Would you have called rapid response?

[uscstu4lfe]

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?

[Pudnluv, ASN, RN]

I wouldn't have called a RRT. We have the same type of guidelines on when to call a RRT and when to call the physician. If we followed these guidelines to the letter, we'd be on the phone constantly. I don't as a general rule call a RRT unless I walk in the room and the patient is literally about to code and I can't the resident up there fast enough. We are all ACLS on my shift and able to push emergency meds in code situations. In the case of a low BP, I would have called the resident or nocturnalist. If the patient condition warrented it, I would have told them to come check the patient. It the patient was decompensating, I would have insisted on sending the patient to the ICU. That being said, if I were a new nurse or worked on a unit that did not routinely deal with emergent type situations, I probably would have called the RRT, if nothing else to cover my butt and maybe use a learning experience.

[Gdschild]

I probably would not have called one. First I would have looked at all the vital signs and if the pt is symptomatic or asymptomatic. I would have looked at the previous vital signs and medications given. But most important is pt. showing signs of any besides just the SBP being 87.

[robred]

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!

This post speaks volumes...I need to say that reading some of the other reply posts in this thread, especially in light of the minimal information the OP initially provided, make me nervous. I, too, have seen a few situations over the last 12 years of those who compensate only to crash and die later. IMHO, I would NOT want to be a nurse who must defend oneself (in a mirror/in one's dreams, to a NM, a family, and/or a jury) as to why a resource wasn't activated when hospital policy made it available to do so. I realize that there is alot of gray in some of this, but why stick a pt's neck (and one's own) out when there's a mechanism out there to cya?

Awsmom: my sincere condolences to you and yours.

Rob

[casi, ASN, RN]

I'd check the patient's baseline before calling anything.

Honestly could you imagine how busy the RRT would be if rapid responses were called on every patient with a SBP below 90? On the cardiac floor I work we always have at least 1 if not more patients with a SBP less than 90.

[MIcrunchyRN]

Well hell you guys wouldn't like me at your facility.. my BP is almost always high 80's/50's

I would not have called RRT... you would have gotten but chewed by them for calling them when not necessary

[back2bRN]

Protocols are great, however they are no substitute for critical thinking. That said, you still look at the pt,document check the baseline TPR,BP document recheck with a manual cuff, document look at the meds, look at the activity level, then make a judgement call document and call or not. Also were you completely alone? There was likely someone with more clinical experince that you could bounce things off of and document some more. But that is just my thoughts, coming from a background where I am RT,ect and work daily with limited resources. So I guess I wouldn't have called the RRT, but I sure would have documented the reasons and rationale.

[canoehead, BSN, RN]

If you are confident in your assessment you can wait and recheck if it seems like the more appropriate course. If you aren't sure why not consult your charge for her opinion? If you are concerned at all calling RRT is a reasonable course of action.

If the facility requires RRT to be called in certain situations they don't have a whole lot of confidence in their floor nurses' assessments. You can teach a monkey to push a button when certain conditions are met. The point of haveing registered nurses at the bedside is to have the benefit of their professional judgement.

[Babs0512]

To answer your question, NO I would not have called. Treat the patient, not the monitor.

If the patient LOC was the same, skin w/d/p, HR wnl, then no need to call. Even baseline readings can be off. When a person first gets admitted to the hospital, it is usually stressful, often the BP is elevated. It comes down after they settle in and relax.

I think you did the right thing, you treated the patient, not the monitor! Bravo!

Blessings

[Virgo_RN, BSN, RN]

Based solely on the small amount of info provided, no, I would not have called RRT.

As far as covering your butt, the best way to do that is that your rationales for your actions should be reasonable and defensible and documented. This shows that you did not ignore it, but rather, that you did address it in a reasonable and prudent manner.

[DabearsDitka]

I agree with many of the things that have been already posted, someone with an ejection fraction of 10-15% would normally run in the 80's and I can assure you the cardiologist doesnt want to get a call everytime I different nurse comes on shift:no: