Rapid Response Team and Families

Specialties MICU

Published

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. icon5.gif 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).

Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.

I can't even imagine what it would be like if families could call RRT. How does this even make the least bit of sense?

It is a bad use of resources. Also, I can't see why a pt would be transferred to the unit just because a family paged the RRT. At least the way ours is set up, they have a protocol they follow. They don't admit to ICU just because RRT is called. The primary or RRT physician must write the transfer order.

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Guess I could go either way on this one, since IM on the code team and the RRT and Im a house supervisor, guess what you get the same members when you call either, and Im just waiting for an idiot call, thats what everyone on my RRT team calls it when we get some stupid jerk calling us to give his mother a bedpan, or roll her, or betteryet get him something to drink, but its good for the patients that need it we actually try to get them stabilized before they crash, its funny to my teams also the trauma team lol! So if you call us for something stupid the RRT physician just might be a trauma surgeon and he might just rip you a new one.

Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.
Guess I could go either way on this one, since IM on the code team and the RRT and Im a house supervisor, guess what you get the same members when you call either, and Im just waiting for an idiot call, thats what everyone on my RRT team calls it when we get some stupid jerk calling us to give his mother a bedpan, or roll her, or betteryet get him something to drink, but its good for the patients that need it we actually try to get them stabilized before they crash, its funny to my teams also the trauma team lol! So if you call us for something stupid the RRT physician just might be a trauma surgeon and he might just rip you a new one.

I can only imagine how livid he would be. :angryfire

Anyway, of note, in 2006 (no RRT) there were an average of 48 cardiac/respiratory arrests per month at my facility. In 2007 (after RRT) there were about 11 a month.

I'm very glad that the patient/family can't call the rapid response team. 99.9% of time I work with a very good crew and we can stop a pt from crashing without paging the RRT. The only people that can call a rapid response at my facility are nursing personnel. If the pt's family member notices an acute change they call the primary nurse who decides along with the charge nurse.

Specializes in Surgical Intensive Care.

I was curious about this. I was in a recent hospital meeting and they were talking about implementing an RRT where families could call them. We have had RRT for a couple of years now and it is excellent and I know that the floor nurses appreciate the extra eyes and ears, but I am wondering how it works when the family calls one. I am a little skeptical because I work in the ICU and have families all the time that are ULTRA NERVOUS and scared to death when their loved ones are moved to the floor. I am curious as to whether there is a problem with the "crying wolf" syndrome with the families. I know it is always better safe than sorry, and the families are with the pt more than the nurse, but how often do you see an RRT called for little/no reason?

Specializes in critical care.
I was curious about this. I was in a recent hospital meeting and they were talking about implementing an RRT where families could call them. We have had RRT for a couple of years now and it is excellent and I know that the floor nurses appreciate the extra eyes and ears, but I am wondering how it works when the family calls one. I am a little skeptical because I work in the ICU and have families all the time that are ULTRA NERVOUS and scared to death when their loved ones are moved to the floor. I am curious as to whether there is a problem with the "crying wolf" syndrome with the families. I know it is always better safe than sorry, and the families are with the pt more than the nurse, but how often do you see an RRT called for little/no reason?

lots of times. if the family really disagrees with the PA/CCP decision to keep them on the floor....well they come back to the us in the unit for some extra special care!!!??? they stay for 24 hours then are shipped back. it is a PIA.

Specializes in SICU/CT-SICU.

RRTs by familes? I think that's absurd. If you don't trust the floor nurses/MS on the floor where your loved one is staying TRANSFER to another hosptial. If the family thinks the floor nurse (and supporting team) are so weak that they can't recognize and emergency so blatant that the family can see it, that family and the patient should go elsewhere.

Specializes in Critical care, neuroscience, telemetry,.

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!:lol2:

Specializes in Critical Care.

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? :typing

Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.

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.

Specializes in private duty/home health, med/surg.

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.

Specializes in Mixed Level-1 ICU.

"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.

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

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.

+ Add a Comment