Rapid Response Team Members: Input desired!

getoverit, BSN, RN, EMT-P · Nov 26, 2008

a) 236 beds + multiple outpatient clinics which we will respond to as well

b) honestly I rarely carry anything and rarely ever need anything that isn't there. every floor/department/etc has an AED and crash cart stocked with ACLS medications. The only things that I carry that I use all the time are an O2 wrench, christmas tree, ABG syringe, carpuject, disposable O2 sensor, etc. This may not help much but it seems like these are the things that are either misplaced or unavailable on most of the responses.

c) sure. it depends on the situation. some are obvious, work the code. always find their DNR status first, this may sound elementary but a percentage of the time CPR is either being performed or at least being contemplated and the patient has expressly declined heroic efforts in his advance directives. we have a separate code pager and I've never activated it, basically because it would mean I'm going back to the unit and one of my co-workers is coming down. And also, in my opinion, less-is-more and codes work much more smoothly when there isn't 25 people around, stumbling over each other, offering advice, etc.

What's even worse is when it's deteriorated into a full arrest and nobody seems to be aware of it yet. e.g. called for "unresponsiveness" but patient was on telemetry and I had seen them deteriorate into an IVR with a rate of about 24, this occurred within 30 seconds of activating the RRT. In fact, I had called the tele floor to inquire about the patient and that alerted them to the emergency. I was anticipating the code pager to alarm, but when the RRT went off....to be honest it was 3 am so myself and another nurse flipped a coin to see who went. (we're not usually that flippant-no pun intended-but it was a slow night and both of us were in a position to have easily responded).

Hope this helps some. I'd be glad to provide more details if you have a specific clinical presentation.

joeyzstj, LPN · Nov 27, 2008

As a Rapid Response or Medical Emergency Team member, would you please answer the following:
a. how many beds does your institution have?
b. what, if any equipment do you take along to a response, i.e. no equipment, cardiac monitor only, select meds, entire crash cart?
c. Have you come upon a situtation in which an RRT was called but deteriorated to a PNB (code) situtation before or upon your arrival? Can you offer details of any specifics about the management in this situation?
Thanks for your input!

A. 375 Beds

B. Myself and an Airway Box with drugs and difficult Intubation equipment. No crash cart is taken due to every floor having one.

C. This one I find especially funny. This happens about once a week when I work. The floors are infamous for calling the CAT team (as we call it) 30 seconds before the patient codes, that way they can write that the CAT team didnt get there fast enough. We usually show up and as nicely as possible get the patient off the floor they are on and to a unit.

stressgal, RN · Dec 1, 2008

a. 250

b. a rapid response bag, contains a doppler, bp cuff, steth, and I can't remember what else. I know it's heavy as I lug it up the stairs. :) These are the only items I have ever needed to pull out. Most everything else is on the units we respond to. Most have a portable monitor on the unit and an ECG is often ordered/performed by the time we arrive. Any "code" meds needed are available on the crash cart, if we reach that point.

c. Our nurses are quite comfortable in calling a rapid response well prior to a patient coding. We educate the staff that it is ok to call a RR if they see or feel a deterioration in the patient's condition. The main goal is to prevent a patient from crashing. It is important to back this up with actions when a nurse does call a RR and not chastize them for their intervention. Often the patient may need to be transfered to a higher level of care.

APNgonnabe · Dec 1, 2008

a. 254 beds

b. We have a fully stocked crash cart in each wing (which really arent that long so a crash cart is readily available). A previous poster said they took abg stuff..that is an excellent idea. We don't typically take anything extra. RT response so if we need more mask or cannula or whatever from them they are there.

c. Generally the person that went on RRT is capable of running the code. We send house supervisor, a trauma icu RN, a M/S thoracic RN, an RT so many of the code team members are all ready on their way. Hearing a code called on the way to a RRT happens about 25% maybe.