : :)

We had a staff meeting yesterday where two representatives of the RRT gave an update on the RRT which I think was initiated within the past 3 months. They said that the RRT members for that shift (ours only runs from 1900-0700 at this point) are determined at the beginning of the shift in ICU and it usually consists of the one RN who only has one patient. They said that then, the nurse who responds to a call for the RRT may even end up getting the patient she/he has been dealing with on the med-surg unit if they deteriorate to the point that they need to be transferred to ICU.

When I asked about bringing the RRT to either 1500-1900 or 0700-1900, the reps. said that traditionally, 0700-1900 is busier on ICU and they don't think they can spare a nurse as easily then. It's got to sometimes be a hardship on ICU when they have to absorb a third patient for a while...

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