Rapid Response Team - page 5

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... Read More

  1. Visit  ZASHAGALKA profile page
    0
    Quote from darienblythe79
    What do you mean teaching comes from a high profile?

    Also, during crunch time we aren't playing what do you think. We provide inservices during down time etc. Patient care always comes first. I agree with your position in that a successful team must be dedicated not outstreched from their typical duties. The facility that I work for just doesn't have that attitude you are describing, and I personally haven't seen any latent hostility. Which isn't to say it is not there, I just can't attest to it.
    You answered my question with your paragraph: your teaching value as a dedicated RRT member comes from what you do when you're not actively intervening: your inservices, making rounds and being highly visible and available, your ability to push who you are and what you do: your high profile - the profile you are creating by your presence. That's the time to be a teacher, when people aren't time crunched and over stressed.

    And I think that part of the reason you haven't seen what I'm talking about is that you are a dedicated team.

    My comments weren't directed specifically at you, but at earlier comments on this thread that I myself have seen in our RRT implementation: healthy doses of 'you rude ICU have to be nice to make this work'. And that kind of manipulation and continuation of stereotypes almost always make me shake my head in frustration. . .

    ~faith,
    Timothy.
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  3. Visit  jmgrn65 profile page
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    Quote from darienblythe79
    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.
    That is how it was explained to me, my hospital is thinking of starting this, apparently it saves lives. Sounded good to me.
  4. Visit  darienblythe79 profile page
    0
    Quote from ZASHAGALKA
    You answered my question with your paragraph: your teaching value as a dedicated RRT member comes from what you do when you're not actively intervening: your inservices, making rounds and being highly visible and available, your ability to push who you are and what you do: your high profile - the profile you are creating by your presence. That's the time to be a teacher, when people aren't time crunched and over stressed.

    And I think that part of the reason you haven't seen what I'm talking about is that you are a dedicated team.

    My comments weren't directed specifically at you, but at earlier comments on this thread that I myself have seen in our RRT implementation: healthy doses of 'you rude ICU have to be nice to make this work'. And that kind of manipulation and continuation of stereotypes almost always make me shake my head in frustration. . .

    ~faith,
    Timothy.
    I can certainly see why you would be frustrated.
  5. Visit  pickledpepperRN profile page
    0
    Quote from darienblythe79
    I can certainly give updates if wanted, after the team had been going for a while.
    I will be interested in how it works out.
    The way you describe it sounds excellent.

    Perhaps for a small hospital in a state with ICU ratios a charge nurse, supervisor, or break relief nurse could fill this role. After all in California, for example, the ICU ratio is two or fewer patients per nurse at all times. Responding to a code blue or health crisis is a time when a dedicated nurse must attend or the nurse who DOES respond must endorse responsibility for assigned patients for the time he or she is not in the unit. Just the same as transporting a patient for tests or eating a meal. Patients continue to require a nurse.
    I agree with Timothy. The RRT nurse must not have a patient assignment. That is unsafe.
  6. Visit  Dinith88 profile page
    0
    Quote from spacenurse
    I agree with Timothy. The RRT nurse must not have a patient assignment. That is unsafe.

    In a perfect world...

    Do you then also think that the code-blue nurses should be without patients?
    It's the same principal (having to rely on her peers to watch patients while away) PHAW! Like that'll ever become the norm...regardless if you think it's better/safer.

    The idea of a 24-hr stand-by code/RRT group that is dedicated to this purpose would be about as acceptable to hospital administrators (in MOST...WAY MOST! hospitals in USA) as would the demand that ALL icu nurses be assigned only one patient (again, in a perfect world).
    This is the real world where $$$ talks...unfortunately.

    And ICU nurses have been running to codes since...well, forever (yes, and the vast majority of 'code responders' have patients).
    The idea that they would/could/should respond to RRT-calls isnt any different...at least in most peoples eyes. Thats the stick...and the point you'll have to convince people of...before you'll ever see the 'dedicated' RRT become widespread. I predict that it wont. The hospitals lucky enough to sustain a dedicated 24hr RRT/code-blue team that has no patients is and will remain a rarity. Period. In my opinion...
  7. Visit  darienblythe79 profile page
    0
    Quote from Dinith88
    In a perfect world...

    Do you then also think that the code-blue nurses should be without patients?
    It's the same principal (having to rely on her peers to watch patients while away) PHAW! Like that'll ever become the norm...regardless if you think it's better/safer.

    The idea of a 24-hr stand-by code/RRT group that is dedicated to this purpose would be about as acceptable to hospital administrators (in MOST...WAY MOST! hospitals in USA) as would the demand that ALL icu nurses be assigned only one patient (again, in a perfect world).
    This is the real world where $$$ talks...unfortunately.

    And ICU nurses have been running to codes since...well, forever (yes, and the vast majority of 'code responders' have patients).
    The idea that they would/could/should respond to RRT-calls isnt any different...at least in most peoples eyes. Thats the stick...and the point you'll have to convince people of...before you'll ever see the 'dedicated' RRT become widespread. I predict that it wont. The hospitals lucky enough to sustain a dedicated 24hr RRT/code-blue team that has no patients is and will remain a rarity. Period. In my opinion...
    Not necessairly a rarity if facilities like mine are able to lead by example and by performing outcomes research on the efficacy of the dedicated team. There already is some research out there that has proven cost effectiveness in having a dedicated team, such as reductions in ICU and hospital bed days among cardiac arrest survivors. Now that is money worth saving. We all must continue to support each other and lobby for our right to have such a dedicated team because you are right money does talk, and if you can prove to your administators that a dedicated team will save you money then they should certainly give it a chance.
    Good luck.
  8. Visit  pickledpepperRN profile page
    0
    Di I think code blue nurses should be without a patient assignment? Here is what I posted:
    Perhaps for a small hospital in a state with ICU ratios a charge nurse, supervisor, or break relief nurse could fill this role. After all in California, for example, the ICU ratio is two or fewer patients per nurse at all times. Responding to a code blue or health crisis is a time when a dedicated nurse must attend or the nurse who DOES respond must endorse responsibility for assigned patients for the time he or she is not in the unit. Just the same as transporting a patient for tests or eating a meal. Patients continue to require a nurse.
    Otherwise which patient gets ignored? Whose pedal pulse fades? Who is found out of bed bleeding where their femoral arterial line or IABP came apart?
    Whose condition deteriorates because their nurse is responding to a code? THJEN who has to accept the post arrest patient in addition to a full assignment?
    If this is how it is at your hospital know that it is wrong.
    Look at the mission statement on your badge. Does your hospital live up to that? or staff to the budget?
    I am apalled thet a hospital would expect a nurse to simultaneously be responsible for patients in a critical care unit AND a patient in full arrest on another unit. That is physically impossible! It is wrong and it is

    We have had in our state regulations, "Two or fewer patients per licensed nurse at all times" for CCU, ICU, and all critical care units since 1976. It took us at our hospital 14 years to frist understand what that meant and then get management to staff so we could. Durimg those years telemetry units were created, taking all our low acuity patients.
    Management actually told us their interpretation was that as long as there was a nurse for every two patients when doing the staffing what happened after was an unforeseen emergency.
    WHAT! So we on 12 hour shifts would do staffing at five for 14 hours later at seven.
    Safe staffing twice a day like a broken clock? NOT SAFE!

    There could be a patient on tele scheduled for open heart or AAA surgery and we were not to staff for them. I have been in charge with five patients, the last being a code blue I responded to leaving my four critically ill patients. That was 1988. They were wrong.
    To be fair we had some ezcellent house supervisors who did staff for patients in the ER with plans to send them to us and for scheduled surgeries. On days our manager would always relieve nurses who had to go off the unit.

    NO MORE. At all times means at all times.
    Does my patient not need their drips titrated or ET tube suctioned while I respond to a code?
    We document on an ADO and protest whenever staffing is unsafe. I have told the supervisor unless there is an RN to relieve me for a meal or bring me something from the machine I will just drink a can of Ensure.

    We finally in 1990 reported our hospital to the Department of Health Services. They were cited for not staffing as required. No fine, they just had to write a plan of correction.
    We used that promise to staff legally signed by the DON to encourage the to keep their word. We discussed making flyers and handing them out on the sidewalk to visitors and doctors if they didn't keep their promise to the state.
    That discussion went into the minutes of the meeting that we send to the DON every month.

    Suddenly supervisors were told to staff as they should have been for fourteen years.
    YEA!
  9. Visit  Dinith88 profile page
    0
    Quote from spacenurse
    I will just drink a can of Ensure.!

    Yuck. Have you really done that ? :imbar

    I agree with you about all that patient safety stuff. I just cant see the difference in responding to a code (where you're off the unit-others watching your pt) or responding to RRT (where you're off the unit-others watching your pt). IN either case a patient has a substitute/babysitter while you're away. My gut feeling is that because nurses have for years (since inception of modern ICU's...(~60 yrs ago??)) responded to codes with no documented increase in pt mortatlity/complications (have there been any studies on this??), that administrators would suddenly become aware of a need for a deicated team. The idea of a dedicated CODE BLUE team is a good one...but again an unfortunately VERY RARE thing. The same thing with RRT's. I doubt we'll see the formation of dedicated RRT's on a wide sacel.
    I fully beleive this. Again...it's all about the $$$$
  10. Visit  pickledpepperRN profile page
    0
    I usually bring my food for the night I have when unable to leave the unit or a patient had a can of Ensure. The black cherry flavor is gritty. Better than working 12+ hours on coffee and H2O.

    Perhaps one of these evidence based studies will influence management somewhere. I have found that the threat of the truth made public is more influential. Kind of like the Linda Aiken study. Those who claimed to want staffing studies done didn't like that one at all.
    http://www.ahrq.gov/research/nursest...nursestaff.htm

    "Lower Staffing Levels Are Linked to Higher Adverse Outcome Rates"
    "Pneumonia Rates Are Especially Sensitive to Staffing Levels"

    Mortality May Be Associated with Staffing Levels - "Failure to rescue" is defined as the death of a patient with a life-threatening complication for which early identification by nurses and medical and nursing interventions can influence the risk of death.
    While inadequate staffing levels place heavy burdens on the nursing staff and adverse events are painful for patients, there is also a considerable financial cost to be considered
    "Hospitals that increase their nurse staffing ratios either across all units or within individual units have reason to be concerned about the impact of such steps on their finances. However, a new study finds that increased staffing of RNs does not significantly decrease a hospital's profit, even though it boosts the hospital's operating costs. A 1-percent increase in RN full-time equivalents increased operating expenses by about 0.25 percent but resulted in no statistically significant effect on profit margins. In contrast, higher levels of non-nurse staffing caused higher operating expenses as well as lower profits." - 21. McCue M, Mark BA, Harless DW. Nurse staffing, quality, and financial performance. J Health Care Finance 2003 Summer 29(4):54-76.

    Conclusion
    The largest of the studies discussed here found significant associations between lower levels of nurse staffing and higher rates of pneumonia, upper gastrointestinal bleeding, shock/cardiac arrest, urinary tract infections, and failure to rescue.6,7 Other studies found associations between lower staffing levels and pneumonia, lung collapse, falls, pressure ulcers, thrombosis after major surgery, pulmonary compromise after surgery, longer hospital stays, and 30-day mortality.
    http://www.ncbi.nlm.nih.gov/books/bv...a.section.9714

    See page 8 of this document - http://www.ics.ac.uk/downloads/clinS...iticalcare.pdf

    "Mortality increased when the nurseatient ratio increased, there was no full-time medical director for the ICU, fewer than 50% of the ICU attending physicians were certified in critical care, or there were no daily rounds by an ICU physician. (3(p1312)) Increased LOS was associated with not having a full-time medical director, a nurseatient ratio of more than 1:2 during the evening shift, not having monthly review of ICU mortality and morbidity, and routine extubation in the OR. Another researcher extended the previous study and found 33% more respiratory complications in ICUs with low-intensity nurse staffing and 78% more cardiac complications in ICUs with medium-versus high-intensity nurse staffing after controlling for patient and organizational characteristics." - http://www.findarticles.com/p/articl...1/ai_n13477156
  11. Visit  pickledpepperRN profile page
    0
    Yes, almost 60 years

    History of Critical Care Nursing
    Although very ill and severely injured patients have always existed, the concept of critical care is relatively modern. As advances have been made in medicine and technology, patient care has become much more complex. To provide appropriate care, nurses needed specialized knowledge and skills, and the care delivery mechanisms needed to evolve to support the patients' needs for continuous monitoring and treatment. The first intensive care units emerged in the 1950s as a means to provide care to very ill patients who needed one-to-one care from a nurse. It was from this environment that the specialty of critical care nursing emerged.
    http://www.aacn.org/AACN/mrkt.nsf/vw...g?opendocument


    Singapore Critical Care Nurses Chapter:
    http://www.sna.org.sg/cms/publish/printer_25.shtml

    History of AACN:
    http://www.aacn.org/AACN/mrkt.nsf/vw...N?opendocument
  12. Visit  Dinith88 profile page
    0
    Quote from spacenurse
    I usually bring my food for the night I have when unable to leave the unit or a patient had a can of Ensure. The black cherry flavor is gritty. Better than working 12+ hours on coffee and H2O.

    Perhaps one of these evidence based studies will influence management somewhere. I have found that the threat of the truth made public is more influential. Kind of like the Linda Aiken study. Those who claimed to want staffing studies done didn't like that one at all.
    http://www.ahrq.gov/research/nursest...nursestaff.htm

    "Lower Staffing Levels Are Linked to Higher Adverse Outcome Rates"
    "Pneumonia Rates Are Especially Sensitive to Staffing Levels"

    Mortality May Be Associated with Staffing Levels - "Failure to rescue" is defined as the death of a patient with a life-threatening complication for which early identification by nurses and medical and nursing interventions can influence the risk of death.
    While inadequate staffing levels place heavy burdens on the nursing staff and adverse events are painful for patients, there is also a considerable financial cost to be considered
    "Hospitals that increase their nurse staffing ratios either across all units or within individual units have reason to be concerned about the impact of such steps on their finances. However, a new study finds that increased staffing of RNs does not significantly decrease a hospital's profit, even though it boosts the hospital's operating costs. A 1-percent increase in RN full-time equivalents increased operating expenses by about 0.25 percent but resulted in no statistically significant effect on profit margins. In contrast, higher levels of non-nurse staffing caused higher operating expenses as well as lower profits." - 21. McCue M, Mark BA, Harless DW. Nurse staffing, quality, and financial performance. J Health Care Finance 2003 Summer 29(4):54-76.

    Conclusion
    The largest of the studies discussed here found significant associations between lower levels of nurse staffing and higher rates of pneumonia, upper gastrointestinal bleeding, shock/cardiac arrest, urinary tract infections, and failure to rescue.6,7 Other studies found associations between lower staffing levels and pneumonia, lung collapse, falls, pressure ulcers, thrombosis after major surgery, pulmonary compromise after surgery, longer hospital stays, and 30-day mortality.
    http://www.ncbi.nlm.nih.gov/books/bv...a.section.9714

    See page 8 of this document - http://www.ics.ac.uk/downloads/clinS...iticalcare.pdf

    "Mortality increased when the nurseatient ratio increased, there was no full-time medical director for the ICU, fewer than 50% of the ICU attending physicians were certified in critical care, or there were no daily rounds by an ICU physician. (3(p1312)) Increased LOS was associated with not having a full-time medical director, a nurseatient ratio of more than 1:2 during the evening shift, not having monthly review of ICU mortality and morbidity, and routine extubation in the OR. Another researcher extended the previous study and found 33% more respiratory complications in ICUs with low-intensity nurse staffing and 78% more cardiac complications in ICUs with medium-versus high-intensity nurse staffing after controlling for patient and organizational characteristics." - http://www.findarticles.com/p/articl...1/ai_n13477156
    Thats a nice array of studies. However, my question wasnt regarding staffing levels/ratios (i think that staffing ratios affecting pt mortality/outcomes is a no brainer thats been studied alot). I was curious if there'd been any studies that directly implicate ICU nurses reponding to Codes as a factor in increased patient mortality/complications. I dont think there has been...and i think it would be great if someone did. (any takers?? )
    Anyway, if you know of any studies that have, i'd be highly appreciative if you could point me in their direction!

    Cheers!
  13. Visit  pickledpepperRN profile page
    0
    Quote from Dinith88
    Thats a nice array of studies. However, my question wasnt regarding staffing levels/ratios (i think that staffing ratios affecting pt mortality/outcomes is a no brainer thats been studied alot). I was curious if there'd been any studies that directly implicate ICU nurses reponding to Codes as a factor in increased patient mortality/complications. I dont think there has been...and i think it would be great if someone did. (any takers?? )
    Anyway, if you know of any studies that have, i'd be highly appreciative if you could point me in their direction!

    Cheers!
    I don't know of any either.
    You're right. It would make an important study.
    My thinking is that since patients conditions can change so suddenly that would be likely to be missed by the nurse responsible for twice as many patients. Leading to 'failure to rescue' caused mortality.
    I don't think a retrospective study could be done unless some units keep excellent records of the timing of codes, who went, and what their assignment was.

    I remember once being asked to go to the ERto assist with an acute MI. I gave the supervisor report on my patients so they became hers.
    I was gone about 45 minutes. When I got back one patients BP was next to nothing, her A-line alarm ringing. I quickly checked her and asked this supervisor to go into my other patients room with the call light on.
    Patient #1 got her head lowered and Dopamine increased.
    Patient #2 was alert and angry in a wet bet. She was on a vent but able to write legibally and use the call light. Receiving Lasix caused her to need the bedpan often as I had reported to the supe.
    This woman was reading a tabloid paper as alarms and call lights sounded.
    Might as well not have had relief. (Clearly her skills were not current. She shouldn't have assumed responsibility for the patients)
    Patient #1 became septic and did not leave the hospital alive. Was it due to the extreme preventable untreated hypotension? I think it may be. Can't prove it.

    I think someone smarter than I am can construct the study you suggest.
    What a great idea!
  14. Visit  darienblythe79 profile page
    0
    Quote from Dinith88
    Thats a nice array of studies. However, my question wasnt regarding staffing levels/ratios (i think that staffing ratios affecting pt mortality/outcomes is a no brainer thats been studied alot). I was curious if there'd been any studies that directly implicate ICU nurses reponding to Codes as a factor in increased patient mortality/complications. I dont think there has been...and i think it would be great if someone did. (any takers?? )
    Anyway, if you know of any studies that have, i'd be highly appreciative if you could point me in their direction!

    Cheers!
    The RRT I belong to is piloting a research study looking at pt mortality/morbidity r/t response and utilization of this team. We have a dedicated code team already from the ER. ICU nurses do not repond to codes outside of the units. Your suggestion would be quite an undertaking, but you sound motivated to do something at least within your own facility. Good luck with that.


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