Rapid Response Team?!?!

allnurses Guide · Jun 19, 2008

Do you not have a calling criteria for you RRT, we use a red flag / chart system where if the patient vital signs record into the red area it is an automatic referral to the RRT

Calling criteria would be things like Tachy 100 / Brady below 60, systolic BP below 80, resps above 20 or below 10, SaO2 92% or below,

Or that they are showing the Portsmouth sign (pulse rate higher than the systolic BP)

If the RRT are then happy with a hypotension so for example, my BP sits at 80 systolic most of the time but I am fit and well and it's normal for me then the RRT would document a new red line level for my systolic

It works very well and we have had some excellent results in reducing cardiac arrest calls where I work

Our RRT consists of an ICU senior nurse, a nurse practitioner and a anaesthetic junior doc, if they need the big guns they can call them in

Okami_CCRN, BSN, RN · Jun 19, 2008

We do have specific criterias that need to be meet before calling the RRT such as O2 sat lower than 90%, HR over 140, Resps over 26, etc.

It was just implemented on May 27th and many times I hear "Rapid Response Team 6 South" then 10 seconds later "Cancel RRT, Code Blue 6 South" It has happened more than once or twice and I do not know if it is just bad luck or are RN's not catching it on time.

Tait, MSN, RN · Jun 19, 2008

Our RRT is an ICU nurse, assigned to certain floors. They check in on ICU transfer patients to make sure they are doing well on the floor, go to codes, and answer questions/check out "iffy" patients.

Parameters for calling RRT are pretty much any abnormal vital sign (high or low) and what they lovingly call "something just isn't right". I use them pretty frequently just to assert that my gut is right.

Tait

allnurses Guide · Jun 19, 2008

We do have specific criterias that need to be meet before calling the RRT such as O2 sat lower than 90%, HR over 140, Resps over 26, etc.
It was just implemented on May 27th and many times I hear "Rapid Response Team 6 South" then 10 seconds later "Cancel RRT, Code Blue 6 South" It has happened more than once or twice and I do not know if it is just bad luck or are RN's not catching it on time.

It may be an adjustment period as well, if it is a new initiative it could take the staff a bit of time to get used to having that extra support. When we implemented it we had a team of nurse educators based in the areas it was implememented helping to support and educate the staff about the RRT, the calling criteria and give a bit of education about recognition of the sick patient. I think the latter probably had the most benefit with early recognition.

Also when the RRT or if the cardiac arrest team was called, they spent time after the event debriefing the staff on the ward and giving education about how to improve for the next time.

It was a long process and we introduced it to only a few clinical areas at a time then rolled out to other areas when we got it right in the pilot areas. I think education is the key, if the recognition of who is sick isn't there then no amount of RRT is going to help.

nrsang97, BSN, RN · Jun 19, 2008

When I worked Med Surg, we had criteria to call.

These are our criteria:

1. Resp distress, increasing oxygen requirements up to 50% VM or higher, labored breathing, restless, lethargic, accessory muscle use, RR >30 or

2. Hypo/Hypertension, SBP 180, Or any significant change from baseline.

3. Chest pain

4. HR >130, HR

5. seizures

6. Acute mental status changes.

7. Or if you feel something "just isn't right" or worried about the patient even if not within the guidelines.

When I worked med surg this really worked well at my previous hospital. Deffinately reduced the number of codes. Now I am at a much larger hospital and am not sure how much it really decreased the number of codes. Sometimes duiring RRT call they end up running a full code. However I believe becasue there is someone that the nurse can call on for backup to check the patient out if she feels something isn't right, I think the number of codes due to that is less.

At the smaller hospital I worked at a ICU nurse, RRT , and House MD would respond. At the much larger hospital we have 2RN's and oncall reident for that unit respond.

namaste_71 · Jun 19, 2008

There's a transition phase for RRTs. Staff have to get used to calling for reasons mentioned in several of the above posts. I would hope there's continual education/PR to the staff about the team, and RRT treats the nurse who paged them with respect (not as if they're bothered).

Good RRTs will use each bedside case as an opportunity to educate the primary care nurse (or other staff member) who made the call.

I can imagine it will take some time for staff to feel comfortable paging the RRT if tangible criteria -- like O2 sats or BP -- aren't present, just a hunch something's not right. Still, better to err on the side of caution. These teams can reduce codes, ICU transfers ... save lives. www.ihi.org has tons of free information about RRTs.

jstbreathe · Jun 19, 2008

We have been using Rapid response team for about 3 yrs now. we do not have as many codes as before. Who responds: Lead ICU nurse, Lead Respiratory Therapist, Nursing supervisor.

Some are called for silly reasons. Some should have been codes called.

glasgow3 · Jun 19, 2008

I think most would expect that summoning a team of several experienced professionals when a patient's baseline vitals deteriorate could have the effect of improving certain outcomes all things being equal.

But what if hospitals compensated /valued nurses to a sufficient degree that experienced, well trained nurses in adequate numbers were always closer to the bedside? After all, someone has to first recognize that the patient has deteriorated to some degree before a Rapid Response is even called do they not? And what if the patient's physician trusted that bedside nurses's judgement/assessment of the situation such that the a call directly to that physician would result in the immediate implementation of the desired intervention or a transfer to a higher level of care if applicable?-----as opposed to calling the RRT, waiting for them to assemble, getting a relevant history, doing their assesments, attempting to formulate conclusions from scratch etc..

My point here is, certainly an RRT is a good idea if you totally disregard their cost. But they DO have a cost. And I would also suspect that an RRT's effect would be magnified for those hospitals with the leanest staffing practices and the least experienced nurses.

Not only do RRTs vary greatly in their makeup from institution to institution, but the institutional environments vary wildly as well. I'm sure that a new grad working nightshift on an urban, high acuity med-surg unit vainly attempting to care for 14 patients would think RRTs are the greatest thing since sliced bread...then again they'd welcome ANY form of help and with good reason.

When reading RRT success stories, dramatic statistics etc view them with a critical eye is my advice.

Rae83 · Jun 19, 2008

We have a RRT at our facility which includes an ICU nurse, Respiratory therapy, float nurse, and supervisor (if able). We have had it for about three years and I think that in the beginning the floors were unsure of when to utilize this team, but over the years the criteria and utilization of the RRT has been tweaked and is really beneficial now that staff is more aware of what it is and what they need to do. Just give it time and it will get better. Educate, educate, and educate some more

S.T.A.C.E.Y, LPN · Jun 19, 2008

My hospital has the same this about parameters to call Rapid Response, and for EVERY new nurse hired, we are issued our ID badge and a card the same size for our lanyard that has rapid response criteria and the number to call--that way you never have to go searching for the criteria or the number if you need it in a hurry. We don't call rapid response in the ER (or respond for that matter), but I think the idea of a little cheat sheet card attached to your name badge would be very helpful.

As a side note, our RRT also followup recent ICU transfers to the floors. So when they're not responding to the floors, several of the team members are out there assessing previous ICU status patients to prevent their decompensation. I don't remember the numbers for code blues, but apparently there was quite a significant drop since RRT began.

gal220RN, BSN, RN · Jun 19, 2008

I was part of the RRT implementation in my large pediatric institution and it was one of the best things that have ever happened. Over a period of 6 months, we saw a major increase in patient codes resulting in deaths on the floor, with the overwheming dx of undiagnosed septic shock.

The idea of an RRT had been floating around for 2 whole years, but we had so much bickering over who would own it, who would play what role, etc. It was stupid posturing. It got lost in the shuffle and we all thought it was a project never to come to fruition.

In an emergency meeting, the team literally came together in one week. It is amazing what you can accomplish when people put aside all the details and focus on the patients. We did an enormous teaching campaign on calling the RRT for all staff, when to call- "It's always the right call." We also did mass viewings of the "Josie King" video, produced by the IHI campaign (part of the 100K lives). If you ever see this video (which I think every nurse should), you will never practice the same- period. Our medical, nursing and respiratory teams rallied around the process and we implemented the entire program in one month- huge accomplishment. We continued to refine the process as we evaluated RRT calls and their outcomes.

Our on the floor codes dropped by 90% in the first year. Totally amazing. Our floor nurses knew what sepsis looks like in children in early stages and how to intervene. They were impowered to accelerate the process if they met resistance to physicians.

It was a great improvement to keep our patients safe.

Search http://www.ihi.org and look up Josie King