Rapid Response Team - page 9

by Lukestar

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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    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
  2. 0
    Quote from ICURN10
    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
    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.
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    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.[/quote]
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    I practice at a "teaching" hospital and we had implemented a Rapid Assessment Team (RAT) approx 2 months ago. U.S. Hospitals have begun these RAT or RRTs in response to the Institute of Healthcare Improvement's (IHI) 100,000 Lives Saved Campaign aimed at saving 100,000 hospital patients lives in a 1.5 year period. They have grown from 50 in 2003 to ~1,400 in 2005. Our team consists of an attending, ICU nurse and respiratory therapist that are available 24/7. The floor nurse continues to follow the chain of command by calling the house staff initially but may call the RAT with acute changes in the patient. As floor nurses we don't mind extra eyes to help evaluate these patients in crisis. We continue to be an active member when the team arrives. I take no offense in someone telling me ways to help my patient. The goal is to prevent or limit hospital complications/resuscitation through early detection and resolution of the problem.The team is used for acute changes only that meet similar criteria as mentioned above. We have found that it seems to be under used in our facility. In a teaching facility we have always had access to an intern or resident and we continue to use them as first line even though the patient meets the criteria for a RAT eval. The general feeling is good however. The idea is fewer codes/mortality related to more timely intervention. It is used as a learning experience for all involved. A debriefing is done immediately after the RAT activation.
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    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!
    billythekid likes this.
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    I posted several comments on this earlier in the thread.

    I've now had a chance to be on the RRT team a few times. Mind you, I have my own pts in critical care, so being drawn away for a RRT takes time away from my pts.

    But, I've found it helpful. The protocol orders can indeed give more options to a situation. Even nurses from the floor that know what is going on and what interventions to take activate the RRT because those protocols include the standing orders to move the situation forward and maybe seek an outcome prior to a 'code' situation.

    I've helped to cut situations off at the pass and fix them before codes and sometimes, before requiring a move to critical care. I had feared that it would be nothing more than an 'expedite to critical care' team, but that isn't the case.

    The only problem is that I've found the average RRT intervention takes about an hour - and that is an hour with my critically ill pts being 'watched' by my co-workers. And there is a difference between my pts being actively monitored by me or just troubleshooted for problems by someone else busy with their own assignment.

    ~faith,
    Timothy.
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    Our hospital employs the RRT. We include TCU Charge RN brings defib and reads strips. ICU or CCU push drugs and assist md, respiratory therepist bags and abg's, and a pharmacist makes sure drugs are appropriate, plus house MD runs code with team assist. Lab draws all necessary labs ordered at bedside. It's nice at times since room is not overcrowded. And all input is advised. The RRT also responds to all code blues. It is a good idea to routinely have mock RRT calls and code blue calls so teams skills stay honed. I wish our hospital would do this. I'm relatively new and not sure what my place is. I usually write and run and read strips. Our RRT treats all RR calls as code blues because it can turn quickly.
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    This thread has been DC'ed for a while, but just wanted to share another use for RRT's I've heard.

    Some RN's I've spoken to say that when the provider isn't giving a patient's increasing acuity the attention it deserves (in their opinion) they can call the RRT which serves two functions:

    1) The patient gets immediate attention
    2) The provider develops a new and sudden interest, and is suddenly is willing to order or figure out labs and treatments they couldn't have been bothered with before

    Anyone else see this?
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    I'm am a full time RRT RN and yes, my presence does spark some new interest. If I'm here to see the pt something must be going on. Sometimes, when a staff nurse calls the doc, they request a rapid response assessment. In the event a doc is ignoring the situation, unwilling to transfer or unable to be reached, I will bypass them and get an IMCU or ICU consult myself. More often than not, my suggestions are well received and the pt gets where they need to be. Ivanna
    PMFB-RN and Cinquefoil like this.
  10. 1
    Quote from ivanna_nurse
    i'm am a full time rrt rn and yes, my presence does spark some new interest. if i'm here to see the pt something must be going on. sometimes, when a staff nurse calls the doc, they request a rapid response assessment. in the event a doc is ignoring the situation, unwilling to transfer or unable to be reached, i will bypass them and get an imcu or icu consult myself. more often than not, my suggestions are well received and the pt gets where they need to be. ivanna
    *** i too am a full time rrt rn. the staff rns love rrt. when a nurse's concernes are being blown off by the physicians they call me. sometimes i assess and am able to reasure the nurse that things are ok. sometimes my assessment indicated the nurse has real concerns and the patient isn't getting the attention they need fromt he physician. a call from the rrt rn certainly gets their attention.
    i once heard one of our im attendings tell a group of second year im residents who were about to start rotations as hospital cross cover on nights:
    "about the rrt, you guys are going to look like a**holes if you don't address a problem and the rrt rn transfers your patient to icu without orders. i suggest you take their suggestions seriously".
    Cinquefoil likes this.


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