Rapid Response Team

The University HospitalCincinnati, Ohio

IHI – Institute for Healthcare Improvement The 100,000 Lives Campaign is an initiative

to engage US hospitals in a commitment to implement changes in care proven to improve patient care and prevent avoidable deaths.

Over 2,800 Hospitals have joined the 100,000 Lives Campaign!

The campaign is the first national effort to promote saving a specified number of lives by a certain date (June 14, 2006).

sample, Footnote 42:288, 2005

The Six Initiatives to the“Save 100,000 Lives Campaign” Preventing Adverse Drug Effects. Acute Myocardial Infarction (AMI)

Care. Preventing Surgical Site Infections. Preventing Central Line Infections. Preventing Ventilator-Associated

Pneumonia. Rapid Response Teams.

Rapid Response Team…Why? Based on research showing that patients

often exhibit signs and symptoms of increasing instability for several hours prior to a cardiac arrest, the idea is to rescue patients early in their decline before a crisis occurs.

The Rapid Response Team intervenes upstream from a potential code situation, relying on bedside caregivers who are highly sensitive to signs that a patient’s condition is deteriorating, and empowered to call others into action.

Rapid Response Team…Why? By the acute care RN or

progressive care RN calling the RRT team this will begin to help build on the team work and RITE values within your division.

And help to provide better outcomes for our patients.

It empowers the bedside practitioner to take ACTIONon behalf of the patient The bedside RN will call the Rapid Response Team

into action, just as with a Code Blue, call …..

3333 They will then ask the Operator, “Please send the

Rapid Response Team to (Patient Room Location, Give Your Name and Call Back Number)”.

Then the operator will broadcast to all team members’ pagers, i.e. “Rapid Response Team: 4 north, room 4426”.

While this is occurring and the team is coming the nurse who called the RRT needs to also call or have someone call the primary care physician/service.

Reasons the bedside RN may call for the Rapid Response Team Respiratory Rate less than 8 or greater than 30. Sp02 less than 90% with increasing Oxygen

Requirements. Heart rate less than 40 or greater than 130. New Onset of Chest Pain or Seizures. Signs and/or Symptoms of a Stroke. Acute Mental Status Changes. Acute Bleed. Fall with Injury. Or, ANY ACUTE CONCERN.

Rapid Response “Team”The Rapid Response Team members

will include: Respiratory Therapist Physician (Hospitalist or Medicine

Resident) Nurse Supervisor Nurse initiating the call Specialty-focused Critical Care Nurse.

RRT Critical Care Division Unit Assignments Cardiology (CCU)

Cardiac Step Down 6 south Cardiovascular diagnostic serves (2nd floor)

RRT Critical Care Division Unit Assignments Medicine

Medical Progressive Care unit 7NW 8CCP Psychiatry (8th floor) OB (3rd floor) 4W Dialysis 2W Endoscopy Same Day Surgery, Pre-Admission Testing ANY AREAS NOT LISTED, MICU IS THE

RESPONDING TEAM

RRT Critical Care Division Unit Assignments Surgical (SICU)

5NW 5E 9CCP 6NW PACU (Postop overnight patients)

Neuroscience (NSICU) 4N 4E Radiology/Nuclear Medicine (Ground floor)

Rapid Response Team: Empowered to Provide IMMEDIATE care.

In case The physician of the RRT is not present at the bedside:

Standing Orders will be available for the rest of the team to follow.

These Standing Orders allow the critical care RN and the Respiratory Therapist to perform the diagnostic and therapeutic care they are used to providing in their ICU’s

Critical Care RRT RN responsibilities The critical care RRT RN will help the

acute care RN or progressive care RN who made the call by using critical care skills to critically think through what is going on with the pt and work together to to determine what intervention needs to occur next.

The critical care RRT RN should thank the RN who made the call and encourage them to call the number again when they need help.

Critical Care RRT RN responsibilities Critical care RRT RN should get a brief history

of the pt and what is going on now. The acute care RN or progressive care RN that called the team should have the patient’s chart in the room, and be ready to provide this information.

“SAMPLE” S = Signs and SymptomsA = AllergiesM = MedicationsP = Past medical and surgical historyL= Last time the pt ate or drankE = Precipitating events ( what led up to this

occurrence)

If Labs need to be sent by the RRT Respiratory therapist can draw radial

arterial blood samples in ABG tubes ABG, H/H, K+, glucose

Put small red “RRT” label on tube Put large red “RRT” label on IRL down-

time lab slip Write “call back phone #_____” at top of

IRL lab slip (nurse supervisor cell or unit phone #)

Tube to station 306

Critical Care RRT RN responsibilities Before leaving the scene, the following

needs to be done: RRT Record

Needs to be filled out by someone at the bedside Needs to be placed in the progress note section of

the patient’s chart. Also remind the RN that made the call to write a

progress note detailing what led up to the call and time of the call.

Copy of the RRT Record should be faxed to the Quality Office (584-5737).

P a t i e n t In f o r m a t i o n :

A l l e r g i e s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

U n i t / L o c a t i o n : _ _ _ _ _ _ _ _ _ _ _ _ S i t e :T i m e C a l l e d : _ _ _ _ _ _ _ _ T i m e E n d e d : _ _ _ _ _ _ _ _ _ _ _ _ _

E n d i n g A s s e s s m e n t :

P t . H i s t o r y / C o m m e n t s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

T e a m M e m b e r s R e s p o n d i n g :

C o m m e n t s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

R e p o r t g i ve n t o : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T i m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N a m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D a t e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _S i g n a t u r e o f p e r s o n c o m p l e t i n g f o r m / D a t e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _F i n a l 9 - 2 0 - 0 5 S e e a d d i t i o n a l i n f o r m a t i o n i n P r o g r e s s N o t e s s e c t i o n o f p a t i e n t c h a r t

D a t e : _ _ _ _ _ _ _ _ _ _ _ _ _ _

A c t i o nP r i m a r y R e a s o n f o r C a l l :

S p e c i f y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

O t h e r In t e r ve n t i o n s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

B P _ _ _ _ _ _ _ _ H R _ _ _ _ _ R R _ _ _ _ _ _ S p O 2 _ _ _ _ _ _ G C S _ _ _ _ _ _ T e m p _ _ _ _ _ _

D i s p o s i t i o n o f P a t i e n t

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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A d d re s s o g ra p h

T e a m n o t n e e d e d

< 3 m in . > 1 0 m in .

S t a ff c o n c e r n e d / w o r r ie d

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R R > 3 0 I n c r e a s in g r e q u ir e m e n t f o r O 2 r e a c h in g 5 0 % o r >

A c u t e m e n t a l s t a t u s c h a n g e

A c u t e s ig n ifi c a n t b le e d

N e w S e iz u r e sN e w o n s e t c h e s t p a in

O t h e r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

O r a l a ir w a y

S u c t io n e d

N e b u liz e r t r e a t m e n t

I n t u b a t e d

N P P V ( B I P A P / C P A P )

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N o in t e r v e n t io n

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E C G

D e fi b r illa t io n

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I p r a t r o p iu m 5 0 0 m c g H H N I N H

F u r o s e m id e _ _ _ _ _ _ _ m g I V

M o r p h in e s u lf a t e 2 - 4 m g I V

A S A 3 2 5 m g P O x 1

L o r a z e p a m 1 - 2 m g I V / P O x 1

F a ll w it h in j u r y

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< 4 t o 1 0 m in s .

T C HT U H S L E S L W T J H F H H

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D e a t h

T r a n s f e r t o T e le m e t r y

A t r o p in e 1 m g I V

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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C r it ic a l C a r e N u r s e ( c ir c le o n e : S I C U M I C U C C U N S I C U )

S u p e r v is o r

R e s p ir a t o r y T h e r a p is t

P h a r m a c is t

C o o r d in a t o r / M a n a g e r

O t h e r P h y s ic ia n ( s ) T r a n s f e r t o I C U

C o n d it io n w o r s e n e d t o a r r e s t

H o u s e D o c t o r / H o s p it a lis t

T r a n s f e r t o p r o g r e s s iv e c a r e

L a b s S e n t

H e m o d y n a m ic C o m p ro m ise

R e sp ira t o ry C o m p ro m ise

C irc u la t io n

N o t ifi e d P r im a r y S e r v ic e P h y s ic ia n : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( N a m e )

A irw a y / R e sp ira t o ry

I n it ia t e O 2

T im e P r im a r y S e r v ic e P h y s ic ia n N o t ifi e d : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

R R T R e sp o n se T im e :

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _

T im e : _ _ _ _ _ I n it ia ls : _ _ _ _ T im e : _ _ _ _ _ I n it ia ls : _ _ _ _

T im e : _ _ _ _ _ I n it ia ls : _ _ _ _

T im e : _ _ _ _ _ I n it ia ls : _ _ _ _

E m e r g e n c y A ir w a y t e a m c a lle d

C o d e T e a m C a lle d

W h ite - c h a rt ; Y e llo w - Q u a lity O ffi c e (F a x 5 8 4 - 5 7 3 7 a t tn : s e c re ta ry) ; P in k - C P R C o m m it te e (M L 0 7 2 3 a t tn : D r . H ill) ; C a n a ry - O r ig in a t in g U n it

R a p id R e s p o n s e T e a m R e c o r d

* T h is f o r m is t o b e c o m p le t e d b y R R T

V e r ifi e d P a t ie n t s I D V e r ifi e d C o r r e c t C h a r t V e r ifi e d C o d e S t a t u s

B a r c o d e

C e n t r a l M o n it o r in g U n it ( C M U )

Critical Care RRT RN responsibilities (cont’d) Also before leaving the scene:

Surveys If surveys are included in packet

Need to be filled out by initiating nurse and RRT members (critical care RN, physician, resp therapist) and faxed to QA office

Survey for primary care team needs to be attached to outside of patient’s chart

Standing Orders Items performed need to be check marked Need to be signed by a physician

Critical Care RRT RN responsibilities (cont’d) If the RRT (ICU nurse, or physician)

decide they are not needed, or if the Rapid Response converts to a Code Blue, a RRT Record still needs to be filled out. Check the box at the top of the

Record “Team not needed“ Check the box at the bottom “Code

Team Called”

RRTIf the patient is UNSTABLE and requires

transfer to an advanced care unit (Step-Down or ICU) for additional monitoring:

Nursing Supervisor will quickly begin working on finding a bed for the patient so the team can cont to provide emergent interventions.

If at any point during the intervention the pt becomes severely unstable (requiring intubation or requiring ACLS drugs) you should call a Code Blue by having someone in the room call 3333

RRT Goal

The goal is to make the entire RRT call less than 30 minutes, from intervention to transfer to the Step-Down or ICU.

Remember - with quick intervention the patient may not have to be transferred to a higher level of care.

If you have any issues or concerns at any point during the RRT call or after the RRT call is over please contact your Nursing Manager or Director. With everyone’s commitment to make this team work we will help to save 100,000 Lives.