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Rapid Response Team and Families

Posted

Specializes in Critical Care. Has 34 years experience.

Our Rapid Response Team (RRT) is about one year old. It has been a success. The nurses on the med surg units have appreciated the assist.

Part of the JACHO requirements for the Rapid Response Team is to involve the pt/families, allowing them to call the RRT themselves. icon5.gif Has anyone started this aspect of the team function?

I don't want this to be a taddling on their nurse or underminding the pt's nurse. I want it to be part of the pt's orientation to the room/unit. Given positively and part of encouraging the pt's participation in their care. Ex: do your I.S. DB/C and call the RRT if you feel like you are in a crisis and your nurse hasn't been able to help. Talk with your nurse first.

We have the Joint Commission "Speak Up" posters everywhere and it would play into that theme.

Do you have a family handout?

Who receives the call from the pt/family? The team itself? A "screener" like the nursing supervisor - to screen out irritation calls? (no one is answering the call bell fast enough).

Dinith88

Specializes in CCU/CVU/ICU. Has 15 years experience.

Part of the JACHO requirements for the Rapid Response Team is to involve the pt/families, allowing them to call the RRT themselves. ).

Are you serious? Your hospital is allowing FAMILIES to call RRT? That's (for lack of a better term) stupid. S.T.U.P.I.D.

I almost didnt want to respond to this...and i hope you're not serious.

Dinith88

Specializes in CCU/CVU/ICU. Has 15 years experience.

whatever. call it a 'successful program'....i call it a well intentioned but misguided over-kill knee-jerk response to a tragic event.

i doubt this will ever take hold in the vast majority of hospitals...at least the ones that trust in their floor-nurses and are confident in their abilities.

...get the code team all lathered-up and sprinting to a room...just because a patient/family wants more narcotics...(for example). a waste of resources and time...

and s.t.u.p.i.d.

in my opinion.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

It is actually well-publicized in the area where I live. I am on staff at five hospitals and all of them have it and the patients love it. Most of the pts I see are in the ICU and even those families talk about it.

missionary

Specializes in cardiac, PAR. Has 10 years experience.

Being a nurse and also being a family member at times, I would think it would be great. I know while I am working, I can't be everywhere at once. And call lights do not elicit emergency help. Better the RRT than having them pull the Code light, right?

If family member err much, it may be that they don't ask for help soon enough -- d/t denial, fear, ignorance. And if they call prematurely and patient is stable, there's no harm done.

eamon66

Specializes in cariothoracic surgery. Has 16 years experience.

Are you serious? Your hospital is allowing FAMILIES to call RRT? That's (for lack of a better term) stupid. S.T.U.P.I.D.

I almost didnt want to respond to this...and i hope you're not serious.

Heh well said! Without undermining the patient, the reality of the situation is that patients often do have unfounded concerns. If you can't identify a potentially adverse situation or help to alleviate their concerns or liase directly with the RRT then maybe nursing isn't for you. The RRT must be getting called every 5 seconds which would be a waste of their time. I'm sorry but the initiative needs to be taken by the nurse NOT the patient/family. I didn't do 4 yrs training for nothing!

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

If you think that the families don't know what's going on, then you must work in a wonderful hospital with wonderful nurse/pt ratios. My grandson has been in the hospital (two different ones) in the last year. At the first (small) hospital,(he was 6 weeks old with RSV) the nurses giggled over him. Said how quiet he was, how little, etc.. I got there, realized he was pale and listless from hypoxia and asked for some oxygen! These nurses were clueless. They didn't want to put an IV in him "because he's so little." Four months later, he was in a large hospital with rotovirus. The nurses didn't want to come in because "he's in isolation."

The frustrations felt by family members is huge. It is important to remember they KNOW the patient better than us. It has nothing to do with being a good or bad nurse. It is the ability to be in all your rooms at the same time, seeing everything.

Dinith88

Specializes in CCU/CVU/ICU. Has 15 years experience.

Heh well said! Without undermining the patient, the reality of the situation is that patients often do have unfounded concerns. If you can't identify a potentially adverse situation or help to alleviate their concerns or liase directly with the RRT then maybe nursing isn't for you. The RRT must be getting called every 5 seconds which would be a waste of their time. I'm sorry but the initiative needs to be taken by the nurse NOT the patient/family. I didn't do 4 yrs training for nothing!

eamon66, Thank you for agreeing! (though i wager you'll soon be showered with cyber pies-in-the-face for agreeing with me)

I think the link provided was an interesting article in that it showed a system-wide (in that particular facility) mis-trust or lack-of-faith of the nursing-staff's judgement and/or ability. If a family has a serious concern they should approach the nurse...not have access to some 'panic button' that mobilizes a team of critical-care practicioners...which takes them a away from their patients...and.

It's a good (but misguided) idea. But for any hospital to assume that families are potentially better at assessing patients is ...well...stupid. Unless of course the nursing staff in these hospitals really IS really bad. ...ummm...

Being a nurse and also being a family member at times, I would think it would be great. I know while I am working, I can't be everywhere at once. And call lights do not elicit emergency help. Better the RRT than having them pull the Code light, right?

If family member err much, it may be that they don't ask for help soon enough -- d/t denial, fear, ignorance. And if they call prematurely and patient is stable, there's no harm done.

I know of too many times that if a family could have called the RRT in, code situations may have been avoided. On a personal note, a friend of mine (who is a nurse) was staying with his father in the hospital post cardiac bypass surgery. His dad wasn't acting right and complaining of abd. and flank pain. After being nice and notifying the nurse twice, and being told "It's OK, it's normal" nothing was done...anyway finally he had to get very verbal, threaten to call the attending himself (which he did) and found that his dad had a large retroperitoneal bleed. If a RRT was available, much anxiety and hassle would have been avoided. I shudder to think what would have happened if he hadn't stayed with his dad.

If you think that the families don't know what's going on, then you must work in a wonderful hospital with wonderful nurse/pt ratios. My grandson has been in the hospital (two different ones) in the last year. At the first (small) hospital,(he was 6 weeks old with RSV) the nurses giggled over him. Said how quiet he was, how little, etc.. I got there, realized he was pale and listless from hypoxia and asked for some oxygen! These nurses were clueless. They didn't want to put an IV in him "because he's so little." Four months later, he was in a large hospital with rotovirus. The nurses didn't want to come in because "he's in isolation."

The frustrations felt by family members is huge. It is important to remember they KNOW the patient better than us. It has nothing to do with being a good or bad nurse. It is the ability to be in all your rooms at the same time, seeing everything.

What you say is true. Then there is the idiot family who screamed "We need some help in here" and I was 8 months pregnant and fell on my stomach trying to get to a patient who needed a bedpan!!! One of the doctors I worked with was there (not this patients doc) and immediately went back and tore them a new one for doing that. Fortunately nothing happened with my daughter.

eamon66

Specializes in cariothoracic surgery. Has 16 years experience.

If you think that the families don't know what's going on, then you must work in a wonderful hospital with wonderful nurse/pt ratios. My grandson has been in the hospital (two different ones) in the last year. At the first (small) hospital,(he was 6 weeks old with RSV) the nurses giggled over him. Said how quiet he was, how little, etc.. I got there, realized he was pale and listless from hypoxia and asked for some oxygen! These nurses were clueless. They didn't want to put an IV in him "because he's so little." Four months later, he was in a large hospital with rotovirus. The nurses didn't want to come in because "he's in isolation."

The frustrations felt by family members is huge. It is important to remember they KNOW the patient better than us. It has nothing to do with being a good or bad nurse. It is the ability to be in all your rooms at the same time, seeing everything.

Listen really sorry abt your personal situation but the failing their is with your son's nurse. Still think that was an unbelievably ridiculous post & I stand by that. What gives patients/families the right to call the RRT? I'm lost on that! If wards feel they need to give pts/families the go ahead to contact the RRT then they shouldn't be nursing. Can't they assess their own patients and make decisions? sorry but this post makes my blood boil....I'm a realist....NOT a fantasist!

JaredCNA, CNA

Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.

At our hospital, RRT has "decreased the number of Code Blues by 70% in the past year." It sounds great to a patient or family member, but 9/10 rapid responses I've been in (aides take the roll of runner, do compressions) turned into cardiac arrest...there's just no need to call it overhead due to the fact that when you call a rapid response at my facility, you get two ICU RNs trained in ACLS, an RRT physician, Respiratory, and the house supervisor.

AKA, the code team. Well, we have standing orders that the nurses carry out without a physician present for rapid responses, but we still don't have to page code blue...if we have to shock the patient we just call ER and have them send a doc.

jbp0529

Specializes in CVICU, CCU, MICU, SICU, Transplant.

This is slightly off the direct subject of families calling the RRT, but I'll try to bring it full circle at the end.

Unfortunately for my hospital, the RRT program has gotten off to a rocky start (we have been doing it for > 1 year or so). Equally unfortunate is the all-too-common floor nurse who calls for silly things like starting IV's, drawing labs, giving neb treatments, even to sit at the tele desk while the tele tech takes a break lol. Or they call when a patient is horribly crashing, and noticeable cues of decompensation have been missed. Our floor nurses have also gotten in the habit of paging the RRT and then thinking its a way for them to pass off responsibility for their patient or to avoid dealing with a doctor.

Due to managements desire to keep the floor nurses happy and not have the floors stop calling all together, they have "encouraged" us to not refuse any call.

In closing, if this is the way the majority of the nurses at my place utilize the RRT, I cant help but imagine what would happen if families paged us as well. Unless of course better education than what was given to the floor staff was provided to family members regarding what/ what not to call for. This post is also by no means meant to degrade those who work the floor as a whole, it is just what happens at my job.

I utilize RRT at my hospital with good results...sometimes just to confer...you know, hey I got a pt with SIRS, and he looks like he's getting ready to go septic, do you agree? or this lady is going to go into pulmonary edema NOW if we don't do something.

But having other ppl call, could be a hassle for RRT. Like last week, had a respiratory therapist who almost called RRT for AMS in pt, RT didn't want to listen to the LVN who wasn't too terribly concerned, it became a big hoorah, RT swearing up and down pt is having a CVA, finally it took not one, not two, BUT 3, yep 3 RN's with the MAR and a drug book over 30 minutes to convince the RT it wasn't a CVA it was 30mg of temazepam. Later I found out RT knows pt outside of hospital. RT was going to go over all our heads and call RRT because the temazepam was working, and the pt was finally getting some much needed sleep. (and it was 30 mg of temazepam because the first 15 mg didn't work, so he got a second dose per MD order 2 hours later)

This is my nightmare when it comes to families calling the RRT.

perfectbluebuildings, BSN, RN

Specializes in Pediatrics.

If you think that the families don't know what's going on, then you must work in a wonderful hospital with wonderful nurse/pt ratios. My grandson has been in the hospital (two different ones) in the last year. At the first (small) hospital,(he was 6 weeks old with RSV) the nurses giggled over him. Said how quiet he was, how little, etc.. I got there, realized he was pale and listless from hypoxia and asked for some oxygen! These nurses were clueless. They didn't want to put an IV in him "because he's so little." Four months later, he was in a large hospital with rotovirus. The nurses didn't want to come in because "he's in isolation."

The frustrations felt by family members is huge. It is important to remember they KNOW the patient better than us. It has nothing to do with being a good or bad nurse. It is the ability to be in all your rooms at the same time, seeing everything.

Wow. I am a pediatric nurse and horrified by both those situations. I can't imagine us not putting an IV in a pt because he is so little!! that is a ridiculous explanation... what about NICU patients? Also, the rotavirus??? That is a very VERY common admission on peds floors at some times of the year, and it is hard for me to imagine a peds nurse that wouldn't be familiar with it and be able to come in, using proper isolation technique, and care properly for their patients. I am sorry your grandson had such terrible experiences, and hope there was some other more legitimate reasons for their behaviors than it sounds from this explanation. Maybe he did not need an IV (many of our RSV patients never have one), or the particular nurse was not a good sticker of tiny kids and wanted to find someone more skilled to start the IV.

Please understand that I am not trying to excuse incompetence, but figure things out, just because the actions (and inactions haha) you describe are so foreign and illogical to me from my own daily nursing practice and that of virtually every other nurse I work with. I hope you also had some good peds nurses while he was hospitalized!!

At our hospital the RRT is for the nurse to call if a pt is worsening acutely but not in a code-type situation. I have only done it once and it was very helpful. I have not witnessed or heard about abuse of it. (I think our hospital is lucky in the high caliber of most of the people they hire.) However they have not even talked about having families to have the ability to use the RRT. I see a lot of potential abuse for it in our patient population, possibly prevented by good patient/family education, but still a lot of potential for abuse. It's an interesting concept.

i work at lourdes hospital in paducah, ky and we have started to implement this. i work in the icu with limited visiting hours, so it wont be to bad on us. but i have floated out recently with low census and all the nurses on the other floors are not looking foward to this. when it is started ill let everyone know how it works out. but my guess is not good. cuz i could see familys using this for pain meds or more food for their family members instead of what it was really used for.

pebbles, BSN, RN

Specializes in Trauma acute surgery, surgical ICU, PACU. Has 17 years experience.

if an RRT is being used to appease families OR compensate for nurses on floors that missed noticeable cues the pt was deteriorating - I think that's a waste of resources and the hospital should focus on ongoing education, in real-time with nurses, and getting them to be better at noticing what's important vs what's not.

And the ones that are lazy and use an RRT when they can manage stuff themselves - should be spoken to by a manager.

If the system worked properly and everybody in floor nursing was on the ball, families wouldn't NEED to be calling the RRT themselves.

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