Quote from renee_rn9
My facility is reviewing our Rapid Assessment / Response Team warning signs. We have noticed here lately that the Rapid Assessment overhead call goes from the RAT to a Code Blue therefore we are reviewing our policy and educating the staff.
I wanted to see what are some of the parameters or early warning signs other facilities have in place for the patients that the staff can look for.
Also if anyone has any positive results which have worked for your facility please share.
Well I've been following this for a week hoping further discussion might ensue. I guess not, so I'll put my opinion out here anyway.
IMO this OP represents problematic thinking.
-These scenarios hopefully are being looked at carefully rather than presuming that a certain thing has happened (in this case, presumed failure to recognize apparent changes in condition).
>Obviously some arrest scenarios happen with little warning
>Sometimes people might call the wrong code then amend to the correct one (it wouldn't be a surprising finding in this setting, since RATs are generally more frequently called than full code/code blue)
-In scenarios where it is apparent that a change in condition could have been recognized earlier, then what is the reason that it wasn't?
>The number one reason would be lack of time for purposeful nursing surveillance/assessment/reassessment. This requires staffing ratios that account for patient acuity and that also account for all the other tasking and housekeeping and documentation and the numerous fiddly little things RNs are charged with accomplishing. As in, the kind of staffing required to take care of patients the way they should be taken care of. First and foremost. Including tech/NA staffing.
>Next up is knowledge and experience - that of the staff members involved in the incidents to which you refer, and
the ratios of experienced and novice or beginner nurses on the floor together at a given time. What is the orientation process like?
-What education has the staff received already regarding RRs/calling RATs?
>Are they being treated appropriately when they call one?
>Are they encouraged to quickly pursue concerns about patient condition?
>Are they allowed to be involved in the care of their patient or is this entirely taken over by the RAT?
>During orientation, do they attend RATs/codes? (If not, they should)
>Is anyone concerned about knowledge of the conditions for which staff frequently care? Is there ongoing education? Case study presentations? A venue through which staff can share experiences and knowledge? Anything like that?
>How is ongoing education/knowledge accrual for newer nurses (say 2-3 years or less) handled? What kind of opportunities do they have for education related to their daily work (not someone's fancy presentation, but rather how are staff supported in learning from their own day-to-day experiences?)
Bottom line - yes, there are numerous urgent and emergent conditions that we have become much better at recognizing earlier and treating more quickly. And there are some things, like ABC-related stuff that is basic knowledge everyone needs. Beyond that, recognizing changes in conditions is about understanding the conditions and knowing what to watch for...
...and my humble opinion is that there aren't always as many shortcuts to that as administrators would like.
Staff support and education
At this point (without more discussion/contemplation) I can't say that I would be in favor of "parameters" for calling RATs. They are supposed to be for any concern. If staff either aren't concerned or don't know to be concerned or don't have time to be concerned, you have big problems that parameters and protocols aren't going to fix - and they'll only create more problems/chaos.