Would you have called rapid response?

Nurses General Nursing

Published

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?

Specializes in tele, oncology.

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.

Up Vote Up Vote ×
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.

Remember that healthy people can compensate, compensate and compensate then decompenstate and crash quickly! My husband showed a few signs of decompensating, such as lower BP and increased HR which was ignored by the staff until he crashed and died. By the time they believed his VS it was too late. And as I've said before, thanks to the med mal settlement I can stay home with the kids.

I would have followed the RRT guidelines. It would give the team a little practice (esp. if it is new) as well as define a possible need for a revision of guidelines. You hung your behind out and would have been hung out to dry if the pt. did eventually crash. One of the purposes of the RRT is a pair of "fresh eyes" to reassess a pt. Don't be afraid to use it. Explain to them why you called them--the guidelines said to but you still feel the pt is fine.

If you do not follow the hospital protocal/guidelines, they would have a field day with you in court. And don't expect the hospital to back you up because the pt looked good!

Up Vote Up Vote ×
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

As the person who runs the RRT at my hospital I would not have been put out at all by being called for a SBP of 87. If you had called I would assume that you are worried about something - so to me it would have become a great teaching momemt.

Are you worried simply because the SBP is 87 and you haven't seen one that low? (assuming a new nurse here)

Are you worried because the patient although A&O is just a bit off than they were before?

Are you worried because the SBP is 87 and the HR is 95 when normally she runs 56? (That can really be a danger sign for the patient who is trying to compensate for the low BP)

If you are worried because you are unsure of something that is part of the reason we are here - to help increase you knowledge and comfort in these situations. I always tell people "if you are worried - call" and "if you aren't certain it should be called, but are still worried - call me directly instead of paging - I'll be glad to walk through the problem." If it doesn't appear too serious but you are still worried I'll walk up and see them - if I am worried from your description I'll run up and have you call at the same time.

Hope this helps

Pat

Up Vote Up Vote ×

I should have included her baseline! I looked at previous charts and it was low - arounds 90s/low 100s

Up Vote Up Vote ×
Specializes in Neuro ICU and Med Surg.

I would not have called RRT either, the pt probably runs low and they were asymptomatic. I however would have rechecked manually if the bp was done with automatic cuff. Also check back on the flow sheet to see what the pt was running like.

Just because there is RRT dosen't mean we shouldn't use our own judegents as well. Treat the pt not the numbers.

My SIL urns low like the high 70's to 80's SBP. This is completely normal for her.

Up Vote Up Vote ×
Specializes in MICU, neuro, orthotrauma.

no i wouldnt have called. i would have shaken her or stimulated her in order to get a better blood pressure and i would have looked at the last 24 hours worth of bp and hr and her i/o status, and based on that might have called the doc, but i think you did the right thing. some nurses are very caught up in numbers with out application. dont sweat it.

Up Vote Up Vote ×
i should have included her baseline! i looked at previous charts and it was low - arounds 90s/low 100s

in that case, definitely not! if your patient's baseline bp is 124/72 and you got a reading of 116/68, you wouldn't be worried. just the same if the patient's baseline is in the 90's, i'm not going to worry about an isolated 87 reading.

of course it stands to reason that if you had any other clinical reason to be concerned about the patient (change in mental status, change in other vitals, bp med due soon, pt symptomatic) then it would warrant further attention. but given the information you've offered, i might have simply rechecked it manually, and continued to monitor the patient.

Up Vote Up Vote ×

Beware of situations where the same sized cuff is used for v/s on EVERYONE, whether due to ignorance or lack of an appropriately sized cuff.

If your patient is 90lbs and the automatic adult large cuff was used - yes the BP will be falsely low. Same goes if the manual cuff is too large. Some nurses will report and treat this pressure. This is a pet peeve of mine.

Just something else to troubleshoot before you call RRT.

Sounds like you handled the situation appropriately.

Up Vote Up Vote ×

I would have checked a manual pressure if the bp was taken by an automatic cuff. Sometimes those are inaccurate. If it was still low I would call the resident and report my findings, and see if they wanted to do anything about it such as IVF. And then recheck the pressure after any interventions. Doesnt sound like RRT was needed in this situation, esp if the patient was asymptomatic.

Up Vote Up Vote ×
Specializes in ED, ICU, PSYCH, PP, CEN.

I would have called, but that's just me. I work with the thought of covering my butt in everything I do. I would rather look goofy than be looking at a dead patient. Or maybe I would have called the MD first.

Of course the most important thing is "what was the baseline" If it was 90 then I maybe would have just kept checking BP every 15 minutes. If baseline was 90 I probably would wait until it had gone down 5 points.

Remember it is always best for you and the patient to cover your butt.

That said you made a decision based on your skill and knowledge and you obviously made an okay decision because patient is still alive

Up Vote Up Vote ×

I don't think it was necessary in this situation BUT if hospital protocol is to call at this level I would do so. Always best to protect your license and not have to worry about a rule like this coming back to bite you.

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

I still say I would have rechecked. The OP stated the baseline VS were 90s/low100s, SBP 87 wouldn't have scared me. Now if the patient had a whole different situation going on like sepsis, elevated HR, febrile, yah then I would have called the doc. But since this patient was asymptomatic, I would have rechecked the BP in 15 minutes and if it was lower than the previous BP then I would call RRT. There is no right or wrong answer. You have to use your own clinical judgement.

Up Vote Up Vote ×
+ Add a Comment