Rapid response in the clinic

[Gamecock RN]

Does anyone have some sort of response team in a small clinic? Whenever we have code purples (i.e someone passes out during a blood draw) it seems like 50 people show up and it's chaos. I suggested a RRT but then all the "what if's" started. What if the RRT nurse is in patient care? What if the physician is at lunch?

Does anyone have a system that works? I was a RRT nurse for 5 years inpatient so I'm not used to the outpatient side of things.

[brownbook]

I'm no expert.... hopefully you don't have that many RRT incidents. Even in the hospital RRT do patient care and go to lunch. The few moments it should take to tell a patient you are needed for an emergency and a coworker will take over, and someone at lunch just has to finish their lunch later. Or if they leave the facility for lunch assign a coworker to cover for them.

[Nerdy RN]

I work in a busy Ambulatory Care clinic, and we have RRTs all the time. Typically, it is only one-to-two ER RNs and an RT. In our hospital, a RRT is meant to be a low key event: it is not advertised over the hospital intercom. The ER RN who shows up decides whether it should be a full-blown Code, or the patient should be transported to ER before it comes to that (which is always what happens). There are no MD who show up, or 100 Residents wanting to get their hands dirty. RRTs should be on the DL, until they need to be upgraded.

[tippeny]

We do have a RRT where I work but it doesn't seem at ALL efficient to me! They overhead page- sometimes code purple, sometimes Rapid Response, sometimes code BLUE!!- but the response time is very lagging. A crash cart is brought (just in case) even though most are patients who vagal from vaccinations or blood draws; an MD, nurse (RN or LPN) and anesthesiologist are on the team but they are coming from all different areas of the clinic; and our overhead paging system can't even be heard from all patient rooms (of the door is closed). It's a very nice idea, but just not executed well. In my opinion, in a facility full of doctors & nurses there is no real need for an RRT as we all are required to have BLS (many of us have ACLS as well) and we send everyone who really needs help out 911 anyway.

[offlabel]

On 2/9/2019 at 6:17 PM, Gamecock RN said:

Does anyone have some sort of response team in a small clinic? Whenever we have code purples (i.e someone passes out during a blood draw) it seems like 50 people show up and it's chaos. I suggested a RRT but then all the "what if's" started. What if the RRT nurse is in patient care? What if the physician is at lunch?

Does anyone have a system that works? I was a RRT nurse for 5 years inpatient so I'm not used to the outpatient side of things.

Why not just assist to the floor, elevate the legs and let the patient recover? An MD and RRT is needed for that? If it is a bona fide medical emergency then all hands on deck doesn't look pretty but it isn't the end of the world.

[xoemmylouox, ASN, RN]

We have different codes. We have the usual code "blue", but we have a specific code "white" for those times a patient passes out, has a vagal, etc.

We have a specific team that responds, and there are enough people on it that we are typically fine.

If someone is on lunch they still come, and we sort out time cards after. We have "go bags" which contain pens, documentation paperwork, b/p cuff, stethoscopes, accuchecks, and biox machines.

We have people from all over respond. Maintenance responds in case they need to direct an ambulance, our "green shirt/greeters" respond with a wheelchair in case it is needed, even admin shows up in case more support is needed. It isn't always perfect, but we often have the staff we need to address the issues as they arise.

[Lemon Bars]

I asked this same question not long ago. The nurse manager at the clinic explained to me that it was fine for employees to practice good teamwork and to operate informally as a sort of RRT, but that our clinic would not adopt an official RRT policy because if we have a policy it would be scrutinized and would be part of any inspections of our clinic. There would have to be an official record of who was on the RRT schedule for each day, etc. and we don't have enough staff at our small clinic for that sort of thing. I think my nurse manager was right; so long as there's at least one nurse who knows what to do and they recruit a couple of medical assistants to help when necessary, things seem to work out alright around here. We get few true emergencies anyway.

[lpn164]

We don't have any alert system in our office but as a whole we have different teams, I am not sure how each team operates however my team (2 LPN's, and 1 MD) have an established plan if needed. We currently will have one person preferably the MD stay with the patient in distress while one calls 911, 1 LPN gets the AED & oxygen upon returning I am on chest compressions if CPR is needed, MD is on bag mask, while other is helping with 911/AED/family members/minutes/ with a plan to rotate every 2 minutes of chest compressions until 911 arrives. I have mentioned in the past a practice scenario and suggested each team also plan and practice this to avoid chaos and delaying CPR, however my management has done little to follow up which is why my team developed the plan we have as for-mentioned.

[RN John]

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