protocol sharing among my fellow RRT RNs

nrsang97, BSN, RN · Sep 26, 2012

Our RRT triggers are as follows:

HR 130

RR 30

SPO2

Hypertensive SBP >180

Hypotensive SBP

Stroke symptoms/mental status changes

Chest pain

Respitory distress

Hard IV starts/ Blood draws (if needed)

Hypoglycemia

I also think the staff is to call if they have a CIWA pt that is escalating even though they have been following protocol.

Any staff member worried about patient even if they don't meet clinical trigger

I just started my RRT position 9/10 so I am fairly new to this. Our team is just coming together. We have one RRT RN, and house physician, and RT. I really like it. We do 24 hour ICU follow ups as well when someone is discharged to the floors.

thomnurse · Sep 27, 2012

Where I work we have had a rapid response team in place for over 5 years. It consist of the hospitalist MD covering the med surg floor, the nursing supervisor, the resp therapist and the charge nurse in the ICU. It has worked very well, and the floor nurses are grateful to have an alternative to calling a code blue. The experience I have had being a charge ICU nurse has varied, some patients have ended up being transffered to the ICU stat, other patients were just overly medicated/sedated. Each episode has been used as a teaching moment for all nurses and not as a challenge or a time when the nurses are looked down on. Every person on the team is there to help the patient and the nurse taking care of that patient.

PMFB-RN, RN · Sep 27, 2012

Each episode has been used as a teaching moment for all nurses and not as a challenge or a time when the nurses are looked down on. Every person on the team is there to help the patient and the nurse taking care of that patient.

*** This is so important! Make the staff RNs feel stupid and they won't call. We (very briefly) had an RRT nurse would do that. Make little comments like "OK I am here to fixed what you messed up" and "if you guys whern't so stupid I wouldn't have a job". Well she doesn't have a job, not with us anyway.

nrsang97, BSN, RN · Sep 28, 2012

*** This is so important! Make the staff RNs feel stupid and they won't call. We (very briefly) had an RRT nurse would do that. Make little comments like "OK I am here to fixed what you messed up" and "if you guys whern't so stupid I wouldn't have a job". Well she doesn't have a job, not with us anyway.

Wow.... I can't believe someone would say that. How terrible. I am new to RRT, and don't want anyone to feel like I think they are stupid. We are there to coach and teach.

armyicurn · Oct 5, 2012

Where I am currently stationed, we have the majority of the ones already posted.

One that I do not see here is: Staff concerns. We get plenty of calls under this one. I do not mind teaching the novice/unexperienced nurses but some of my colleagues get an attitude.

For IV starts, they are always calling us regardless if the facility just spent >15k dollars on 3 funny looking helmet devices that utilize near IR technology to visualize the veins. A pretty cool concept but I think it was money poorly spent.

PMFB-RN, RN · Oct 5, 2012

Where I am currently stationed, we have the majority of the ones already posted.
One that I do not see here is: Staff concerns. We get plenty of calls under this one. I do not mind teaching the novice/unexperienced nurses but some of my colleagues get an attitude.
For IV starts, they are always calling us regardless if the facility just spent >15k dollars on 3 funny looking helmet devices that utilize near IR technology to visualize the veins. A pretty cool concept but I think it was money poorly spent.

*** Our RRT RNs do get staff concern calls, and called to start difficult IVs and a hundred other things. However the clinical triggers are when they HAVE to call us by hospital policy, not a list of when they are allowed to call us. They can and do call use for a huge number of things. Last month I was called to the poly trauma unit cause one the the long term patients (a 21 year old male who has been there for 5 months) asked for set up help to masterbate. All he wanted was his nurse to put his video in and provide him with lotion, a towel and 30 min of privacy. Things he can't do himself. 2 of the 4 nurses working that night were outraged. The other two were like what's the big deal? The 4 of them were arguing about it and the solution was to call RRT!?

I talked to them, reminded them that this was perfectly normal sexual behavior for a 21 year old and that he LIVES here. Were he just in the hospital for a 2 or 3 days stay I would expect him to control himself but the poly trauma unit is his home for now. The young man got what he needed and a crisis was averted thanks to another timely intervention by RRT RNs:)

armyicurn · Oct 5, 2012

I'd side with you PMFB. Is not like they have to do it for him.

By the way, I like your avatar. Did you make it yourself? I need a copy of it but a bit bigger....

PMFB-RN, RN · Oct 5, 2012

I'd side with you PMFB. Is not like they have to do it for him.
By the way, I like your avatar. Did you make it yourself? I need a copy of it but a bit bigger....

*** Thanks but I can't take credit for it. When I was a medic serving with the infantry we wore that pach on our uniforms. We have one on the bulletin board of the RRT office.

nrsang97, BSN, RN · Oct 6, 2012

I was referred to see a pt by the unit clerk the other day. The nurse didn't call. We were rounding on the units and the clerk stopped us and said that the pt in room x had a bed in the stepdown unit due to elevated BP. We went and spoke to the nurse and she said the attending was on the unit, and her charge nurse talked her out of calling. The pt had BP 200/100, lethargic, difficult to arouse at times needing a sternal rub to awaken her. She went for a CT, don't know what it said. I did tell the nurse that if she felt the need to call even if the attending was on the floor then do so and not let her charge nurse talk her out of it. She met triggers to call.