[cloister]

We have family initiated rapid response in my hospital. We call it Condition H, and the family receives a flyer on it when their loved one is admitted. There are also posters up in the rooms. In our case, the house supervisor takes the call and then goes up to find out what the deal is. Grandma hates her lunch? Call dietary and pt. relations. Grandma hates her nurse? Call the charge nurse and pt. realtions. Grandma's short of breath? Call Rapid Response.

So far, in the few months we've had the program, I think we've had one call. I was the lone curmudgeon at the hospital wide practice council who gave the idea a thumbs down, a fact that did not go unnoticed by the critical care director.

So far, it's been OK. They have admitted, however, that they have no plans to roll it out in our ER, where on any given night, 90+ people are waiting for treatment. That would be a nightmare!

[Grumpy's Girl]

Thanks for everyones thoughts.
We haven't started this part of the program yet but I think doing it like you are sounds logical. We are a 150 bed hospital, 8 bed ICU and the RRT ICU nurse has a patient assignment also. So having the supervisor check things out initially for a FAMILY call will help - with the pt's RN in tow. One look at the patient as she walks in the room will tell her whether to call the RRT. We would have the heads up and be expecting the call. If she was tied up then it would fall to RRT to go immediately. We and RT and pt's MD are called first by the RNs on the floor and the supervisors next. We need to work on our brochure, signs. Can you share yours?

[JaredCNA]

Out of curiosity, how is everyone else's RRT program set up?

Like mentioned earlier, only a member of the nursing staff can page the rapid response team. The family is encouraged to call for the nurse if the patient appears in distress, etc. So...the page goes out.

I'm quite surprised that apparently they have a 10-minute window to arrive, but I guess that's not too bad. Our team is comprised of the house supervisor, two ICU RN's, and a respiratory therapist. The RRT Physician is one of the ER docs but they hardly ever have to call him.

They have a HUGE protocol list they follow. We're talking atropine, lidocaine, bicarb, lasix, dig...the lists goes on. The orders are initiated based the ICU RN's assessment of the situation. It works pretty good. I've seen about 10 rapid responses before but the rrt physician was never paged any time I saw except for when they needed to cardiovert.

Most of them were successful that I saw in that the patient didn't even have to go to the unit.

[rnmi2004]

We use NPs for our rapid response. That is their only job. I can pretty much guarantee they'd quit if they had to start fielding calls from family members. Our floor staff are very good at calling the rapid response nurse if they have a patient with problems, so I don't see the need for family members to make that call.

[interleukin]

"But to take critical-care staff away from their critically-ill patients because grandma is constipated and being ignored is...well...STUPID."


I'm waiting for someone to realize that family-initiated RRT is another way that hospitals can further fragment nursing care and still have some sort of "monitoring" of patients. Nurses are becoming slowly inundated with more and more tasks and duties and are spending less and less time with patients.

This "family empowerment" simply helps hospitals fills those "gaps" when nursing can't monitor disease processes because they're filling out duplicate forms, answering phones, running after pharmacy for meds, etc., etc. etc. Why hire nurses or reduce tasks or ratios when we can have families "monitor" for changes. After all, they all watch E.R., aren't they as skilled as seasoned nurses?

Do you not see a fundamental problem here?

Just as important is the fact that no RRT should ever have a patient assignment. And any RN--with any courage--shouldrefuse to take RRT should he have a patient load.

Hoping that there will be no RRT calls so that one will not be called away is a fool's utopia. It is this type of perspective that keeps nurses and nursing down and prevents our getting the respect we truly deserve.

When we do voluntarily overburden ourselves, we are tacitly stating, "We nurses have always danced as fast as you tell us even though we know it is in direct contrary to what best practices dictate."

Are you patient advocates in theory or reality?

If your RRT's are always independent of patients...great. If not, never complain that you were pulled away from your patients, you fell behind, you missed your lunch, you felt alienated by your fellow workers were angry because they had to pick up your crashing patient which put them behind, yadda, yadda, yadda.

Some may argue that's just teamwork. I will argue that it is indicative
of a profession that is afraid to finally say, "Enough is enough!"

When you figure out how you can micro-manage nursing--when you can figure out exactly how and when a patient will act/react to a specific illness--please let me know. We'll both make a killing in the futures markets and we can sell a slew of fortune-telling franchises.

Until then...stand up for the patient and, more importantly, stand up to those who tell you to do what you know--and the research confirms--is not in your patients' best interests...nor yours.

[rgroyer1RNBSN]

Well my team had a family initiated call today. The patient was diophoretic, cp, sob...etc..etc, well the flor nurse told the pt. and family it was anxiety, so the pts. family called are rrt, being the supervisor I went down and checked it out first, well let me tell you it was not anxiety, this patient was having a true emergency, when I got there she was like exausted and almost half dead, well she had a hip replacement 2 days before, and Im glad the family called us she had a massive PE, she was transferred to my SICU immediately, we couldnt get the emboli with the cath lab it was to big, we ended up taking her down to OR for a ride sided thoracotomy, she also ended up with a pneumo. from the CVC. Im just glad we got there and I hope she pulls through.

[Dinith88]

Originally Posted by interleukin

[i]

[b][i]Hoping that there will be no RRT calls so that one will not be called away is a fool's utopia..

What???

A 'fools utopia' is one where the RRT doesnt have patients.

In the very lucky, very big, awesome level-1 trauma there may be resources allocated for staff (including doctors?) to be a designated RRT and not have patients.

However, in reality, 99.9% of hospitals dont have dedicated patient-free RRT's.

And...any hospital that lets family members call RRT's, DOES NOT trust the floor nurses' judgment. Period.

A critical-care nurse (or two)...a RT (or two)..and perhaps a doctor...who dont take patients and only respond to codes and RRT's??...THATS your fools utopia for the VAST majority of nurses/hospitals in the nation...(but i agree it would be nice. Just not reality.)

And if you think famlies are better at assessing patients than nurses...well, umm...the floor nurses at the very awesome level-1-trauma-best-in-the-nation hospital must suck. Or adminitration thinks so.

[sharrie]

There is some great information within this thread could I remind all members to please debate the topic and refrain from personal comments as it only serves to derail the thread.


Thanks

Sharrie

[interleukin]

"In the very lucky, very big, awesome level-1 trauma there may be resources allocated for staff (including doctors?) to be a designated RRT and not have patients.


I sense a bit of sarcasm in your reply.

While it may be "lucky" to have extra staff, the fundamentals are the same regardless of where one practices, how big or small the institution, whatever level.

If nurses are pulled away from their patients, for whatever reason, it opens the door for increased morbidity and mortality for those patients left behind.

You may argue that nurses are assigned to codes and they are pulled away when one is called. But code calls are far fewer that RRT calls and the nurse may be at the RRT call for a very long period of time only to be followed by another call. Sure it happens in codes, but we're talking odds here, not exceptions.

Take nurses away from their patients and it's another place that talks the talk, but doesn't walk the walk.

"However, in reality, 99.9% of hospitals dont have dedicated patient-free RRT's."

Perhaps those places need to reevaluate their budgets in light of the research.

[Dinith88]

Originally Posted by interleukin

"In the very lucky, very big, awesome level-1 trauma there may be resources allocated for staff (including doctors?) to be a designated RRT and not have patients.


I sense a bit of sarcasm in your reply.

.

Just a bit?

I agree with you. It would be nice to have dedicated RRT with no patients. NOw...if you can lobby for this and convince hospital administrators across the nation...

A pipe dream i'm afraid...

for most of us at least.