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.

Yes, my hospital has implemented a RRT about 3 or 4 months ago or so. I guess that it has been going o.k. It appears to be a "spin-off" of calling a code (just a easier way of stating it over the intercom). Most of the patients that need the RRT has coded, thus needing to be transferred to an ICU. So I really do not understand its true purpose. Supposedly this is what is called when a nurse (or any staff member) thinks that a pt "looks different" and you need the RRT to come access them. Like I said, on a Med-Surgical floor where patient-nurse ratios are higher, by the time a RRT is called... you probably needed to call a code blue instead.

Just looking for an update. Our team has just pulled in some data. From the same time last year compared to now, codes on the floor has dropped 40%! I just wanted to see if other hospitals were seeing similar changes.

Specializes in ICU, Education.

My hospital has been doing the Rapid response team for just over a year now with extremely postivie results. We actually have documeted decreased length of stay. Very diffiuclt to document any decreased mortality, but we are working on that data as well. Our rapid response program is strictly vouluntary and includes the ICU nurses(MS ICU or CVICU- it is rotated) we only do it from 1900-0730, as that is when mortality is highest in the hospital. We acutally have a rapid response nurse scheduled , & out of the count every night. We carry a cell phone, and all the units know the number. we round on every patient that was transferred out of ICU in the past 24 hours and review the chart, meds, labs, speak to the floor nurse and the patient and help address any problems or concerns. This is a Pro-active visit. We are also available to all the floor nurses for any crisis or any concern whatsoever about how their patient is doing. These are Re-active visits. The nurses can call us if they have a concern, are not sure about an assessment, or how to handle a situation ( patient is tachycardic , dyspnic, hypotensive chest pain etc...) The nurses are told they can call us with any true concern. Sometimes we can answer the question right over the phone and never go to the unit : ie Patient hasn't urninated .... we tell them to scan the bladder and call doc if no urine or if lots of urine and needs foley etc. Some calls are kind of silly and don't warrant a visit. Most calls are pertinent and we have offered much help. The floor nurses really appreciate our input. We are not to take over, just to give our input and help to trouble shoot. If the nurse needs more help, many times we can help them "get their ducks in a row" before calling physician. There are times when we have spoken to the physican oursevles if the nurse requests, or it is clear that the nurse cannot relay the proper info (these times we always include the floor charge as well) We DO NOT have standing orders yet, which has been my pet peeve. We are working on getting approval of them. I have acutally quit doing RR untill they are approved due to my fear of liability. When we started the program it was drilled in to us that we were not to do anything we didn't have an order for or was not included on any standing orders for THAT UNIT. Very difficult for an ICU nurse to see a post op patient tachycardic, hypotensive and oliguric and not get a stat H&H and give a fluid bolus without first getting an order. In fact I had an incident where i was begging the physician for the appropriate orders I wanted and could not get from him with a very poor outcome. The physician was brought up for review, but I will not place myself in that position again. I told my manger when they have the standing orders approved, I'll start doing it again.

the goal is to decrease mortality and decrease lenght of ICU stay and decrease re-admission to ICU. The emphasis has to be on decreasing mortality. YOur RRN cannot forget that sometimes the patient needs to get back to ICU pronto. The #1 goal of RRT is DECREASED MOTALITY. We have one nurse who does everything in her power not to get the patient to ICU. She thinks the first goal is to decrease unnecessarry admissions/transfers to ICU. She has overstepped the floor nurses on several occassions, and spoken to the physician and talked him out of ICU transfer. Some of those patients really needed to be in ICU and eventually ended up there anyway. Also the RRN should have good people skills as stupid as that sounds. This same nurse has be-littled, talked down to floor nurses, and taken over the situation on several occassions. These are the only negative inputs we have gotten from the floor nurses. With every other RRN, we've had very postiive feedback. Think the managers would get a clue about that one.

Also the floor nurses are told that we are not the house "IV nurse" or Swat nurse or the House Supervisor's toy or ticket out of staffing troubles ( we are not to be a road trip nurse when needed, and not to go in count when staffing is short) We need to be available rapidly. If you start a program, IT IS VERY IMPORTANT THAT THE SUPERVISORS KNOW THIS, AND THAT MANAGMENT WILL BACK THIS UP! When we first started our program, the administrative supervisor was constantly trying to pull us for monitored road trips to radilogy, iv starts, into the count, etc. , even though they were in all the meetings and told that this was NOT to happen. Our manger backed us whole heartedly (RRT was her pet project :] )

All in all, it is a wonderfull program. I am very proud to be a part of the beginnings of it and would highly recommend it to any hospital.

One last thing... Respiratory Therapy has a stat pager and we can call them if we need them for help. Resp manager has been included in meetings and input taken as well.

The nurses can call us if they have a concern, are not sure about an assessment, or how to handle a situation ( patient is tachycardic , dyspnic, hypotensive chest pain etc...) The nurses are told they can call us with any true concern.

This is also a wonderful way to teach and mentor novice nurses- by being able to call you when they are uncertain about what to do, perhaps the next time a similar situation pops up they'll remember what you advised and be able to take action without calling so soon.

Also helpful to any nurse (new or experienced) that just needs to toss an idea around, or explore solutions to problems BEFORE they become a crisis.

On off shifts, there is often a scarcity of very experienced nurses and I would think that a new grad would feel good about having someone to consult with.

I love the idea!

:rolleyes: You guys have a great set up, sounds very similar to ours. We don't use cell phones, though. We have pagers instead and respond as if it were a code. Yes, we get bogus calls, but most of the time they really need help. We are developing an order set and should be brought into action within a few weeks. Do you find having the phones allows you to respond better? It has been an idea to switch to them, but we don't have a lot of feedback on their usage in our role. Any thoughts would be most welcome.:rolleyes:
Specializes in ICU, Education.

The phones work great because it is immediate contact. We can start advising in rout or even call resp therapist or ICU charge in rout if truly sounds bad. Also, as I said, some calls don't even warrant a visit and can be handled over phone.

Specializes in Vascular/trauma/OB/peds anesthesia.

RRT at my hospital is much akin to a track team. "Run them to ICU as fast as possible." I told them they could save money by going to the local university and hiring the fastest two guys on track schoalrship and let them sprint the patient to ICU as fast as they can. Sometimes it seems that they dont even unplug the bed or IV pump...they just get a good running start and snatch it all out of the wall.

Seriously...our RRT is so flaky they bring patients to the unit without even calling the primary. They are more of a problem than a solution.

I think I would like having a RRT at my hospital...it won't happen though, the hospital has been in the news quite a bit lately over our staffing issues, they wouldn't pay for an RRT. But thinking back to the days when I had less than a years experience and was the the senior RN on an evening shift, it would have been nice to have an RRT to consult with, especially for the times when I KNEW something was wrong with the patient,but I couldn't put my finger on WHAT and sure as heck couldn't articulate exactly WHY I felt that way. Those times I called a different floor where a friend with years of experience would listen to my patient woes over the phone and advise.

HELLO RTT'S,

BECAUSE OF THE 100,000 LIVES CAMPAIGN OUR HOSPITAL DECIDED TO

START UP A RAPID RESPONSE TEAM ALSO. THE TEAM WILL CONSIST OF A DEDICATED ICU OR CICU RN.TH RN WILL HAVE A FEW ORDERS THAT CAN BE IMPLEMENTED IF NEEDED. WE WILL BE ABLE TO UTILIZE THE RESP. THERAPIST ON THE FLOOR WHO ORIGINATED THE CALL OR REQUEST ONE FROM THE "CORE" IF NEEDED.WE PLAN GO LIVE THE END OF JANUARY AND THERE IS SO MUCH TO DO AND ESTABLISH BEFORE THEN. ONE QUESTION HAS COME UP AS TO WHAT TO DO WITH THESE RN'S WHEN THERE IS NO CALLS AND THE PAPERWORK IS UP TO DATE.SOMEONE SUGGESTED TASKS THAT DO NOT SEEM APPROPRIATE AS THEY ARE TOO TIME CONSUMING AND ALSO WE DO NOT WANT TO BE VIEWED AS A FLOAT HELPER RN AS THIS IS NOT WHAT THE CONCEPT OF THE TEAM WAS.DOES ANYONE HAVE ESTABLISHED TASKS THAT NURSING SUPERVISOR CAN CALL THE RN FOR? ANY HELP WITH THIS WOULD BE GREATLY APPRICIATED. THANKS.ICURN10:confused:

HELLO RTT'S,

BECAUSE OF THE 100,000 LIVES CAMPAIGN OUR HOSPITAL DECIDED TO

START UP A RAPID RESPONSE TEAM ALSO. THE TEAM WILL CONSIST OF A DEDICATED ICU OR CICU RN.TH RN WILL HAVE A FEW ORDERS THAT CAN BE IMPLEMENTED IF NEEDED. WE WILL BE ABLE TO UTILIZE THE RESP. THERAPIST ON THE FLOOR WHO ORIGINATED THE CALL OR REQUEST ONE FROM THE "CORE" IF NEEDED.WE PLAN GO LIVE THE END OF JANUARY AND THERE IS SO MUCH TO DO AND ESTABLISH BEFORE THEN. ONE QUESTION HAS COME UP AS TO WHAT TO DO WITH THESE RN'S WHEN THERE IS NO CALLS AND THE PAPERWORK IS UP TO DATE.SOMEONE SUGGESTED TASKS THAT DO NOT SEEM APPROPRIATE AS THEY ARE TOO TIME CONSUMING AND ALSO WE DO NOT WANT TO BE VIEWED AS A FLOAT HELPER RN AS THIS IS NOT WHAT THE CONCEPT OF THE TEAM WAS.DOES ANYONE HAVE ESTABLISHED TASKS THAT NURSING SUPERVISOR CAN CALL THE RN FOR? ANY HELP WITH THIS WOULD BE GREATLY APPRICIATED. THANKS.ICURN10:confused:

My team follows up on patients that have been transferred out of the ICU in the past 24 hours, and we make rounds on each floor to make ourselves available to answer questions nurses might have but didn't want to activate the team. This was especially helpful when we first got started as it gave the floor nurses the opportunity to meet with us and get to know us a lot better. It really helped to develop a great rapport. It has been very clear from the beginning that we do not take over the patients and we are not transport nurses. That takes us away from our flexibility to respond to any call we may receive. Sometimes we have a bit of downtime, but generally we keep busy with calls and follow ups. Also. we are not required to respond to codes, but I usually do unless I am busy with another patient. It is always helpful to have an ICU-trained nurse helping out with a code on the floor. We still have a bit of trouble with the supers calling us to transfer patients, but not nearly so much. Stay firm on what you need for your team to succeed, and your results will help you keep that respect.

HELLO AGAIN RRTS,

THE YOUR RESPONSES TO MY QUERY HAVE BEEN VERY HELPFUL AND INFORMATIVE.I HAVE ALREADY E-MAILED THE HEAD OF OUR TEAM WITH WHAT NOT TO DO'S FROM YOU GUYS. THANKS SO MUCH.I ALSO PLAN ON TAKING IN YOUR RESPONSES AND SHOWING THEM TO HER AS SOME OF THE INFO REALLY NEEDS TO BE IMPLEMENTED IN WRITTEN FORM.THE IDEA OF SHOWING UP ON THE FLOORS EACH DAY TO ANSWER QUESTIONS AND DEVELOP A RAPPORT WITH THE FLOOR NURSES IS SOMETHING THAT SHOULD HAPPEN. I HOPE THEY LISTEN TO THIS AND SEE THE VALUE OF IT. I WILL KEEP YOU POSTED AS TO OUR PROGRESS. MORE THAN ONCE I HAVE FELT LIKE THIS PROGRAM IS A LITTLE SHAKY AND I WANT TO RUN FROM IT.THE CONCEPT IS BRILLIANT. I WAS MORE CONCERNED ABOUT A LACK OF ADMINISTRATIVE SUPPORT. THANKS TO ALL. MICHELE.

te=darienblythe79]My team follows up on patients that have been transferred out of the ICU in the past 24 hours, and we make rounds on each floor to make ourselves available to answer questions nurses might have but didn't want to activate the team. This was especially helpful when we first got started as it gave the floor nurses the opportunity to meet with us and get to know us a lot better. It really helped to develop a great rapport. It has been very clear from the beginning that we do not take over the patients and we are not transport nurses. That takes us away from our flexibility to respond to any call we may receive. Sometimes we have a bit of downtime, but generally we keep busy with calls and follow ups. Also. we are not required to respond to codes, but I usually do unless I am busy with another patient. It is always helpful to have an ICU-trained nurse helping out with a code on the floor. We still have a bit of trouble with the supers calling us to transfer patients, but not nearly so much. Stay firm on what you need for your team to succeed, and your results will help you keep that respect.

I am a nurse manager on a cardiac telemetry floor. My hospital implemented a RRT about 6 months ago. I was kind of hesitant about the program, I feel that my nurse;s skills are pretty up to par and didn't want ICU nurses "swooping in and taking over" so to speak. However, I have utilized the RRT on a few occasions and found it very helpful. First of all, we on the floor don't have the authority to automatically order a chest xray or ABG's, etc. without a Dr.'s order. If the Dr. is ignoring calls, this is a great alternative to get something done in a hurry! For example, the other night we had a patient with decreased LOC and a history of COPD. Sats were falling into the low 80's, extremely labored breathing, wheezing, high anxiety levels. The nurse caring for this patient and I both knew she was "swirling the drain" so to speak, and she was still a full code. The Dr. just told us to support her with more oxygen - which we felt was just raising her CO2 levels, probably. He didn't want ABG's and didn't want to deal with it. I called the RRT. Her CO2 level was 98! We had her to the unit on BiPAP, THEN called the Dr. and informed him. It was great! The nurses were very attentive to our input, and I felt like we all worked together to get done what was best for the patient. My night shift has called the RRT several times - with our staffing problems, night nurses sometimes have 10 cardiac telemetry patients. If one starts going bad, they don't have time to spend all night working on that one patient. It is a good way to get some extra hands in the room before the patient gets more critical or ends up in a code situation. In my opinion, properly implemented, the RRT is a great program!

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