TulsaTime

Yes I am. I work at Hillcrest on the night shift. I also joined the FB group

I just have to point out that as a male, it doesn't matter what degree you have. You walk into many patients rooms and you are a doctor despite how many times you correct the patient that you are a NURSE. I can only imagine it will be worse when I finish my NP.

I am also staring the dual role program in January at USA. I'm also very nervous as I'm trying the full time option and still working full time. I just sent a request to join the FB page. I think that was a great idea!!!!

I work on a dedicated rapid response team. As we have grown we continue to try to find other facilities with a dedicated team to benchmark against for activities or ideas to increase the value of our RRT. We do not have patients and we work closely with the house supervisors. We currently round throughout the hospital and attempt to identify high risk patients, answer questions, assist with mock codes and education, assist with stroke alerts, In house STEMI alerts, follow up on patients transferred out of the ICU, and follow up on falls. I was hoping there might be others out there on a similar team to compare and also was wondering if any of you would be interested in sharing statistics (how many patients remain on the floor or are transferred to another level of care, what is the final disposition i.e. home, nursing home)? We have a new director and she wants to know how we compare to other programs but it's very difficult to find information to compare to.

The reason to use a central line for phenylephrine and many other drugs is related to the pH of the infusion. Yes, we have many biologically similar agents already running around in us but they are not in a solution that is acidic and can damage the tissues. Phenylephrine, for example, has a pH of 3.5-6 in solution. That's very acidic and will cause significant tissue damage if it extravasates. That being said, I have often run these agents in a pinch through a PIV until central access can be established. As someone else mentioned--dead patient or live patient with a chance of extravasation? I'll take the live patient every time.

I agree completely. If you're sick stay home! And if you have staffing issues (I work Rapid Response so there is only one of us) call early if you are even thinking you might not be there! We try to even call the day before sometimes so we can find coverage. Nobody wants to do our job!!

when i worked in a system with computer charting & no interface we still did our frequent vitals on paper charting because of the huge amount of time it took to put it all in the computer. we entered hourly into the computer but all our 15 minute vitals were on paper

It is correct the patient needs to be comatose and hemodynamically stable with or without pressors. There are a number of other factors (overdose, coagulopathy) that may make a patient unsuitable for the protocol. It should be initiated within 6 hours of return of spontaneous circulation although we occassionally stretch this out a bit on the premise that it won't do any harm. The cooling is often started prehospital by EMS if they are bringing in a postcode patient with chilled saline. We will start chilled saline or use gastric lavage (did lavage for the first time this weekend & it worked great!) and ice packs. We use the gaymar with the hypothermia wraps--2 full leg wraps & 1 chest wrap. These go completely around the patient & circulate chilled water continuously (basically a cooling blanket turned into a wrap). The patient is chilled to 32-34 C for 24 hours & then slowly rewarmed over 24 hours. They are kept sedated this entire time. It is important that you understand the purpose is to help preserve neurologic function IF the patient survives. Most post arrest patients do not survive to discharge, but the research shows if they do they have better neurological outcomes with the hypothermia protocol. In our hospital my team (Rapid Response) initiates and resources for all of the ICU's on this so I'm pretty well versed in it. We did 4 in the last week. Let me know if you have any other questions!

Another option if you are having that much trouble & need it emergently is I/O access. Our ER keeps an IO kit available and the ER docs will come up & help us out if needed. I've only had to do this once but it's soooooo good to know it's available when you need it!

This is an issue that comes up frequently in our hospital as well. I am attaching a link to an excellent article about DNR status. DNR does not and should not be inferred to a refusal of care of treatment!!! Every major group of care providers, including the ANA, have issued statements to this effect regarding DNR orders. The American Nurses Association’s position statement on DNR states: “There should be no implied or actual withdrawal of other types of care for patients with DNR orders.” http://www.annalsoflongtermcare.com/article/3421

If you're a member of AACN go to their site & search for effective communication. There is an excellent webcast there from nti 2008 that gives some ideas & tools to help make that phone call to the doctor a little less stressful. I thought it was interesting that they noted the number 1 anxiety producing event for new nurses was having to call the doctor!

Another option if your pumps will do it is to run your IVPB concurrent. We have the plum pumps & we can run 2 lines (the primary & piggyback) concurrently so you don't have to add another fluid, more pumps, etc to the mix.

You did the right thing. I know that calling a doctor in the middle of the night can be daunting. But think of it this way--if you didn't call & your patient coded because you left them sit & didn't call for orders--who do you think is going to be out of a job & potentially out of a license? Not the doctor--you never notified him. And that's not to mention how bad you'd feel about not doing the right thing for your patient. You are an advocate for that person who has put their very life in your hands. Think about that next time you are worried about waking a doctor up!

I agree with you 100%. I have an ICU and ER background having done both areas. I've been in the RRT role for just over a year now and LOVE it. We just can't figure out how to "measure" that part of the job prior to someone being hired in.

Our rapid response team in our hospital consists of a dedicated RRT nurse who does not take patients & a respiratory therapist. Our team has really grown in breadth of resource calls we get over the last year & we have been discussing how best to assess for new team members qualifications/skills for full time & relief staff (we have 1 RRT nurse in house at all times). I'm interested in finding out what other hospitals have done for requirements to do RRT, competency testing, and evaluation? We currently use the ICU competencies but don't feel they accurately reflect the skills required to do RRT. Example: You can handle your patient circling the drain in ICU where it's controlled but can you do the same on the floor where everyone is looking to you for direction?

I was wondering if it was Bedside Gas & Electrolytes like on an Istat? We can get results at the bedside in 2 minutes.

I am also an RRT nurse. In our hospital we have an adjoining office with the house supervisors & are all cross trained for house supervisor as well. We are all ICU RN's but as the basis of rapid response is to bring the ICU to the patient we spend most of our time on the floors rather than in the ICU's. We round to the floors several times throughout the shift, answer questions & help with procedures (we assist with all line placements on the floors), help with difficult IV starts, help with taking transfer calls if the house supervisor is backed up, etc. We also provide back up in the ICU's and ER if they are busy also. A good share of our pages are simply resource calls from nurses both on the floor & in the ICU's asking our advice or for help with something they are not familiar with. We also assist with chart reviews, ventilator bundle audits, and quailty review of all falls. Basically, we wear a lot of hats & it works great for our hospital. There is always a dedicated RRT nurse 24/7 who never takes a patient assignment.

I am a rapid response nurse & we have had a couple of issues recently with patients we were having difficulty in gaining vascular access either peripheral or through a central line during code situations. We of course gave drugs down the ETT. I am trying to work toward a protocol for the rapid response/code blue & IVT nurses to be allowed to place an I/O in hospital for critical situations such as these. While I can find a lot of research supporting I/O use including the current ACLS guidelines where it is listed as being preferred over ETT administration, I have not been able to locate any guides for protocols for in hospital placement. I am wondering if there is anyone out there where they do this? Protocols/competencies that you would be willing to share for us to use as a jumping off point? Or ideas where to look?

Thank you all for the feedback. I have been there 3 months now & we have grown the proactive portion similar to what many of you have suggested. We now get a LOT of "resource" calls also for help with admits, iv starts, or just to troubleshoot or be extra hands. We have also taken on a lot of quality review doing chart reviews and environment of care rounds, handwashing audits, and doing inservices & mock codes throughout the hospital. We have also all cross trained to house supervisor to provide that group a back up so we get in the middle of a lot of stuff and it is a LOT of fun!

this is the ICU report sheet I use. I don't know if it will help at all for getting a start to ideas for long term care but thought I would share it. St. John ICU Report.doc

That's what I did at the last hospital I worked at (took an assignment with RRT). But I am now at a hospital where we do NOT take an assignment. Rapid Response is a position all in its own. We are under the administration not the ICU so that we are more a housewide helper. I'm just kind of looking for ideas/suggestions what other hospitals have done to justify it being a dedicated position (right now we are helping with QA, mock codes, some education, stroke team, etc)

Here is my report sheet that I currently use when I'm in the ICU as well. I've had a number of people PM me and sent copies via email so here is a copy of the one I like! St. John ICU Report.doc

I just took a new position at a new hospital doing rapid response team. I am looking for input from others where there is a dedicated rapid response nurse. What are your duties/responsibilities when you are not on a RRT or code call? We have been discussing how to make this work as it's a new position & we are going to have to keep it justified that it is worth having us there as a dedicated position. Any input is greatly appreciated!

Our unit is room 17. We opened our unit in january and about 75% of the patients in that room have done very poorly. We actually DID have one of the sisters at our hospital do a cleansing but so far it still seems cursed!

This is a cross post but I want to hit everyone here so sorry. I am wondering about how you set up your rooms in regards to IV pump placement? We have a group that is being very vocal because is has been the past practice before we got our new unit with big rooms to put the vent under the monitor and the IV pumps on the opposite side of the bed. I argue that it is more appropriate to place them on the side where the line is so things are not running across the patient and it's easier to trace your lines. Plus you don't have to put in extension tubings for pressure lines that way. There's plenty of room so it's not an issure if pumps are on the same side as the vent now. What do your units do? Does anyone have any leads to any research or best practice links to support either practice? Thanks!