rapid response team - page 2
I just took a new position at a new hospital doing rapid response team. I am looking for input from others where there is a dedicated rapid response nurse. What are your duties/responsibilities... Read More
Aug 6, '09This sounds like the job I have at the moment - called Critical Care Outreach. In England, Outreach teams have been running, mainly 24/7, for some years - my hospital is somewhat behind the times.
I'm a Band 6 Outreach Sister, with 7 years ICU experience. My team consists of 3 other Sisters and a specialist physiotherapist.
We work independently of the ICU. We see each patient discharged from ICU or HDU to the wards, usually for 3 daily visits. We also carry bleeps and see any patient who scores above a certain level on Modified Early Warning Scores - from the vital signs monitoring.
We include plenty of informal teaching and mentoring for nurses, doctors, students etc on the wards, but also set up formal teaching packages (for the wards and ICU). We also teach on the ALERT course, and one of our team is an Advanced Life Support Instructor. One of our most successful packages was on Sepsis, for the staff on the Medical Assessment Unit.
Every day is different, usually busy. In quiet moments there are always more educational packages to create / update, audits to complete, or we can go to the intensive care unit to offer our services - not to take a patient but maybe to assist with meal breaks, turns, etc.
It's a fantastic job, with variety and a lot of patient care. Can be frustrating at times when you can see that the best care isn't being given, usually due to staff shortages or incredibly busy wards - but then sometimes that's when we can make the most difference.
TulsaTime, hope this helps and the best of luck with your new position. You can find more information by searching for Critical Care Outreach, or check out the National Outreach Forum (NORF). Every NHS Trust will run their outreach slightly differently.
Aug 7, '09When we first started our rapid response program, it included proactive visits of patients discharged out of the ICU within the last 24 hours. It also included reactive visits-where any nurse could call us for a patient concern. They stopped the proactive visits because of the time involved adn because they no longer budgeted RR nurse out of the count. Now the RR nurse is in charge of a very large ICU or is in the count.
I think the proactive visits prevented a lot of problems. We would round on patients that were discharged from ICU withing the last 24 hours. We would look at the patient and assess if warranted. We reviewed labs, meds, etc. We made sure all restricted medications requiring ICU were off the MAR. We caught a lot of stuff. Sometimes patients were sent out of ICU with labs that should have been replaced. Sometimes we saw potential problems adn fixed them before they became real problems that might have resulted in transfer back to ICU or affected patient outcomes. I believe the proactive visits were almost more beneficial than the reactive visits (less reaction required when you are proactive). It is a shame that they sopped the proactive part
Aug 10, '09I would agree with Dorimar.
Our 'outreach' visits (proactive) are more of a priority than our 'MEWS' visits.
Aug 10, '09Thank you all for the feedback. I have been there 3 months now & we have grown the proactive portion similar to what many of you have suggested. We now get a LOT of "resource" calls also for help with admits, iv starts, or just to troubleshoot or be extra hands. We have also taken on a lot of quality review doing chart reviews and environment of care rounds, handwashing audits, and doing inservices & mock codes throughout the hospital. We have also all cross trained to house supervisor to provide that group a back up so we get in the middle of a lot of stuff and it is a LOT of fun!
Aug 12, '09Quote from Southern Fried RNOur RRT nurse does not take a pt assignment, and what we do is definitely NOT a waste of time. There are many things to do besides actual calls. For example, check on any patients transferred out of ICU within the last 24 hrs, this really helps because sometimes they need to go right back. We do a lot of education especially with newer nurses. We assist with STEMI patients in the ED and getting them to the cath lab. A stroke team is forming and I suspect we will be a part of that. Along with education, we help with basic skills such as a IV insertion or maybe a question about a chest tube. There are chart reviews and QA paperwork to be done on "down time." We make rounds on the floors and talk with the nurses about the more acute patients. Doctors who are not in house will ask us to check on a patient if they get a call from a floor nurse and need more info. We've even had a few family members call us to check on their loved one. Sometimes these don't fit into the technical criteria but it's another set of eyes and ears with ICU experience helping out with the patients.
No offense, but most of that sounds like things that other people are already assigned to do. Checking on patients on the floor that might need to go back? Are the floor nurses or step down nurses not competent enough to determine that and call the doc for orders? For new nurses they usually have a preceptor then a resource person in addition to the shift coordinator and the education department to do their education??? IV insertions and Chest Tubes? This is pretty basic stuff that anyone applying for a critical care position should be very familiar with. I absolutely can see ER transports and being another set of hands if needed. We have positions called Critical Care Cordinators that are different from actual unit coordinators. They take patients if we get in a bind, transport to and from CT and MRI if we are busy and watch patients for lunch and such, but I dont think they would have a job due to annoyed staff if they were doing some of the things you mentioned above. Maybe its just a difference in hospital environments???
Aug 13, '09Like I said in my original post, those things I described are what I do IN BETWEEN actual calls. Sometimes I am so busy I don't get a chance to do them. If you saw some of the things I have seen from doctors and nurses you wouldn't think it was a waste of time to check on certain patients or situations. Answering questions about a chest tube? No problem--since a floor nurse clamped a chest tube on a thoracotomy patient going down for CT which led to a bad outcome. My hospital really compartmentalizes medicine, ortho/neuro to one floor, CV surg here, post-cath there, gyn surg on that wing. It's because these doctors want things a certain way and want expert nurses for their patients. Which is great, until a total joint who goes into rapid a-fib on a tele floor and the nurse doesn't have a clue how to get the patient out of bed. That's where we come in to help. True, it doesn't fall under the definition of a rapid response and should be assignment to the floor educator. However, things happen on the weekend and at night when educators aren't there or even a decent resource person. TPTB decided to cut back the internships for new grads and the retention rate isn't so good for the preceptors. So my hospital environment needs people to fill that role in the meantime. My director doesn't want us taking a patient load or going on a field trip with an ICU pt or lunch reliefs because it takes away from that educator piece.