What critical vital signs would institute a rapid response

Nurses Safety

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I'm still a little foggy as to what would be a signal to cal a RR obviously if pt looks in distress but what critical sbp? Pulse, o2, rr.. Thanks!

Specializes in Emergency.
It's not just having a checklist of numbers, because if that's all you go on, when somebody asks you, "Didn't you think that when the BP dropped over six hours from 180 systolic to 104 systolic with no changes in medication that something had to be going on?" you won't have a better answer than, "Well, our BP for calling RRT is

I know that new grads in particular don't want to rock the boat, don't want to look dumb, and don't want to call RRT and get embarrassed. They are too close to the student clinical checklist mentality and not experienced enough to have good enough assessment skills to have good judgment yet. Always ask for a second opinion from a more experienced nurse if you see trends developing.

This this this.

When I used to work the floors, while I was looking information up before report started, I would always scroll back 24-36 hours and look at their vitals. I've managed to catch several patients starting to circle the drain, that no one else noticed. Simply by looking at their trends.

I agree with the above.

Look at the patient, look at the trends in the vital signs, not just the numbers.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Our hospital has hard numbers that must trigger an RRT by policy. However our nurses are also told "if you are worried about anything please feel free to call RRT".

The clinical triggers are only when a nurse must call RRT, not a list of when they are allowed to call RRT. They can (and do) call us for just about anything.

Our rapid response team is really just one nurse. Everybody knows we don't have a patient assignment and are almost always available to come and see a patient for just about any reason.

Besides experience and clinical skills we look for people who would never make nurses feel stupid for calling. When we are called for a silly reason we view it as a teachable moment, not an opportunity to belittle some new nurse.

The official triggers are:

BP systolic

HR 130

RR 25

SPO2 10 min on any amount of O2

Any change in O2 device

Visibly labored breathing or respiratory distress

New neurological change or deficit

Suspected CVA

New chest pain

Other:

Common reason we get called not listed include just about every thing. Uncontrolled pain, violent patients, help interpreting EKGs, help with a skill or procedure, we are the IV placer of last resort and have an ultra sound for placing very difficult IVs. In addition we on nights often get a call at the start of our shift by the day attending's who have a patient, or a couple of patients they want us to put on our "keep an eye" on" list. Less common reasons include the great masturbation debate on a rehab floor, on call physicians blowing off the staff nurse, and calls to remove ticks from new admissions. We have been called for just about everything you can imagine.

We also check on all ICU transfers every 4 hours for 24 hours.

Specializes in ICU.

yea you def cant go by the numbers, i work on a stroke unit where high bp's are good bp's... we call for sbp >220

Specializes in Pediatrics.

Most facilities have guidelines for calling a RRT based off of vital signs, but at least where I work we rarely follow them. For instance, I had a patient whose BP went from 130s systolic to 70s systolic at the next vital signs check. She was completely alert, asymptomatic, and everything else was normal. I'm not going to call a RRT for a completely stable patient, which is a huge waste of resources. I stat paged the physician, and heard back within 5 minutes (while remaining at the patient's bedside). If I wouldn't have heard back, I would have called the emergency in-house line to receive orders and have a physician examine the patient. THEN I would move on to a RRT if I still hadn't received some orders.

If a patient's spo2 went from 90s or so to 60s, I would be instantly calling a RRT. Although I can throw on a NRB and bring the sats back up, there is obviously a life-threatening acute change that will warrant an ICU transfer. With the above scenario, usually they will not if the BP can be stabilized with some pressors or IVF.

Critical thinking and experience will go a long way to calling a code or handling the situation without.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Most facilities have guidelines for calling a RRT based off of vital signs, but at least where I work we rarely follow them. For instance, I had a patient whose BP went from 130s systolic to 70s systolic at the next vital signs check. She was completely alert, asymptomatic, and everything else was normal. I'm not going to call a RRT for a completely stable patient, which is a huge waste of resources. I stat paged the physician, and heard back within 5 minutes (while remaining at the patient's bedside). If I wouldn't have heard back, I would have called the emergency in-house line to receive orders and have a physician examine the patient. THEN I would move on to a RRT if I still hadn't received some orders.

*** That situation is why my hospital went away from a part time, multidisciplinary RRT team to one full time RRT RN. Nurse were reluctant to call before when it means that a couple of ICU RNs where going to be pulled away from their patients and a team including a physician, RT and various others would arrive at the bedside.

Now we are the first and preferred call for the staff nurses. They know we have no patients assigned to us and are available very rapidly. It means we get a lot of false alarm calls, it also means that we rarely miss something.

Lots of our calls are not to "fix" the problem for the nurse, but rather to back her up while she deals with the situation herself.

Specializes in CICU.

My opinion is that if you are questioning whether or not to call the RRT, you need to go ahead and call. At worst, an inexperienced nurse gets an opportunity to learn something new (I've been there). At best, the patient rapidly receives a higher level of care.

I think there is a ton of room for education.

I really LIKE going to RRTs and codes. I am still fairly new to ICU, and learn a lot every time I respond. Plus, I have learned to look at and assess patients quite differently than I did "out on the floor". I would love to have (or even be, one day) a resource nurse that is free to float around - RRT, assistance with procedures, etc.

Specializes in Pedi.
Our hospital has hard numbers that must trigger an RRT by policy. However our nurses are also told "if you are worried about anything please feel free to call RRT".

The clinical triggers are only when a nurse must call RRT, not a list of when they are allowed to call RRT. They can (and do) call us for just about anything.

Our rapid response team is really just one nurse. Everybody knows we don't have a patient assignment and are almost always available to come and see a patient for just about any reason.

Besides experience and clinical skills we look for people who would never make nurses feel stupid for calling. When we are called for a silly reason we view it as a teachable moment, not an opportunity to belittle some new nurse.

The official triggers are:

BP systolic

HR 130

RR 25

SPO2 10 min on any amount of O2

Any change in O2 device

Visibly labored breathing or respiratory distress

New neurological change or deficit

Suspected CVA

New chest pain

Other:

Common reason we get called not listed include just about every thing. Uncontrolled pain, violent patients, help interpreting EKGs, help with a skill or procedure, we are the IV placer of last resort and have an ultra sound for placing very difficult IVs. In addition we on nights often get a call at the start of our shift by the day attending's who have a patient, or a couple of patients they want us to put on our "keep an eye" on" list. Less common reasons include the great masturbation debate on a rehab floor, on call physicians blowing off the staff nurse, and calls to remove ticks from new admissions. We have been called for just about everything you can imagine.

We also check on all ICU transfers every 4 hours for 24 hours.

Hard numbers would never work in pediatrics. 130 is a perfectly fine HR for an infant or toddler but by 80-90 they're bradycardic. 130 for a teenager, on the other hand, could indicate a problem where as 80-90 is normal. Cardiac babies can have baseline O2 sats in the 70s-80s (I have a patient right now whose goal O2 sat is 75-89% and they do NOT want him to go above 90) and be perfectly fine. (I was at PALS or something one time and they showed a video of a child with an O2 sat of 92% and the instructor actually said, "I know you're all thinking 'eh, I've seen worse' because this is a pediatric hospital".) I've seen kids desat to the 50s-60s during seizures and no rapid response was called. Actually the lowest O2 sat I've ever seen recorded on the monitor was 7%- the medical team felt that that couldn't possibly be real but this kid did end up intubated. Systolic BPs under 90 are expected in babies.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Hard numbers would never work in pediatrics. 130 is a perfectly fine HR for an infant or toddler but by 80-90 they're bradycardic. 130 for a teenager, on the other hand, could indicate a problem where as 80-90 is normal. Cardiac babies can have baseline O2 sats in the 70s-80s (I have a patient right now whose goal O2 sat is 75-89% and they do NOT want him to go above 90) and be perfectly fine. (I was at PALS or something one time and they showed a video of a child with an O2 sat of 92% and the instructor actually said, "I know you're all thinking 'eh, I've seen worse' because this is a pediatric hospital".) I've seen kids desat to the 50s-60s during seizures and no rapid response was called. Actually the lowest O2 sat I've ever seen recorded on the monitor was 7%- the medical team felt that that couldn't possibly be real but this kid did end up intubated. Systolic BPs under 90 are expected in babies.

*** Our peds and L&D have their own triggers that are differen than those used for adults. We respond to peds and L&D RRTs but so does a PICU RN (usually).

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I really LIKE going to RRTs and codes. I am still fairly new to ICU, and learn a lot every time I respond. Plus, I have learned to look at and assess patients quite differently than I did "out on the floor". I would love to have (or even be, one day) a resource nurse that is free to float around - RRT, assistance with procedures, etc.

*** It is SWEET!. While most hospitals do not have a full time RRT RN, I think we will see more and more of it. The data we are generating is very encouraging. I don't have them in front of me but we have cut ICU bounce backs by more than half, decreased the out-of-ICU codes by something like 75%. shortend ICU stays by half a day on average because our physicians are more willing to transfer them out sooner since they know we will be keeping an eye on them.

Our team more than pays for it's self.

Specializes in CICU.
*** It is SWEET!. While most hospitals do not have a full time RRT RN, I think we will see more and more of it. The data we are generating is very encouraging. I don't have them in front of me but we have cut ICU bounce backs by more than half, decreased the out-of-ICU codes by something like 75%. shortend ICU stays by half a day on average because our physicians are more willing to transfer them out sooner since they know we will be keeping an eye on them.

Our team more than pays for it's self.

Very interesting... Maybe I should do some research for school... and create a new job for myself :sarcastic:

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Very interesting... Maybe I should do some research for school... and create a new job for myself :sarcastic:

Good idea. You go girl!. I really do love this job. Even more than doing ground and air transport.

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