RN John

I am pasting the protocol I put together for our urgent care clinic, we do not have different codes. feel free to use what I've put together if it helps you out at all. I typically will debrief those involved in the response after the incident to find out what went well and what could be improved, which has helped to identify weak points in our responses and in the way our office is set up. 5 PHASES OF RR Detection - accurately identify pt’s in distress or leading to distress. Activation - alert team members in a timely manner. Response/ Assess/ Stabilize - work together to gather information and react appropriately Disposition - recover pt or hand off to EMS Evaluation - review RR for positive and negative RAPID RESPONSE CRITERIA Loss of consciousness HR > 140, < 40 RR > 28/min, < 8/min SBP >180, < 90 02 < 90 Take a second look, is pt symptomatic? Machine error? Treat pt not machine. Change in mental status Stroke: BE FAST (balance, eyes, face, arm, speech, time) Seizure Chest pain Staff has significant concern about pt’s condition RAPID RESPONSE ROLES ACTIVATOR - can be anyone who recognizes a situation that meets RR criteria Qualifications: be alert Responsibilities: Alert a staff member or member of the RRT of situation needing Response. If a witness of pertinent events then remain available to give details to Lead. LEAD - walk in provider or RN Qualifications: ACLS/PALS certification Responsibilities: coordinate response, assess pt, request resources, delegate orders, SBAR handoff to EMS COMMUNICATION - MA/shift lead Qualifications: familiar with phone system, able to communicate with EMS/ER Responsibilities: activate EMS, identify pt, record vitals as dictated, make note of times, record RR activity on roomer RESPONDERS - 1 and 2 - RN or MA Qualifications: BLS certification Responsibilities: bring SBAR form, PPE, aed, crash cart, CPR, bvm as appropriate, RN to do initial assessment RUNNER - MA Qualifications: be familiar with medical supplies and locations Responsibilities: bring needed supplies as requested as directed by the lead responder. monitor roomer/walky talky

I'm not sure if this is a fluke as this is my first nursing job, but It is a privately owned urgent care/primary care. They've given me quite a bit of freedom to create my position how I see it.

The walk talkies were about $50-60 on Amazon and work well. I'm the only nurse at the clinic and have been able to create some of the protocols, its been a real blessing to have the freedom to have input and transform the way we do some things. Also our providers interact well with staff, I think better than most institutions. We only have 1 or 2 providers who would be uncomfortable running a response, in that case I try to talk through the response steps and assessments with them to help me keep my mind focused as well as theirs.

This is the Rapid Response Protocol I put together for our urgent care clinic in Northern Ca. It has been working well since implementation a year ago. We assign roles in the morning and hand out a walky talky to each member on the RRT (roles listed below). The walky talkies are only used for rapid response (no idle chit chat). When rapid response is activated Lead responder and responder 1 go to the scene to evaluate the situation. Lead responder delegates orders and is in charge of the response. Communication responder calls EMS or ER while in contact via walky talky to the responders. Front desk prints out registration sheet, med list, and triage sheet. responder 2 and runner are only activated when called on by Lead or responder 1. This has improved our response times and prevented the chaos that used to occur when someone would yell for help down the hall and evryone would come running. 5 PHASES OF RR 1.Detection - accurately identify pt’s in distress or leading to distress. 2.Activation - alert team members in a timely manner. 3.Response/ Assess/ Stabilize - work together to gather information and react appropriately 4.Disposition - recover pt or hand off to EMS 5.Evaluation - review RR for positive and negative RAPID RESPONSE CRITERIA Loss of consciousness HR > 140, < 40 RR > 28/min, < 8/min SBP >180, < 90 02 < 90 Take a second look, is pt symptomatic? Machine error? Treat pt not machine. Change in mental status Stroke: BE FAST (balance, eyes, face, arm, speech, time) Seizure Chest pain Staff has significant concern about pt’s condition RAPID RESPONSE ROLES ACTIVATOR - can be anyone who recognizes a situation that meets RR criteria Qualifications: be alert Responsibilities: Alert a staff member or member of the RRT of situation needing response. If a witness of pertinent events then remain available to give details to Lead. LEAD - walk in provider or RN Qualifications: ACLS/PALS certification Responsibilities: coordinate response, assess pt, request resources, delegate orders, SBAR handoff to EMS COMMUNICATION - MA/shift lead Qualifications: familiar with phone system, able to communicate with EMS/ER Responsibilities: activate EMS, identify pt, record vitals as dictated, make note of times, record RR activity on roomer RESPONDERS - 1 and 2 - RN or MA Qualifications: BLS certification Responsibilities: bring SBAR form, PPE, aed, crash cart, CPR, bvm as appropriate, RN to do initial assessment RUNNER - MA Qualifications: be familiar with medical supplies and locations Responsibilities: bring needed supplies as requested as directed by the lead responder. monitor roomer/walky talky

at our urgent care clinic in Northern California we have 4 providers doing appointments and 1 provider doing walk in's. Our response to emergent situations used to be that someone would yell down the hall and half the staff would come running. I was able to help put together a rapid response protocol for our office that works very well. We have 6 walky talkies given to specific staff with specific roles: Front desk, Walk in provider (leads the response), Nurse(responder 1 leads response in absence of provider), head MA(communicates with EMS or ER), and 2 other MA's (responder 2 and runner) as secondary responders. when an emergent situation occurs the rapid response is activated and nurse and walk in provider go to the location of the incident and assess the situation and call for backup if needed. This keeps the response professional and prevents a clog up of people standing around. It also communicates to the key staff who have walky talkies what is going on and equipment such as the crash cart or AED can be requested quickly and secondary responders can be activated as needed. One important part of the protocol is to debrief all of the staff after an incident to find out how things went, what went well, what could go better and make improvements to the plan at that point. This has transformed how we respond to emergent situations for good.

we have a system in our office with call buttons in each room (these can be purchased off amazon for a reasonable price) the buttons alert the nurse and lead MA in the lab of which room has an issue. We also have walky talkies given to designated responders throughout the day. If there is a situation such as a vaso-vagal, the nurse or lead MA is alerted and someone stays with the pt and assists them onto the bed or into a safe position if sitting. We elevate the pt's knees and direct them to take slow deep breaths while taking manual vitals and calming/re-assuring the patient that a vaso-vagal is common and should pass in a few moments. Typically the patients walk out under their own power after a few minutes to recover assuming stable vitals. We may get 1-2 vaso-vagals or near syncope with injections per month on the high side. We also get about the same amount of injection site pain/cramping reactions which are helped with Ice packs and massage and typically only last a few minutes.