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- Aug 18, '05 by darienblythe79Quote from Dinith88they are dedicated by your definition. they just come from the er not icuI beleive there've been a few notable studies that suggest the RRT improves mortality/morbidity, etc. (first coming out of Australia??)...
Anyway, actually the study i would *like* to see done isnt so much another "does RRT improve pt outcomes" but rather a "do icu nurses responding to codes (or rrt, etc) adversely affect pt outcomes"-type study. I dont know if anything like that has ever been done.
By the way, do your dedicated code ER nurses take patients? If they do, then thats not exactly what i meant by 'dedicated'. I was meaning dedicated in a 'stand-by' type role.
- Aug 30, '05 by christianRNOur hospital has had a RRT for about 4 mos. The ICU charge nurse and an RT carry a beeper, and if a nurse from another unit wants "another set of eyes and ears," to check on a pt, she can call the RRT. Often times the RRT may think of something else (let's check her blood sugar, etc.) and it's not a big deal. Sometimes the RRT calls a code immediately after assessing the scene. Sometimes the RRT talks to the family and/or pt about DNR status.
The goal of the RRT is to prevent actual codes before they happen. Overall, I think our team has been very successful. We have some freedom as far as we can do an ABG, CXR, labs, give O2, or do an EKG, etc. before calling the doc.
- Sep 3, '05 by acquiesce1908Yes, 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.
- Nov 9, '05 by darienblythe79Just 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.
- Nov 9, '05 by dorimarMy 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.Last edit by dorimar on Nov 9, '05
- Nov 9, '05 by nursemaaQuote from dorimarThis 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.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.
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!
- Nov 9, '05 by darienblythe79You 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.
- Nov 9, '05 by dorimarThe 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.
- Dec 2, '05 by PhishininauRRT 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.
- Dec 2, '05 by elthiaI 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.