Rapid Response Team - page 5

by Lukestar

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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... Read More


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    Quote from Fornursesdotorg
    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.
  2. 0
    Quote from ZASHAGALKA

    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!!
  3. 0
    Here is the previous thread on RRT:
    http://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/Improv...ponseTeams.htm

    The MEDICAL EMERGENCY TEAM (MET) is designed to intervene to prevent cardiac arrest. - http://www.metproject.org.uk/html/th...ject_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/th...ject_team.html
  4. 0
    Quote from Dinith88
    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.
    Last edit by ZASHAGALKA on Aug 5, '05
  5. 0
    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.
  6. 0
    Quote from spacenurse
    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.
  7. 0
    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 :
  8. 0
    Quote from Celia M
    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...
  9. 0
    Our hospital has a MET nurse, medical emergency team, every shift. An ICU or CCU nurse is one who goes around each unit in the morning for rounds. You can call them if you feel uncomfortable with your patient's status. They can expedite a transfer to higher level of care and even start an IV if nurses on the floor have tried and no luck. They are very handy.
  10. 0
    I work in a hospital in Houston, as part of a dedicated RRT, meaning the nurses on the team do not take patients. Our team consists of an ICU nurse, RT, 3rd year resident, and surgical intern, and is available 24/7. The role of the RRT is to assess, stabilize, assist with communication with the primary physician, educate and support staff, and then assist with transfer if necessary. We have an algorithm to follow. The staff nurse notifies the RRT nurse, RRT nurse completes pt. assessment, RRT nurse identifies need for medical intervention, and the other members of the RRT notified and interventions carried out as necessary. The RRT nurse is also responsible for conducting clinical rounds on all the floors thoughout the shift to provide visiblity of the RRT role, and opportunity for staff referrals. The nurse is also expected to provide insevices to the staff as seen fit. The nurses hired to the team were carefully selected for their ability to remain diplomatic, and able to provide non-judgemental, non-punitive feedback to the staff initiating the call. We are paid from the Patient Safety and Quality Dept. instead of Nursing, so that we cannot be pulled into the census when staffing is short. The hospital has budgeted for 8 part-time FTEs or 4 full-time FTEs or a combination of the two. I chose to do the team part-time and continue to work ICU part-time to maintain my skills. The other members of the team are paid from their respective depts and are not dedicated to the unit. The MDs are expected to respond to us immediately as if it were a code situation, eventhough they have their own call to do. This team is just now being implemented, but everyone I have encountered in my hospital is very excited to have this available to them, floor and ICU nurses alike. I can certainly give updates if wanted, after the team had been going for a while.


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