Rapid response protocols

[ICUNurseG]

Does your hospital have any nurse-driven protocols for RRTs? Where I work were limited to ACLS protocol, but a physician is expected to show up. We are wanting to implement protocols to use in case a physician is late or doesn't show, especially for things like seizures, severe hypotension, etc. We respond to any calls in the hospital, including outpatient areas. Any input/thoughts are appreciated. Thanks!

[kool-aide, RN]

500 ml NS bolus for hypotension

10mg hydralazine IVP for HTN

Stat ct for stroke Sx

Stat 12 lead EKG, 325mg Asa, SL nitro, 2L O2 for chest pain

1-4L o2, venturi, nrb mask, ABG, stat CXR for resp distress

2-8mg ativan ivp for tonic clonic seizure

And bmp, cbc, t&s, PTT, ptinr for emergent labs

in addition to ACLS protocols.

Rapid response respiratory therapy also have a long list of protocols of their own

[ICUNurseG]

Thanks! Does a physician or advanced practice nurse respond as well?

[Nalon1 RN/EMT-P, BSN, RN]

500 ml NS bolus for hypotension

10mg hydralazine IVP for HTN

Stat ct for stroke Sx

Stat 12 lead EKG, 325mg Asa, SL nitro, 2L O2 for chest pain

1-4L o2, venturi, nrb mask, ABG, stat CXR for resp distress

2-8mg ativan ivp for tonic clonic seizure

And bmp, cbc, t&s, PTT, ptinr for emergent labs

in addition to ACLS protocols.

Rapid response respiratory therapy also have a long list of protocols of their own

Sounds similar to what ours is, as well as D-50 for hypoglycemia (I am sure yours is too).

We do have a Hospitalist that is supposed to show up, but if they are busy they have a phone that we can call to get additional orders if they can't make it for a bit.

[Esme12, ASN, BSN, RN]

Even though the protocols are nurse driven they are cleared through pharmacy/therapeutics and the medical staff. Usually the critical care director set up the protocols them make them policy

[RN_EMT]

I agree with ESme12, implementing the protocols is the fun stuff and you can knock yourself out wit response teams, meds, fluids, etc.... But they can't be put to use unless you find a medical director willing to sign off on them.

[RN_EMT]

We have a doctor, respiratory, x-Ray, house supervisor, one ER nurse, security, and one ICU nurse.

[achurupinti]

very helpful to me. thanks

[kool-aide, RN]

Thanks! Does a physician or advanced practice nurse respond as well?

No, just the rapid response nurse. The RR nurse determines the need to page the hospitalists.

[ICUNurseG]

Thanks! And that is the plan- we are going to do a lit review, find ideas, then bring them to a hospitalist for approval, since they are the ones who are supposed to respond.