Rapid Response Team and Families

[Grumpy's Girl]

Our Rapid Response Team (RRT) is about one year old. It has been a success. The nurses on the med surg units have appreciated the assist.

Part of the JACHO requirements for the Rapid Response Team is to involve the pt/families, allowing them to call the RRT themselves. Has anyone started this aspect of the team function?

I don't want this to be a taddling on their nurse or underminding the pt's nurse. I want it to be part of the pt's orientation to the room/unit. Given positively and part of encouraging the pt's participation in their care. Ex: do your I.S. DB/C and call the RRT if you feel like you are in a crisis and your nurse hasn't been able to help. Talk with your nurse first.

We have the Joint Commission "Speak Up" posters everywhere and it would play into that theme.

Do you have a family handout?

Who receives the call from the pt/family? The team itself? A "screener" like the nursing supervisor - to screen out irritation calls? (no one is answering the call bell fast enough).

[JaredCNA, CNA]

At our hospital, RRT has "decreased the number of Code Blues by 70% in the past year." It sounds great to a patient or family member, but 9/10 rapid responses I've been in (aides take the roll of runner, do compressions) turned into cardiac arrest...there's just no need to call it overhead due to the fact that when you call a rapid response at my facility, you get two ICU RNs trained in ACLS, an RRT physician, Respiratory, and the house supervisor.

AKA, the code team. Well, we have standing orders that the nurses carry out without a physician present for rapid responses, but we still don't have to page code blue...if we have to shock the patient we just call ER and have them send a doc.

[jbp0529]

This is slightly off the direct subject of families calling the RRT, but I'll try to bring it full circle at the end.

Unfortunately for my hospital, the RRT program has gotten off to a rocky start (we have been doing it for > 1 year or so). Equally unfortunate is the all-too-common floor nurse who calls for silly things like starting IV's, drawing labs, giving neb treatments, even to sit at the tele desk while the tele tech takes a break lol. Or they call when a patient is horribly crashing, and noticeable cues of decompensation have been missed. Our floor nurses have also gotten in the habit of paging the RRT and then thinking its a way for them to pass off responsibility for their patient or to avoid dealing with a doctor.

Due to managements desire to keep the floor nurses happy and not have the floors stop calling all together, they have "encouraged" us to not refuse any call.

In closing, if this is the way the majority of the nurses at my place utilize the RRT, I cant help but imagine what would happen if families paged us as well. Unless of course better education than what was given to the floor staff was provided to family members regarding what/ what not to call for. This post is also by no means meant to degrade those who work the floor as a whole, it is just what happens at my job.

[elthia]

I utilize RRT at my hospital with good results...sometimes just to confer...you know, hey I got a pt with SIRS, and he looks like he's getting ready to go septic, do you agree? or this lady is going to go into pulmonary edema NOW if we don't do something.

But having other ppl call, could be a hassle for RRT. Like last week, had a respiratory therapist who almost called RRT for AMS in pt, RT didn't want to listen to the LVN who wasn't too terribly concerned, it became a big hoorah, RT swearing up and down pt is having a CVA, finally it took not one, not two, BUT 3, yep 3 RN's with the MAR and a drug book over 30 minutes to convince the RT it wasn't a CVA it was 30mg of temazepam. Later I found out RT knows pt outside of hospital. RT was going to go over all our heads and call RRT because the temazepam was working, and the pt was finally getting some much needed sleep. (and it was 30 mg of temazepam because the first 15 mg didn't work, so he got a second dose per MD order 2 hours later)

This is my nightmare when it comes to families calling the RRT.

[perfectbluebuildings, BSN, RN]

If you think that the families don't know what's going on, then you must work in a wonderful hospital with wonderful nurse/pt ratios. My grandson has been in the hospital (two different ones) in the last year. At the first (small) hospital,(he was 6 weeks old with RSV) the nurses giggled over him. Said how quiet he was, how little, etc.. I got there, realized he was pale and listless from hypoxia and asked for some oxygen! These nurses were clueless. They didn't want to put an IV in him "because he's so little." Four months later, he was in a large hospital with rotovirus. The nurses didn't want to come in because "he's in isolation."

The frustrations felt by family members is huge. It is important to remember they KNOW the patient better than us. It has nothing to do with being a good or bad nurse. It is the ability to be in all your rooms at the same time, seeing everything.

Wow. I am a pediatric nurse and horrified by both those situations. I can't imagine us not putting an IV in a pt because he is so little!! that is a ridiculous explanation... what about NICU patients? Also, the rotavirus??? That is a very VERY common admission on peds floors at some times of the year, and it is hard for me to imagine a peds nurse that wouldn't be familiar with it and be able to come in, using proper isolation technique, and care properly for their patients. I am sorry your grandson had such terrible experiences, and hope there was some other more legitimate reasons for their behaviors than it sounds from this explanation. Maybe he did not need an IV (many of our RSV patients never have one), or the particular nurse was not a good sticker of tiny kids and wanted to find someone more skilled to start the IV.

Please understand that I am not trying to excuse incompetence, but figure things out, just because the actions (and inactions haha) you describe are so foreign and illogical to me from my own daily nursing practice and that of virtually every other nurse I work with. I hope you also had some good peds nurses while he was hospitalized!!

At our hospital the RRT is for the nurse to call if a pt is worsening acutely but not in a code-type situation. I have only done it once and it was very helpful. I have not witnessed or heard about abuse of it. (I think our hospital is lucky in the high caliber of most of the people they hire.) However they have not even talked about having families to have the ability to use the RRT. I see a lot of potential abuse for it in our patient population, possibly prevented by good patient/family education, but still a lot of potential for abuse. It's an interesting concept.

[bradleyshanetaylor]

i work at lourdes hospital in paducah, ky and we have started to implement this. i work in the icu with limited visiting hours, so it wont be to bad on us. but i have floated out recently with low census and all the nurses on the other floors are not looking foward to this. when it is started ill let everyone know how it works out. but my guess is not good. cuz i could see familys using this for pain meds or more food for their family members instead of what it was really used for.

[pebbles, BSN, RN]

if an RRT is being used to appease families OR compensate for nurses on floors that missed noticeable cues the pt was deteriorating - I think that's a waste of resources and the hospital should focus on ongoing education, in real-time with nurses, and getting them to be better at noticing what's important vs what's not.

And the ones that are lazy and use an RRT when they can manage stuff themselves - should be spoken to by a manager.

If the system worked properly and everybody in floor nursing was on the ball, families wouldn't NEED to be calling the RRT themselves.

[misschelei]

One of the hospitals I work for has a specific name called overhead for a family called RRT. I don't know if that's just an FYI to the responders or if it means walk slower (lol) but the whole thing is a little silly.

[Ahhphoey]

I've worked at three different hospitals in this area that have RRT and it is an asset. When it first came about, I was working on med-surg and felt it was a great resource to have other nurses with critical care experience check the patient in case I missed something and like another poster mentioned, it decreases codes outside of the ICU. Nurses, RT, or any other staff can initiate RRT; we've had techs in CT initiate it when outpatients have allergic reactions to the dye. The thing is, everyone was educated on RRT and why to call; it was not to be used for reason such as starting IVs or monitoring the tele monitors while someone is at lunch!

Another hospital in the area, though, is trialing a similar team that family and visitors can initiate. Only the nursing supervisor and charge nurse for the unit respond to those calls though as they are often not emergent. Thus far, that hospital reported very little abuse of the system, but then again they encourage families and patients to call for any problems. The phone number is on a sticker on the phone in the room and a brochure is given to each pt upon admission.

[scott_EMT]

It appears to me that having patients be able to access the RRT is an important fail safe(ideally by dispatching the floor sup. to make the actual decision). It is impossible for a a nurse burdened with so many patients on a floor to catch subtle signs in every patient every time they happen. This really is no different than family members/patients calling 911 from a nursing home, bypassing the staff. I have experienced these responses and normally they are non emergent and do not need an ALS ambulance, but sometimes the nurses do miss things and they really do need paramedic assessment and intervention. Much in the same way that things can be missed on the floor.

Preventing the abuse of such a system also shows great skill in the nurses ability to educate the patient and family. Really the healthcare team is not complete without the involvement of the patient and their family.

[Dinith88]

but sometimes the nurses do miss things and they really do need paramedic assessment and intervention. Much in the same way that things can be missed on the floor. QUOTE]

This is a silly statement. If a patient/resident of a nursing home needs a 'paramedic assessment' it's because the resident is down. not breathing. pulsless. etc. What a fantastically dumb notion that the emergency 911 system (ie tax-dollars) should be used like this. If a paramedic is needed for 'subtle' things, it would be a stupid misuse of all kinds of resources, funds, etc.

Paramedics need ONLY be called to the nursing home if a patient needs packaged and transported to a hospital. Period.

:angryfire

And i still stand by the opinion that families calling RRT is dumb and likely implemented by admistarative morons with no concept of critical-care or trust in their floor staff. I do think, though, that if specific units want to have a panic-button that summons the unit manager to rush in and kiss family butt that's fine.(which not be an actual RRT...) But to take critical-care staff away from their critically-ill patients because grandma is constipated and being ignored is...well...STUPID.

[lorilou22RN]

Yes we have an RRT team, and yes families can call an RRT! I believe that the system is GOOD, but family members? The patient ends up transfering to us in the unit, most of the time bogus, but the family wants some action. These typically are PIA family members and patients. What a waste of bed space.

[squirlkeeperCCRN]

I stopped doing resource when our facility implemented the RRT that families could summon. I think it is poor use of resources. I laugh when these patients are then transferred to the unit because they needed lasix and bipap...soon enough the same families are demanding to know why their family member can't eat or shower...you can't please everyone and I think administration sees this as a good pr move. I think staff calling an RRT is legit and a good idea...families, not so much.