Rapid Assessment / Response Team warning signs

JKL33 · Sep 22, 2018

Don't forget to examine time for nursing surveillance as you are looking for ways to improve staff recognition of changes in condition.

Tweety, BSN, RN · Sep 26, 2018

We have case reviews on patients that go to the unit or who die and we carefully examine what might have been done earlier. If it's a really bad outcome that might have been prevented the floor staff are mandated to attend.

Sepsis has been out big thing. We are trained and trained again on the warning signs and try to nip it early.

I'm not sure we have parameters on when to call one though, so that's an interesting idea. Staff should be empowered and encouraged to call a Rapid Response.

JKL33 · Oct 1, 2018

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.
Thanks!

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.

Staffing

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.

Wuzzie · Oct 1, 2018

I can tell you one of the biggest barriers I've experienced is the emergency response team treating the staff calling the RATs like idiots if they don't think patient condition warranted the call resulting in the staff being reluctant to call for help in the future. This has happened in every facility I have worked in. It has nothing to do with "sterile communication". We all have are big-girl panties on but when the responding staff challenges your reasoning for calling IN FRONT of the patient it leaves a really sour taste in your mouth and makes you question your judgment. I have been talked down to on more than one occasion and frankly I find it a bit galling. Especially since my background far surpasses the experience of the responding team members (FTR a fact that I choose not to throw around). Yes I now work in a clinic but I'm not an idiot or less of a nurse and I deserve to be treated respectfully. Some of our younger nurses are actually afraid to call for help. Fortunately our manager has witnessed it and it is being addressed but I wish I could say this was an isolated incident.

psu_213, BSN, RN · Oct 1, 2018

I can tell you one of the biggest barriers I've experienced is the emergency response team treating the staff calling the RATs like idiots if they don't think patient condition warranted the call resulting in the staff being reluctant to call for help in the future.

I have seen nurses who ask colleagues "do you think I should call a RR for this patient?" It is often followed by "I don't want them to think that I am an idiot for calling it when the patient really doesn't need it."

I can't remember a time when a member of the RRT confronted a nurse in a public place about the appropriateness of the rapid response. However, what I have seen with some regularity might be worse. It is a member of the team (for some reason, it seems like it is often a respiratory therapist, but that is just my observation) who says just loud enough for people to hear, "she called us all over here for this," as if the RRT shouldn't be called until the patient is dead (or really close to it). When looking at RRTs, it needs to be asked, "should the RRT have been called earlier?" If so, "why was it not called?" There needs to be assurances to the nurse who did not call the RRT that responses are for educational/research purposes and not so that nurse can be thrown under the bus.

Wuzzie · Oct 1, 2018

I have seen nurses who ask colleagues "do you think I should call a RR for this patient?" It is often followed by "I don't want them to think that I am an idiot for calling it when the patient really doesn't need it."
I can't remember a time when a member of the RRT confronted a nurse in a public place about the appropriateness of the rapid response. However, what I have seen with some regularity might be worse. It is a member of the team (for some reason, it seems like it is often a respiratory therapist, but that is just my observation) who says just loud enough for people to hear, "she called us all over here for this," as if the RRT shouldn't be called until the patient is dead (or really close to it). When looking at RRTs, it needs to be asked, "should the RRT have been called earlier?" If so, "why was it not called?" There needs to be assurances to the nurse who did not call the RRT that responses are for educational/research purposes and not so that nurse can be thrown under the bus.

That's exactly what we get too. We once called an RRT on a family member who was having chest pain and had a history of MI. She looked like dookie. She had nitro on her and I encouraged her to take it after ensuring that it was a current prescription. The team that responded said, in front of the patient, "you should have called a 'visitor assist' not an RRT". I asked them who would have responded and she said "we would". I just rolled my eyes. The visitor said "if you don't want to take care of me I can get my husband to take me to the ER". How pathetic is that.