Rapid Response Team

letina · Jan 10, 2008

We had been using a system in the UK, long before I moved to the US, called MEWS (Modified Early Warning System)

It's an assessment tool which identifies patients who have the potential to deteriorate. When used appropriately, we would call in the Rapid Response Team who would treat the patient at the bedside, or if necessary, have them transferred to ICU before they deteriorated further.

It would take a much bigger post than this to go into the fine details, but the basis of the system involves monitoring the following :

systolic blood pressure

heart rate

respiration rate

temperature

urine output

and "scoring" each one. If any of the above stray outside normal limits, you give it a score. If the total score is outside of the guideline of what is deemed to be normal, it flags up a need to involve the outreach team.

If anyone wants to read more about this, you can find much written about it, just google MEWS.

At the hospital I work at now here in the US, I was surprised to find they have only just started using RRT's in the last 18 months. There is no policy as such, the nurse just has to use her assessment skills and gut feeling as to if the team should be called. I don't know if that's a good or a bad thing. I think by just relying on the nurse's instinct, things can get missed.

I'll follow this thread with interest. It's a subject I'm very interested in.

suzanne4, RN · Jan 10, 2008

I am going to make this as a sticky for now so that everyone can find it, and then link the different topics together as we go along.

We can make a difference.

Thanks for your input, please keep it coming.

JCAHO actually has the RRT program as an initiative for all hospitals to have in place in 2008 with set protocols in place. Expect to see much more on this in the future, and I would like other countries that do not have something in place to start it.

Others that are reading, please post your input as well.

Roy Fokker, BSN, RN · Jan 13, 2008

Rapid Response Teams were introduced in my hospital last year (Midwest. Medium size hospital - my unit is the largest @ 34 beds).

There are no "specific guidelines" : although there are "suggestions" e.g. If patient suddenly requires way more care than you can reasonably provide, vital signs deteriorate, sudden alteration in consciousness or mentation, uncontrolable pain or for any reason you feel 'uncomfortable'.

There are also signs posted everywhere which encourages family members saying: "No one knows your loved ones like you do. If for any reason you feel uncomfortable about the status of your loved one, ask your nurse to call the Rapid Response Team!"

I personally love having them around for back up - can't tell you the number of times they've saved my bacon (and pts. life) when I was drowning under my work load. They have protocols and more leeway in pt. care than us floor nurses and I'm sure they've prevented their fair share of pt. deteriorating to the point of declaring a Code Blue.

BBFRN, BSN, PhD · Jan 13, 2008

I've been a RRT member, and I think they're great to have. It gives the bedside nurse more hands and resources when a patient has deteriorated, but hasn't coded. It allows things to get started without having to wait for a doctor to respond, and the patient can have labs drawn, meds given, films done, etc. and be transferred to the ICU without having to waste precious time. I can't tell you how many codes were prevented by being able to act ASAP without the red tape.

Most of the docs like it, too. I've only had one that got his hackles up, because he didn't 'order' an ICU transfer. He dropped it after he went up and saw the pt intubated and on multiple pressors, though.

suzanne4, RN · Jan 13, 2008

Thanks for your responses.

Working on putting something together that I think can be implemented in other countries as well, no matter where they are located. After all, the goal of the RRT programs is to save lives.

suzanne4, RN · Jan 16, 2008

What type of numbers are you looking at in your facilities as far as RRT calls? Are they determining how many fewer Code Blue calls are made since there has been an attempt to stabilize the patient before things get that bad?

What is your survival rate like when the RRT is called?

zuzi · Jan 16, 2008

From where I come RRTs was not seated by hospital, they was seated into ER departments or by geografical regions, long time ago (I don't know now how it is). Also RRTs had two seattings from two categories: civilian and military. What I know about civilian one is that it was started like a private institution (one young physician with big dreams started this service) with lot of young people new residents and nurses, with lot of dreams to change somenthing, and they are now one of the top ER-RRTs teams in the country. They are private, rapids, qualified, and as much as I know about them, for sure that they could have statistics data about them cases.

BBFRN, BSN, PhD · Jan 16, 2008

What type of numbers are you looking at in your facilities as far as RRT calls? Are they determining how many fewer Code Blue calls are made since there has been an attempt to stabilize the patient before things get that bad?
What is your survival rate like when the RRT is called?

At the last place I worked, we averaged about 2 RRT calls a day. The team consisted of all the asst. nurse mgrs, a RT, and the house super (same as the code team, except with a code, we also had a pharmacist, a surgical resident, and the ER attending).

Most of the rapid response calls did not become codes, about 2/3 ended up being transferred to critical care. We were able to prevent a code by giving the appropriate meds, pacing, etc in most cases.

The survival rate was very high. It was much higher for the same issues than in the previous place I worked where there was no RRT- even though residents were in-house and available 24/7.

BBFRN, BSN, PhD · Jan 16, 2008

http://www.ihi.org/ihi/search/searchresults.aspx?searchterm=rapid+response&searchtype=basic&Start+Search.x=0&Start+Search.y=0

Here's a link to many articles about rapid response teams, how to set them up, etc. IHI offers a toolkit for implementing one as well, if that's what you need.

suehp · Mar 14, 2008

Our hospital has been using the RRT for about 3 years I think. It is like Tina said about her hospital - there is no real set policy on it...but all the staff know what their role is when there is one called. If I am the shift leader i dont get involved - I look after the nurse's other pt's while she is dealing the RRT, unless I am needed in the room which I was a couple of weeks ago when we found a Pt with a B/P of 62/38 and unresposive and the Pt's nurse went to pieces...(she is a new nurse and needed a lot of guidance but she did get through it)

We just call the RRT if we find a Pt unresponsive, or their vitals are dnagerously low or there is something just not right...no specific tool to go by really. But I do like the idea of Mews - might look into that (Thanks Tina)

The hospital have determined that Code Blue's have been cut in half at the very least.They had one last night - we heard a RRT being called on another floor and within 5 minutes it had turned into a code blue - thankfully the Pt survived and is on ICU.

Things have changed a little in the last month...the RRT used to be able to give Nitro and Narcan without an order from a Doctor, but now they need an order which means speed is of the essence.....

I like the RRT and they always stress if something isnt right with your Pt and you cant put your finger on it then call, between all the team members that come up someone can figure out what is going on.

We also have a Stroke alert and have certain symptoms that occur we call the RRT and say Stroke alert - that appears to be working well too.

LKG6 · Mar 15, 2008

We call it Rapid Assessment Team. They've given us a card that I keep on my badge holder behind my ID card. This RAT card has guidelines for calling the team. For example, call if HR 130, SBP 30, etc. I work on a low risk postpartum floor so I have never seen them there. But I do know that an RN and RT person answer the call and they build up their team as needed. They get about 5 calls a day.