When to call Rapid Response Team?

HurdYou · Mar 13, 2017

Does anyone else work on a unit where you don't call rapids? I work on a cardiac telemetry/universal bed and we receive both tele and ICU patients, though only ICU trained nurses take those patients. Anyway, we don't call rapids, possibly because we already have ICU nurses at the ready. We call a code if things get real bad, but no rapids. Anyone else in this situation?

Creamsoda, ASN, RN · Mar 13, 2017

Hello all,
Let me start off by saying I'm a new grad, just started working in a Progressive Care Unit (step-down ICU) almost 2 months now. My unit is connected to the ICU (we have the same managers covering both units and nurses often get floated between the two). I frequently hear codes and rapid response calls on the overhead and I have a few questions..
My preceptor was telling me how sometimes if a patient is in severe pain and the RN cannot get in touch with their attending to get pain meds ordered, you can call a rapid and get that physician/resident/whoever shows up to administer a one-time dose of pain meds. I was under the impression that you'd only call rapid response for things like: concerning changes in BP/HR/R/O2 sat, changes in mental status, new chest pain, etc. So now my first question is - What are appropriate times to call a rapid response? Or is it just different per hospital policy?
My second inquiry - I understand the rapid team is usually made up of respiratory therapists, PAs, residents, intensivists, critical care nurses, etc. Am I expected to respond to rapid calls if I am free? I'm ACLS/PALS certified and have been encouraged by my preceptors and managers to answer code blues if I can. I'm also just curious because I hear overhead announcements of rapid response and code teams needed on other floors. Are critical care nurses expected to leave their patients and run to these calls throughout the hospital?
Sorry if these are dumb questions.. I'm just a newbie to all this. Thanks!

it seems either it was not explained very well the roles to you or your hospital hasnt set clear expectations on whose responsibility it it to actually go to these calls? Why are they telling you you should go to these calls or codes? Maybe just for exposure so you can see how they run? Because someone else should be the one responsible for going. Usually its someone like the ICU charge nurse who usually doesnt have a patient assignment. That being said, my old hospital, the code beeper would rotate among all the nurses. Usually it is given to someone with less acute patients so they can jump away if needed. Not someone who is taking care of someone with multiple drips, CRRT etc.

Your a new nurse so it should never be expected you go to these calls with any expectation of you "intervening" or making decisions on how to treat these patients. There should be a dedicated nurse that is assigned to this role. You dont have enough experience. But if its more just for exposure for your own learning where you can assist with CPR, recording that kind of thing, then if its the norm at your hospital to go, then thats totally ok!

So I am a rapid response nurse. The situation you described with the pain issues...thats not necesisarily an appropriate reason to call a RRT call. But it depends on the situation. If they waited 5 min for a phone call and then call a RRT...yeah no, inappropriate. If they have called numerous times, and exhausted all efforts to get hold of this doc, and they think something else is going on, like sudden onset severe abdominal pain with concern for perf bowel putting the patient at risk for sepsis, or acute chest pain, concerning for MI, then absolutely its reason to call RRT. But your hospital may have a culture where its totally ok for to call for inappropriate things because theyre antsy?. Who is your team comprised of?

My rapid response team is actually just comprised of a nurse and a RT and house supervisor. So we will go to a call, assess the situation, then I will decide who I need to call to get further assistance. i have protocols I can initiate while waiting for calls back from the attending. (think sepsis, ACS, stroke). So I will go ahead and start ordering things like EKG, fluid, labs, ABG, nitro and other diagnostics if appropriate. I cant order things like pain meds though. 75% of my calls turn out to be nothing much but the nurse was concerned enough to call to have me evaluate and all i might do is suggest closer monitoring, or see what is already ordered that the nurse might not have seen and things to try like that. The rest of the time its an acute deterioration. Rarely can we ever not get a hold of the doctor in a timely manner. The only time I will start going up the chain of doctors is when the attending isnt calling back (they could be in a procedure etc), and its truly a life threatening issue and im suspecting brain hemorhage, airway compromise, impending circulatory collapse etc. I will then call the ICU and intensivist to tell them what is going on and that we need to come to the ICU now and worry about the attending later. If it turns into a code, then we just call a code over head and then everyone shows up.

I am a dedicated RRT nurse, meaning i dont have a patient assignment. Its really aweseome because I have the ability to be available at the drop of a hat. So we encourage nurses to call for the reasons you stated like changes in vital signs, AMS etc. But also encourage to call if they just feel something isnt right. I can go to the bedside to help troubleshoot the concern whether its subtle changes in mentation...maybe they need a ABG to eval for co2 retention or maybe they just had too much narcotic? Or maybe they really havent been "sleeping" soundly all morning like they thought, but are now unresponsive to even a sternal rub. I figure out if anything is going on and suggest whether a call to the doc is needed and suggest what to ask for (they will just call me, not page an entire RRT call for the more minor things). We try to intervene before it truely becomes a bad RRT call or a code. And we have been sucessfull over the years!

So figure out who your team is comprised of. If you come on shift and expect your day wont be too bad, ask your RRT nurse/charge nurse if you can tag along just to see how things are done. You will learn a lot from those situations. You really have to be able to critically think because you have no idea what your walking into and have no background on that patient. Its a fun job!

Creamsoda, ASN, RN · Mar 13, 2017

Does anyone else work on a unit where you don't call rapids? I work on a cardiac telemetry/universal bed and we receive both tele and ICU patients, though only ICU trained nurses take those patients. Anyway, we don't call rapids, possibly because we already have ICU nurses at the ready. We call a code if things get real bad, but no rapids. Anyone else in this situation?

Sounds like you pretty much work in a mixed level ICU. So you shouldnt really need a rapid response team as you have your ICU charge and other ICU nurses there. And presumably an intensivist or other physician handy. RRT calls tend to be for med/surg or any other unit OUTSIDE of the ICU where these specialties are not readily available and the nurses are not critical care nurses.

HurdYou · Mar 13, 2017

Thanks. I always wondered about that. I never heard rapids called, only codes so I assumed it was due to the type of unit but was not sure.

kataraang, BSN · Mar 14, 2017

New grad here. Also working in step-down. I've called RRT twice. Once was pretty darn obvious, he was on the floor nonresponsive. Had a rhythm, pulse, and breathing. The other was in respiratory distress but was alert/oriented. He was tripod position, using accessory muscles, wheezing, etc. Called respiratory first. She gave a neb treatment and no improvement. Then we called a rapid and a few residents, a senior MD, an ICU nurse, my charge nurse, other nurses on my floor arrived. We got him some solumedrol, more neb, and on a bipap. He recovered fairly quickly and had a good outcome. That is why RRTs exist! It worked out perfectly that time. The pain med thing seems iffy to me. Look up your policy/procedures.

blackvans1234 · Mar 14, 2017

A rapid response for pain medication is inappropriate. The nurse should follow their chain of command (Charge RN -> Manager -> supervisor). Its almost universal (USA anyway) that a rapid response is for an acute change in patient condition, IE something vital signs related/assessment related.

In my hospital MD's don't show up to the rapid response (DUMB!).

Now if you're patient dropped their pressure, high heart rate, Sa02 with 10/10 abdominal pain then that is different than patient with a ''toothache''.

Does anyone else work on a unit where you don't call rapids? I work on a cardiac telemetry/universal bed and we receive both tele and ICU patients, though only ICU trained nurses take those patients. Anyway, we don't call rapids, possibly because we already have ICU nurses at the ready. We call a code if things get real bad, but no rapids. Anyone else in this situation?

If my patient suddenly looks like they're about to die with a Sa02 of 56% im going to call a rapid, even if there are ICU nurses at the ready. When ICU nurses start writing orders/intubating patients then I guess I could depend on them.

If your afib patient throws a clot and has a CVA what will the ICU nurses do then?

ArrowRN, BSN, RN · Mar 14, 2017

New grad a word of advice, refer to and always ask for referring hospital and unit policies on a topic , read up on it and DO NOT take ANY nurses word for it, not even your preceptors. Your unit should have said policy. If you don't know where it is, find out. This is key to becoming an independent RN and saving you from loosing your license and possibly your job.

HelloWish, ADN, BSN · Mar 14, 2017

What I learned at my hospital is that RRT is to prevent a code. So it is for a deteriorating patient and pain is not something that would be appropriate. Our RRT team includes the charge RN, ICU nurse, RT, and a lab tech to draw immediate labs. Usually several nurses show up and the nurse for the patient for that shift is expected.

foggnm · Mar 14, 2017

It is probably best you review your RRT policy and/or discuss this with your manager or charge nurse.

mcas · Mar 16, 2017

The short answer is yes, if you feel that this is an acute change in your patient's condition, then calling a RRT is appropriate. I had a situation where we prevented compartment syndrome in a patient who had a clotted sheath in place who suddenly developed pain and swelling in her leg. Where I work you can text page the RRT nurse who's job is to respond to RRT and make rounds on the units in his/her assigned service (surgical, medical, peds. etc.) for a consult and they can order certain diagnostics and call for further help, including getting a telephone order for pain medication if that's what is needed. In the case I described, STAT PVLs were done, the sheath was pulled at bedside and the patient was taken to VIR emergently and that solved the problem. Her pain was obviously something else going on, this is where your assessment skills will come in, as a new nurse, you may not have mastered that yet. Know your chain of command, keep your charge nurse in the loop.

russianbear · Mar 17, 2017

I've heard cases of people calling rapids because of pain meds. That sucks. Shows you don't have good relationships with hospitalists. I've noticed if you do, often you can get a one time order for something until the attending calls back. The rapid should really only be used when a patient's condition is deteriorating and you want to prevent a code. I'm shocked people are saying they have RRTa that do not include a physician.

SopranoKris, MSN, RN, NP · Mar 17, 2017

It is really institution-specific on when you should/shouldn't call a Rapid Response. Does your hospital have a policy & procedure manual? If so, it should address Rapid Response parameters in it.

Having said this, when your gut is telling you to call a Rapid Response, it's better to be safe than sorry. When I was a brand new nurse just off of orientation, I had a gut feeling I needed to call the Rapid Response nurse and I'm glad I did. My patient ended up needing to be intubated after the other interventions we tried failed. Had I waited to call, it would have ended up being an emergent situation and a possible code. Always err on the side of caution :)