Jump to content

Rapid Response Team and Families

Posted

Specializes in Critical Care. Has 34 years experience.

You are reading page 2 of Rapid Response Team and Families. If you want to start from the beginning Go to First Page.

misschelei

Specializes in Picu, ICU, Burn. Has 8 years experience.

One of the hospitals I work for has a specific name called overhead for a family called RRT. I don't know if that's just an FYI to the responders or if it means walk slower (lol) but the whole thing is a little silly.

Ahhphoey

Specializes in ICU, M/S,Nurse Supervisor, CNS. Has 16 years experience.

I've worked at three different hospitals in this area that have RRT and it is an asset. When it first came about, I was working on med-surg and felt it was a great resource to have other nurses with critical care experience check the patient in case I missed something and like another poster mentioned, it decreases codes outside of the ICU. Nurses, RT, or any other staff can initiate RRT; we've had techs in CT initiate it when outpatients have allergic reactions to the dye. The thing is, everyone was educated on RRT and why to call; it was not to be used for reason such as starting IVs or monitoring the tele monitors while someone is at lunch!

Another hospital in the area, though, is trialing a similar team that family and visitors can initiate. Only the nursing supervisor and charge nurse for the unit respond to those calls though as they are often not emergent. Thus far, that hospital reported very little abuse of the system, but then again they encourage families and patients to call for any problems. The phone number is on a sticker on the phone in the room and a brochure is given to each pt upon admission.

It appears to me that having patients be able to access the RRT is an important fail safe(ideally by dispatching the floor sup. to make the actual decision). It is impossible for a a nurse burdened with so many patients on a floor to catch subtle signs in every patient every time they happen. This really is no different than family members/patients calling 911 from a nursing home, bypassing the staff. I have experienced these responses and normally they are non emergent and do not need an ALS ambulance, but sometimes the nurses do miss things and they really do need paramedic assessment and intervention. Much in the same way that things can be missed on the floor.

Preventing the abuse of such a system also shows great skill in the nurses ability to educate the patient and family. Really the healthcare team is not complete without the involvement of the patient and their family.

Dinith88

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

but sometimes the nurses do miss things and they really do need paramedic assessment and intervention. Much in the same way that things can be missed on the floor. QUOTE]

This is a silly statement. If a patient/resident of a nursing home needs a 'paramedic assessment' it's because the resident is down. not breathing. pulsless. etc. What a fantastically dumb notion that the emergency 911 system (ie tax-dollars) should be used like this. If a paramedic is needed for 'subtle' things, it would be a stupid misuse of all kinds of resources, funds, etc.

Paramedics need ONLY be called to the nursing home if a patient needs packaged and transported to a hospital. Period.

:angryfire

And i still stand by the opinion that families calling RRT is dumb and likely implemented by admistarative morons with no concept of critical-care or trust in their floor staff. I do think, though, that if specific units want to have a panic-button that summons the unit manager to rush in and kiss family butt that's fine.(which not be an actual RRT...) But to take critical-care staff away from their critically-ill patients because grandma is constipated and being ignored is...well...STUPID.

lorilou22RN

Specializes in critical care. Has 11 years experience.

Yes we have an RRT team, and yes families can call an RRT! I believe that the system is GOOD, but family members? The patient ends up transfering to us in the unit, most of the time bogus, but the family wants some action. These typically are PIA family members and patients. What a waste of bed space.

squirlkeeperCCRN

Specializes in 11 years oncology, 8 years ICU. Has 19 years experience.

I stopped doing resource when our facility implemented the RRT that families could summon. I think it is poor use of resources. I laugh when these patients are then transferred to the unit because they needed lasix and bipap...soon enough the same families are demanding to know why their family member can't eat or shower...you can't please everyone and I think administration sees this as a good pr move. I think staff calling an RRT is legit and a good idea...families, not so much.

JaredCNA, CNA

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

I can't even imagine what it would be like if families could call RRT. How does this even make the least bit of sense?

It is a bad use of resources. Also, I can't see why a pt would be transferred to the unit just because a family paged the RRT. At least the way ours is set up, they have a protocol they follow. They don't admit to ICU just because RRT is called. The primary or RRT physician must write the transfer order.

rgroyer1RNBSN, BSN, RN

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Guess I could go either way on this one, since IM on the code team and the RRT and Im a house supervisor, guess what you get the same members when you call either, and Im just waiting for an idiot call, thats what everyone on my RRT team calls it when we get some stupid jerk calling us to give his mother a bedpan, or roll her, or betteryet get him something to drink, but its good for the patients that need it we actually try to get them stabilized before they crash, its funny to my teams also the trauma team lol! So if you call us for something stupid the RRT physician just might be a trauma surgeon and he might just rip you a new one.

JaredCNA, CNA

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

Guess I could go either way on this one, since IM on the code team and the RRT and Im a house supervisor, guess what you get the same members when you call either, and Im just waiting for an idiot call, thats what everyone on my RRT team calls it when we get some stupid jerk calling us to give his mother a bedpan, or roll her, or betteryet get him something to drink, but its good for the patients that need it we actually try to get them stabilized before they crash, its funny to my teams also the trauma team lol! So if you call us for something stupid the RRT physician just might be a trauma surgeon and he might just rip you a new one.

I can only imagine how livid he would be. :angryfire

Anyway, of note, in 2006 (no RRT) there were an average of 48 cardiac/respiratory arrests per month at my facility. In 2007 (after RRT) there were about 11 a month.

I'm very glad that the patient/family can't call the rapid response team. 99.9% of time I work with a very good crew and we can stop a pt from crashing without paging the RRT. The only people that can call a rapid response at my facility are nursing personnel. If the pt's family member notices an acute change they call the primary nurse who decides along with the charge nurse.

ptadvocate81

Specializes in Surgical Intensive Care. Has 3 years experience.

I was curious about this. I was in a recent hospital meeting and they were talking about implementing an RRT where families could call them. We have had RRT for a couple of years now and it is excellent and I know that the floor nurses appreciate the extra eyes and ears, but I am wondering how it works when the family calls one. I am a little skeptical because I work in the ICU and have families all the time that are ULTRA NERVOUS and scared to death when their loved ones are moved to the floor. I am curious as to whether there is a problem with the "crying wolf" syndrome with the families. I know it is always better safe than sorry, and the families are with the pt more than the nurse, but how often do you see an RRT called for little/no reason?

lorilou22RN

Specializes in critical care. Has 11 years experience.

I was curious about this. I was in a recent hospital meeting and they were talking about implementing an RRT where families could call them. We have had RRT for a couple of years now and it is excellent and I know that the floor nurses appreciate the extra eyes and ears, but I am wondering how it works when the family calls one. I am a little skeptical because I work in the ICU and have families all the time that are ULTRA NERVOUS and scared to death when their loved ones are moved to the floor. I am curious as to whether there is a problem with the "crying wolf" syndrome with the families. I know it is always better safe than sorry, and the families are with the pt more than the nurse, but how often do you see an RRT called for little/no reason?

lots of times. if the family really disagrees with the PA/CCP decision to keep them on the floor....well they come back to the us in the unit for some extra special care!!!??? they stay for 24 hours then are shipped back. it is a PIA.

JohnW

Specializes in SICU/CT-SICU.

RRTs by familes? I think that's absurd. If you don't trust the floor nurses/MS on the floor where your loved one is staying TRANSFER to another hosptial. If the family thinks the floor nurse (and supporting team) are so weak that they can't recognize and emergency so blatant that the family can see it, that family and the patient should go elsewhere.

cloister

Specializes in Critical care, neuroscience, telemetry,. Has 25 years experience.

We have family initiated rapid response in my hospital. We call it Condition H, and the family receives a flyer on it when their loved one is admitted. There are also posters up in the rooms. In our case, the house supervisor takes the call and then goes up to find out what the deal is. Grandma hates her lunch? Call dietary and pt. relations. Grandma hates her nurse? Call the charge nurse and pt. realtions. Grandma's short of breath? Call Rapid Response.

So far, in the few months we've had the program, I think we've had one call. I was the lone curmudgeon at the hospital wide practice council who gave the idea a thumbs down, a fact that did not go unnoticed by the critical care director.

So far, it's been OK. They have admitted, however, that they have no plans to roll it out in our ER, where on any given night, 90+ people are waiting for treatment. That would be a nightmare!:lol2:

Grumpy's Girl

Specializes in Critical Care. Has 34 years experience.

Thanks for everyones thoughts.

We haven't started this part of the program yet but I think doing it like you are sounds logical. We are a 150 bed hospital, 8 bed ICU and the RRT ICU nurse has a patient assignment also. So having the supervisor check things out initially for a FAMILY call will help - with the pt's RN in tow. One look at the patient as she walks in the room will tell her whether to call the RRT. We would have the heads up and be expecting the call. If she was tied up then it would fall to RRT to go immediately. We and RT and pt's MD are called first by the RNs on the floor and the supervisors next. We need to work on our brochure, signs. Can you share yours? :typing

JaredCNA, CNA

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

Out of curiosity, how is everyone else's RRT program set up?

Like mentioned earlier, only a member of the nursing staff can page the rapid response team. The family is encouraged to call for the nurse if the patient appears in distress, etc. So...the page goes out.

I'm quite surprised that apparently they have a 10-minute window to arrive, but I guess that's not too bad. Our team is comprised of the house supervisor, two ICU RN's, and a respiratory therapist. The RRT Physician is one of the ER docs but they hardly ever have to call him.

They have a HUGE protocol list they follow. We're talking atropine, lidocaine, bicarb, lasix, dig...the lists goes on. The orders are initiated based the ICU RN's assessment of the situation. It works pretty good. I've seen about 10 rapid responses before but the rrt physician was never paged any time I saw except for when they needed to cardiovert.

Most of them were successful that I saw in that the patient didn't even have to go to the unit.

rnmi2004

Specializes in private duty/home health, med/surg. Has 10+ years experience.

We use NPs for our rapid response. That is their only job. I can pretty much guarantee they'd quit if they had to start fielding calls from family members. Our floor staff are very good at calling the rapid response nurse if they have a patient with problems, so I don't see the need for family members to make that call.

interleukin

Specializes in Mixed Level-1 ICU. Has 14 years experience.

"But to take critical-care staff away from their critically-ill patients because grandma is constipated and being ignored is...well...STUPID."

I'm waiting for someone to realize that family-initiated RRT is another way that hospitals can further fragment nursing care and still have some sort of "monitoring" of patients. Nurses are becoming slowly inundated with more and more tasks and duties and are spending less and less time with patients.

This "family empowerment" simply helps hospitals fills those "gaps" when nursing can't monitor disease processes because they're filling out duplicate forms, answering phones, running after pharmacy for meds, etc., etc. etc. Why hire nurses or reduce tasks or ratios when we can have families "monitor" for changes. After all, they all watch E.R., aren't they as skilled as seasoned nurses?

Do you not see a fundamental problem here?

Just as important is the fact that no RRT should ever have a patient assignment. And any RN--with any courage--shouldrefuse to take RRT should he have a patient load.

Hoping that there will be no RRT calls so that one will not be called away is a fool's utopia. It is this type of perspective that keeps nurses and nursing down and prevents our getting the respect we truly deserve.

When we do voluntarily overburden ourselves, we are tacitly stating, "We nurses have always danced as fast as you tell us even though we know it is in direct contrary to what best practices dictate."

Are you patient advocates in theory or reality?

If your RRT's are always independent of patients...great. If not, never complain that you were pulled away from your patients, you fell behind, you missed your lunch, you felt alienated by your fellow workers were angry because they had to pick up your crashing patient which put them behind, yadda, yadda, yadda.

Some may argue that's just teamwork. I will argue that it is indicative

of a profession that is afraid to finally say, "Enough is enough!"

When you figure out how you can micro-manage nursing--when you can figure out exactly how and when a patient will act/react to a specific illness--please let me know. We'll both make a killing in the futures markets and we can sell a slew of fortune-telling franchises.

Until then...stand up for the patient and, more importantly, stand up to those who tell you to do what you know--and the research confirms--is not in your patients' best interests...nor yours.

rgroyer1RNBSN, BSN, RN

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Well my team had a family initiated call today. The patient was diophoretic, cp, sob...etc..etc, well the flor nurse told the pt. and family it was anxiety, so the pts. family called are rrt, being the supervisor I went down and checked it out first, well let me tell you it was not anxiety, this patient was having a true emergency, when I got there she was like exausted and almost half dead, well she had a hip replacement 2 days before, and Im glad the family called us she had a massive PE, she was transferred to my SICU immediately, we couldnt get the emboli with the cath lab it was to big, we ended up taking her down to OR for a ride sided thoracotomy, she also ended up with a pneumo. from the CVC. Im just glad we got there and I hope she pulls through.

Guest
This topic is now closed to further replies.