Proactive Rounding and Family Initiated RRT

Pprwrk · May 22, 2016

I agree with the drain on resources. That's why I really want to know the first-hand failure and success stories with this approach. I know that it sounds like it could be false alarms and staff being pulled away unnecessarily.. but is that what ACTUALLY happens? As for the bedside RN being notified, the family/patient/visitor call would be promoted as something to initiate if issues were addressed with the nurse/MD

Pprwrk · May 22, 2016

How often IS it used?

Pprwrk · May 22, 2016

This is the 'problem' and where this, if rolled out, may have to be tailored to our resources... The ICU Charge sometimes has a patient assignment. If she doesn't, then she is responsible for charge duties and responding to codes and RRTS. If she DOES have an assignment, then the codes are assigned to another nurse, and the RRTs to yet another nurse. So, in this situation, the nurses have suggested NO physical rounding, but a phone call to each floor's charge. OR, maybe the program would simply be a follow up visit to patients recently admitted from the ER to the floors or to patients recently moved from the ICU to the floor...

Pprwrk · May 22, 2016

In a perfect world, the chain of command would be followed appropriately, and all problems addressed in a timely manner. If this is not happening, I think the rounding may help uncover this, hold people accountable, and provide opportunities for education eventually improving the system. And perhaps the rounding does not have to be a physical presence, rather a phone call to each unit's charge nurse. It's easy to get aggravated about how things 'should' be, but we must also look at how they really are, the latest evidence-based practices, and how to best incorporate them into our own facilities. The rounding is not my idea, and neither is the family initiated RRT call. We are just late to the party in initiating the programs. These are not new ideas. I have been a bedside nurse for 22 years and an ICU nurse for 18 years I am well aware of the taxing nature of the physical AND paperwork involved. Seeking feedback from other facilities, nurses, and physicians is way to identify what works and doesn't work. It can identify facilitators and barriers to the programs, along with thoughts, feelings and attitudes brought on by the very idea of the program to be compared with personal experiences by nurses who actually have the programs up and running in their facilities.

Pprwrk · May 22, 2016

And wow, THese were all comments as 'replies' to comments left by others, and yet they were all piled onto the end of the thread. This site is very glitchy.

calivianya, BSN, RN · May 22, 2016

My personal experience is that family members are more likely to call a rapid response if the patient doesn't get ice on time or if the nurse doesn't smile enough than if the patient is having an actual emergency. I have had family members hit the code button because the patient was hungry and they knew that would get people in the room, too. :sarcastic:

However, there have been a few times that family was on the money with the call. It is probably worth it for the rare occasions that the family members use it appropriately.

As far as proactive rounding... how many RRT people do you have on a shift at any given time? We have a primary and a secondary person, from different ICUs, but even with two there is no way to go up to all the units and just talk to the nurses. Some nights both RRT people are tied up all night long and don't even get a chance to take a lunch break.

RainMom · May 22, 2016

As far as rounding, the shift supervisor does that as they respond to any RR as well.

Just thought I'd clarify this. The RN supervisor does not physically round on the pts. Rather, he/she comes to the floor at least once each shift to check with the charge regarding any high risk pts that may be a concern. Most of them are former ICU RNs & can give a little insight/troubleshooting with the staff over a pt's condition. The supervisors pass the info along at their change of shift to follow-up if needed. They then have at least a rough idea of a pt's background (sometimes) if a situation does deteriorate to a RR or code.

KatieMI, BSN, MSN, RN · May 22, 2016

Family initiated rapid responce... please do not do it. Just PLEASE.

Families are not able to notice, understand and analyze the clinical situation, period. Not only they will call incessantly for water with no fresh ice and no "adult fun" available on tv, but there will be missed deteriorations with patient appearing to snooze peacefully.

I know there were couple of cases that appear to justify family-initiated rapid responce, but those were exclusions. If you do not want families running your unit as they see it fits, simply make sure that nurses react promply on alerts and educate family right upon admission about who is doing what here.

offlabel · May 22, 2016

This site is very glitchy.

Agreed... lot's of good examples of medical/nursing forums on the web.... this one has room to be way more user friendly

Boomer MS, RN · May 22, 2016

Family initiated rapid responce... please do not do it. Just PLEASE.
Families are not able to notice, understand and analyze the clinical situation, period. Not only they will call incessantly for water with no fresh ice and no "adult fun" available on tv, but there will be missed deteriorations with patient appearing to snooze peacefully.
I know there were couple of cases that appear to justify family-initiated rapid responce, but those were exclusions. If you do not want families running your unit as they see it fits, simply make sure that nurses react promply on alerts and educate family right upon admission about who is doing what here.

I agree with two previous comments. With inadequate staffing for bedside nurses, where is the additional staffing going to come from? And with hospitals cutting back, who will pay for the proactive team? The professional bedside nurse should be the one to make the call after hearing a family's concerns. I propose hiring more nurses at the bedside to improve patient care. Visitor initiated RRT calls? Not a good idea.

Pangea Reunited, ASN, RN · May 22, 2016

I heard a code blue for my patient once over the hospital intercom. It was terrifying and very confusing. Luckily, it was an accident and his family was only trying to turn off the light (English was not their first language).

I think I do a pretty good job at keeping up with what's going on with my patients. I do not want families of my patients calling rapid responses. I imagine it would cause "fatigue", as there would be so many false alarms that people would stop taking it seriously.

nutella, MSN, RN · May 22, 2016

I am looking into developing a proactive rounding aspect to our Rapid Response system. I am also looking into developing a process for patients and visitors to activate the rapid response team. The proactive rounding would have the ICU nurse/RRT nurse (we have no dedicated RRT nurse) round to each inpatient unit at least once per shift, to talk to the floor nurses and see if there are any concerns about patient conditions (not yet an RRT call, but may be heading that way) and help to address the concerns of the nurse, facilitate interventions for the patient, and get the patient on the ICU 'radar' (what this would entail as far as ICU physician follow-up or contact with the floors' medicine teams/surgeons, I do not know yet). What are YOUR experiences with proactive rounding and/or patient and visitor initiated RRT calls??

I have worked at a major teaching hospital that had implemented a "mandatory trigger" program in which the nurse was mandated to trigger the patient and call a rapid response. The criteria were based on HR,BP, RR, O2 sat, change in MS but there was also the possibility of family requesting a rapid response. The while idea is to prevent patient from coding because they had found that nurses were hesitant to call a rapid response despite clear signs of something not being ok. The mandatory action took away a lot of pressure as physicians were not longer able to say "I do not see a reason for this" and moved to "ok - lets look at this patient and make sure we do not miss something". It also brought the needed resources in case the patient was not well. Since it has been some while and have left the hospital I can not recall the exact triggers but it was something like HR below 50 and above 120 or RR below 8 and above something - you get the idea.

It was a very busy hospital with very sick patients on tele floors. Not all RR resulted in an admission to the ICU or step down - some were evaluated and some additional measure were put in place or monitored. But a fair amount was not doing well and had to go to a step down or ICU.

There were hardly ever any RR requests by family. It happened very very occasionally and in that cases everybody was responding to a value concern by a family member. It was never about food/ice/service but real concerns over mental status or uncontrolled pain.

I am not a big fan of proactive rounding as this will most likely result in too many concerns or patients on the "radar" and tie up resources that can be used otherwise. I find mandatory triggers the best idea.

I now work in a hospital with the traditional idea of a rapid response team - not mandatory - and it is often unclear why a nurse did not call a rapid response after the patient went down the drain.

I have seen the attending nurse in action in another teaching hospital and thought that it was a great model as well. The had an attending nurse for the critical care areas and perhaps they have rolled it out to other areas as well.

I am against having critical care nurses round on regular floor to discuss patients concerns. Non CC areas are very well capable of discussing concerning patients with their charge nurse or have their own attending nurse. I think that having somebody from CC round will be seen as controlling and also may result in supporting the wrong idea that floor nurses are "less" or not capable to make critical thinking decisions.

I think it is important to look at the system and what you want to achieve. Why is it not working out? What are the barriers?