Would you have called rapid response?

We have a RRT at our hospital. We have a list of criteria we use to call them, or if we just feel like we need them. One of the criteria is if their SBP is below 90. A few days ago I had a patient whose SBP was like 87. During shift report the oncoming nurse got so upset because I didn't call a rapid response when the patient needed one. I explained to her that the patient is fully alert and oriented, with absolutely no other signs of low BP other than the number. I was ALWAYS taught in nursing school to pay attention to everything, not just one specific parameter. Would you have called a RRT on someone like my patient?

What was the patient's baseline BP? If the patient was alert/oriented and all of their other vital signs were WNL and they weren't cold/clammy/lightheaded, no I would not have called RRT. You don't call RRT based on a number, the patient would also need to be assessed not just the BP. How was the patient after your shift? I'm sure they were fine. You did alright, kid.

What I would have done is after I got that SBP of 87, I would have went back about 30 minutes later and rechecked the BP.

As long as the patient wasn't decompensating, I'd have left her alone. We see that all the time. I get nervous, but some people just hang out in that 80's neighborhood and they're fine.

The patient seems like they were OK, and no harm done, but I think that if the facility has a protocol or algorithm in place for such things then I would have called RRT. It would have covered your buttsky if nothing else!

As long as the patient wasn't decompensating, I'd have left her alone. We see that all the time. I get nervous, but some people just hang out in that 80's neighborhood and they're fine.

So true, so true. So they are suppose to call RRT on a patient with an SBP 87 and the patient is not decompensating? What if the patient's baseline SBP was 87, are they still suppose to call RRT. I wonder how that patient is and what their baseline BP is.

SBP less than 90 does not mean poor perfusion, look at the Mean Arterial Pressure. Assess your patient. If this was an automatic pressure, check a manual one. Ask your patient if they are light headed, do they have a headache, do they feel dizzy or are they nauseated. Check what their previous pressures were in the last 12 or 24 hours. Are they a fresh post op, are they bleeding, is this a cardiac patient, what does their EKG show? Do they look in distress? What did they look like during a prior assessment? What medications where they given in the past 2 hours? Lots of critical thinking to be done in a minute or two prior to calling a rapid response team in. I am assuming you checked all critical possiblities of a slightly low SBP and nothing to warrant a RRT. Document your assessment and leave knowing you did what you are supposed to do.

I would have checked her baseline, rechecked the bp, see if she had had any bp meds, made sure to hold the next dose. Since she was A&O, and asymptomatic, I would not have called rapid response. Was she dehydrated? Maybe push fluids if not contraidicated.

As a RRT member, I would have been okay with you having called for the team had I ben a responder to your situation. Granted, one must take in the whole picture (pt's baseline, meds given in the last 24 hrs, hx, and adm dx among others), but if it's an accurate bp and activation criteria at your facility states SBP

like others have said, i'd like to know what the pt's baseline sbp was- but if my patient was a&o, with good color, cap refill, etc- and had no complaints- then, no, i wouldn't have called the rrt. in fact, if the patient was otherwise fine, i wouldn't have even called the doctor !! (unless of course i was scheduled to give a beta blocker and didn't have hold parameters, etc) i bet some of nurses walk around with a bp that low sometimes!

just because you can call a rapid response for a specific reading doesn't mean you must. we can call the rrt for a pox

like others have said, i'd like to know what the pt's baseline sbp was- but if my patient was a&o, with good color, cap refill, etc- and had no complaints- then, no, i wouldn't have called the rrt. in fact, if the patient was otherwise fine, i wouldn't have even called the doctor !! (unless of course i was scheduled to give a beta blocker and didn't have hold parameters, etc) i bet some of nurses walk around with a bp that low sometimes!

just because you can call a rapid response for a specific reading doesn't mean you must. we can call the rrt for a pox

if you had to call rrt for every spo2 below 90%, you'd have to call it on nearly every single copder.

if you had to call rrt for every spo2 below 90%, you'd have to call it on nearly every single copder.

exactly! but like i said, we can call rrt, but that doesn't mean we have to! of course, our guidelines are just that, guidelines, and are intentionally vague. we can call an rrt anytime we "just don't feel right" about a patient- but oftentimes there are plenty of other interventions we can (and do) try first.

My two cents...

If there are no clinical indications to call RRT on a patient, and there are interventions which I can apply using nursing judgement first, why tie them up unnecessarily? I understand that they have parameters in place for a reason, but 87 is pretty close to 90. There have been plenty of times that I haven't even called a doc in regards to SBP in the 80's depending on the patient. Yes, if they've dropped from 150 to 85....but not if they've dropped from 100 to 85 and I know they've got meds kicking in.