Rapid Response Team

RN-PA, RN · May 19, 2005

My hospital began a pilot program using a Rapid Response Team (RRT) a month ago on our 65-bed Med-Surg Unit. It consists of an ICU RN and Respiratory Therapist. For now, it is available between 1900 and 0700.

The criteria for calling RRT can be any of the following:

Change in heart rate (130), change in Systolic BP (24) or threatened airway, change in SaO2, significant bleed, change in mental status, new, repeated, or prolonged seizures, failure to respond to treatment to an acute problem/symptom, or staff member concerned or worried about patient.

The hospital operator will beep the RRT members and the nurse supervisor, and the RRT and RN/LPN responsible for the patient will assess the patient together. The RRT implements interventions per RRT protocol as needed. There are special order sheets-- I haven't seen them yet-- and copies of the interventions implemented are placed in the chart. They also document on a special RRT sheet which is given to Quality Initiatives. The RRT calls the attending MD or house MD to report their assessments and interventions and for further orders.

Interventions which can be initiated by the team include: ECG, cardiac monitor, lab work, O2 therapy and nebulizer therapy, and a chest pain protocol.

The nurses who have used the RRT so far like it. I've only heard positive responses to it and I think we see it as a "safety net" of sorts. It may prevent the patient from being transferred to Telemmetry or ICU and gives us more information before the attending MD is contacted.

Dinith88 · May 19, 2005

This must be the newest trend. My hospital is currently piloting a RRT. It includes an ICU nurse and an IMCU nurse. The thing they've stressed to us is that we (in ICU) are not the 'captain' of this team (unlike code-blue where we're expected to captain)...and should be very sensitive to the floor (and IMCU) nurse's input. It seems the biggest concern is that the ICU nurse will swoop down like wonder-woman (super-man) and belittle or otherwise come across like a pretentious know-it-all. (which will undoubtedly happen most of the time).

RN-PA, RN · May 19, 2005

It seems the biggest concern is that the ICU nurse will swoop down like wonder-woman (super-man) and belittle or otherwise come across like a pretentious know-it-all. (which will undoubtedly happen most of the time).

I certainly hope that wouldn't happen. The RRT would end up getting very few calls from us, and our nurse manager wouldn't tolerate that attitude, either.

Lukestar · May 19, 2005

It seems the biggest concern is that the ICU nurse will swoop down like wonder-woman (super-man) and belittle or otherwise come across like a pretentious know-it-all. (which will undoubtedly happen most of the time).

This is exactally what I don't want to happen. I want this to be a nurses helping nurses type experience. I wish for it to be more of a mentoring experience where the less experienced nurses learn from and gain experience from the seasoned nurses. I don't want it to look like the Critical Care Nurses are there to take over as in a code situation.

RN-PA, RN · May 19, 2005

This is exactally what I don't want to happen. I want this to be a nurses helping nurses type experience. I wish for it to be more of a mentoring experience where the less experienced nurses learn from and gain experience from the seasoned nurses. I don't want it to look like the Critical Care Nurses are there to take over as in a code situation.

The "mentoring" aspect just needs to be emphasized during training, I guess. There's sometimes a feeling of inferiority with Med-Surg vs. ICU nurses that some ICU nurses may perpetuate or exascerbate in a RRT situation. We're getting a slew of GN's on our Med-Surg unit in the coming months and the more experienced nurses are often already up to our eyeballs with our own patients' problems and sometimes find it difficult to help the GN's as much as we would like. Knowing that a Rapid Response Team is available for them will help alleviate some of our stress and hopefully help insure better patient care and outcomes.

letina · May 19, 2005

Is anyone here a part of or does your hospital participate in a Rapid Response Team. Our hospital sent me to a conference a couple of weeks ago and now I am supposed to come up with criteria for a team. The RRT will be members of Critical Care that will go thru out the hospital to the various floors and areas when a nurse has a patient that they are feeling uncomfortable with. Either the patients vital signs are declining or just that the floor nurse feels uncomfortable with the patient and wants an extra set of experienced eyes to look at a patient before the patient crashes. It is supposed to be more of a nurses helping nurses type of program rather than the unit nurses coming to take over. Anyone with any expeirence with a program like this. I am wondering how the nurses involved respond to this. Do the floor nurses feel like they are looked down on if they have to call for help or do the nurses on the RRT feel put out for having to go help. Any input will be appreciated.

I worked on a Unit here in the UK a couple of years ago where we were piloting the Modified Early Warning System (or MEWS). The objective was to identify patients who had the potential to deteriorate rapidly, this was done by 'scoring' depending upon sudden changes in HR, BP, Resps, Temp and Output. Once an 'at risk' patient was identified, the Critical Care Team would assist/advise and where possible, the patient would be treated there and then, preventing the need for transfer to Critical Care.

You could find out more on this if you google 'Modified Early Warning System'. There are a few in-depth reports and findings online (somewhere). There's also a similar project called 'Patient at Risk Team' (or PART) which I think was developed in Australia, if my memory serves me well.

Well worth a search on google :)

Lukestar · May 20, 2005

I worked on a Unit here in the UK a couple of years ago where we were piloting the Modified Early Warning System (or MEWS). The objective was to identify patients who had the potential to deteriorate rapidly, this was done by 'scoring' depending upon sudden changes in HR, BP, Resps, Temp and Output. Once an 'at risk' patient was identified, the Critical Care Team would assist/advise and where possible, the patient would be treated there and then, preventing the need for transfer to Critical Care.
You could find out more on this if you google 'Modified Early Warning System'. There are a few in-depth reports and findings online (somewhere). There's also a similar project called 'Patient at Risk Team' (or PART) which I think was developed in Australia, if my memory serves me well.
Well worth a search on google :)

In the conference I went to there were several hospitals that presented there teams and how they were developed, criteria and who was on the team. It ranged from volenteer nurses in units to hospitals that had dedicated teams that this was their sole responsibility. I do not have the budget to dedicate a team so I will have to go with volenteers. Does anyone know how this was promoted to the nurses in the unit to get participation or was it manditory. I pefer volenteers, I do not want to force this on anyone.

Dinith88 · May 20, 2005

In the conference I went to there were several hospitals that presented there teams and how they were developed, criteria and who was on the team. It ranged from volenteer nurses in units to hospitals that had dedicated teams that this was their sole responsibility. I do not have the budget to dedicate a team so I will have to go with volenteers. Does anyone know how this was promoted to the nurses in the unit to get participation or was it manditory. I pefer volenteers, I do not want to force this on anyone.

Lukestar, We have no dedicated RRT. During over-view in our icu (which happens at shift change, just prior to receiving report) one of us is assigned 'code captain'. Currently, whoever is assigned code-captain is also responsible for representing us in the RRT. It's as simple as that, and no-one has yet to complain about it. Obviously, if this same nurse is busy with a code or RRT and another situation developes, another nurse steps up to the plate and responds. So...i suppose we utilize a 'volunteer' RRT, and it has suited us well.

**canoehead, BSN, RN** · May 20, 2005

Seems like it would make more sense to have the unit nurses mentor each other in a crisis as they are the ones that know each other and the patients. If they wanted to designate someone to come to the floor and help out while they are busy with a patient in crisis it would be more cost effective, and safer for the patient to just have an extra float nurse.

Lukestar · May 20, 2005

Seems like it would make more sense to have the unit nurses mentor each other in a crisis as they are the ones that know each other and the patients. If they wanted to designate someone to come to the floor and help out while they are busy with a patient in crisis it would be more cost effective, and safer for the patient to just have an extra float nurse.

The RRT is not created to go to the floor and help out. It is designed to be an extra set of eyes and ears. They do an assessment of the patient in crisis and make suggestions to the floor nurse. It's still the floor nurses patient. If it is done on a volenteer basis without a dedicated team, the unit nurse doesn't have time to go to the floor just because the floor nurses are busy. You wouldn't want the team being called to come start IV's or insert cathaters.

heart queen · Jun 3, 2005

My understanding of the purpose of this... is to;

1. free up the hands of a VERY busy floor nurse

2. lend an extra helping hand in assessing a pt. by a nurse more familiar with the "pt. crumping routine"

3. have that extra set of hands to hang drips, push meds.. maybe not allowed on a particular unit, look at an ekg, draw a blood gas... hook up to a portible monitor (which many floor nurses are not trained to read).. and get the whole picture to present to a doc.

4. That nurse can now call the primary doc and give an assessment (not that afloor nurse can't... but the stat nurse has additional skills to not only aid the doc on the phone in a diagnosis... but help treat emergent situations... that fllor nurses not only don't have the time for... but might not be allowed to provide.. regardless of their knowlege or skill level.

ie. your pt's crumping.. you call the stat nurse, they arrive.. you give them the MAR, chart and a quick report.... you can now attend to your other UMPTEEN pt's and let that nurse handle the crisis. You check in as frequently as possible. Your sick pt. now has an ICU nurse at the bedside... you aren't two hours behind and ALLLLLL the patients continue to receive care!

I would take each interaction as indepedent. A stat nurse with a crappy attitude twords you can be pulled aside post situation, or a note to their manager. Consider the learning possible if you actually have time to be in the room and assist in the process.

If this plan is presented in this way.... the way it SHOULD work... with and additional plan for ego's... you'll have immediate buy in by the floor nurse staff.

ps. this stat nurse CANNOT have patients in the ICU. they should be utilized for IV service, educational classes, and an ICU pair of hands during off need time. IF NOT, this is doomed for failure.

try to keep an open mind as how this can REALLY free you up and give the best care possible to all the patients.