Nursing Grand RoundsNursing Grand Rounds
April 10, 2007April 10, 2007
Medical Emergency Teams at MUHAMedical Emergency Tea...
ObjectivesObjectives
• Understand the history and evolution ofUnderstand the history and evolution of
Medical Emergency Te...
Medical Emergency TeamsMedical Emergency Teams
Historical PerspectiveHistorical Perspective
andand
EvolutionEvolution
Stagnate OutcomesStagnate Outcomes
• Studies from the 1970’s to presentStudies from the 1970’s to present
continue to demo...
Fact:Fact:
Studies have shown that patientsStudies have shown that patients
often demonstrate signs andoften demonstrate s...
For example…For example…
• 70% of patients show evidence of respiratory70% of patients show evidence of respiratory
deteri...
The
Aussie
Answer
““We can do better…”We can do better…”
• Austin Hospital in Heidelberg, Victoria,Austin Hospital in Heidelberg, Victoria,
...
The Rapid Response Team is BornThe Rapid Response Team is Born
• Proponents of a Rapid Response Team spentProponents of a ...
Results???Results???
• Overall adverse outcomes: relative risk reduction 57.8%Overall adverse outcomes: relative risk redu...
Getting Started Kit:Getting Started Kit:
Rapid Response TeamsRapid Response Teams
How-to GuideHow-to Guide
A national init...
Differences MET can make:Differences MET can make:
• 50% reduction in non-ICU arrests50% reduction in non-ICU arrests
BMJ....
You are a nurse on a general medical/surgical unit.
One of your four patients is seriously ill and you are
worried that he...
Suddenly (or not…)Suddenly (or not…)
The entire course of your day is changed when a
family member of the patient you were...
Failure to RescueFailure to Rescue
Three main causes:Three main causes:
• Failures in planningFailures in planning
– (asse...
MET Evolution at MUSCMET Evolution at MUSC
It’s a process…It’s a process…
MUSC’s MET historyMUSC’s MET history
• Began as a small task force with interest in the “idea”Began as a small task force ...
Nurses Make the DifferenceNurses Make the Difference
• Majority of MET initiation is nurse driven –Majority of MET initiat...
SBARSBAR
• Addresses all 3 causes of Failure toAddresses all 3 causes of Failure to
RescueRescue
• A crucial tool to impro...
Role Delineation for NursesRole Delineation for Nurses
General floor:General floor:
• utilizes assessment skills to follow...
Role Delineation for NursesRole Delineation for Nurses
• ICUICU
• Arrives with advanced monitoring equipment –Arrives with...
FYIFYI
• Physicians collaborate to determine furtherPhysicians collaborate to determine further
intervention and patient d...
Nursing Grand Rounds April 10, 2007
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Nursing Grand Rounds April 10, 2007

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Nursing Grand Rounds April 10, 2007

  1. 1. Nursing Grand RoundsNursing Grand Rounds April 10, 2007April 10, 2007 Medical Emergency Teams at MUHAMedical Emergency Teams at MUHA Review and UpdateReview and Update Helena Walo, RN, BSNHelena Walo, RN, BSN Interim Manager, 8 EastInterim Manager, 8 East Shelia Scarbrough, RN, MSNShelia Scarbrough, RN, MSN Manager, Critical InterventionsManager, Critical Interventions Cathleen Walters, RN, CCRNCathleen Walters, RN, CCRN Clinical Nurse Leader, MICUClinical Nurse Leader, MICU
  2. 2. ObjectivesObjectives • Understand the history and evolution ofUnderstand the history and evolution of Medical Emergency TeamsMedical Emergency Teams • Recognize opportunities for collaborationRecognize opportunities for collaboration and empowerment for nursing staff inand empowerment for nursing staff in utilizing METutilizing MET • Discuss the nursing roles during a METDiscuss the nursing roles during a MET call at MUHAcall at MUHA
  3. 3. Medical Emergency TeamsMedical Emergency Teams Historical PerspectiveHistorical Perspective andand EvolutionEvolution
  4. 4. Stagnate OutcomesStagnate Outcomes • Studies from the 1970’s to presentStudies from the 1970’s to present continue to demonstrate >50% mortalitycontinue to demonstrate >50% mortality from unexpected in-hospital cardiacfrom unexpected in-hospital cardiac arrestsarrests BMJBMJ. 2002;324:387-390. 2002;324:387-390 • From 1966 to 1999, the average ICUFrom 1966 to 1999, the average ICU readmission rate remained relativelyreadmission rate remained relatively unchanged at 7%unchanged at 7% Chest.Chest. 2000;118:492-5022000;118:492-502
  5. 5. Fact:Fact: Studies have shown that patientsStudies have shown that patients often demonstrate signs andoften demonstrate signs and symptoms of physiologicalsymptoms of physiological instability for several hours prior toinstability for several hours prior to a cardiac arresta cardiac arrest
  6. 6. For example…For example… • 70% of patients show evidence of respiratory70% of patients show evidence of respiratory deterioration within 8 hours of arrestdeterioration within 8 hours of arrest ChestChest. 1990;98:1388-1392. 1990;98:1388-1392 • 66% of patients show abnormal signs and symptoms66% of patients show abnormal signs and symptoms within 6 hours of arrest and MD is notified in 25% ofwithin 6 hours of arrest and MD is notified in 25% of casescases Crit Care MedCrit Care Med. 1994;22(2):244-247. 1994;22(2):244-247 • Abnormal clinical observations independently associatedAbnormal clinical observations independently associated with an increased high risk of mortality: decreased levelwith an increased high risk of mortality: decreased level of consciousness, loss of consciousness, hypoxia,of consciousness, loss of consciousness, hypoxia, hypotension, and tachypnea.hypotension, and tachypnea. • Most common arrest-preceding events: hypoxia (51%)Most common arrest-preceding events: hypoxia (51%) and hypotension (17%).and hypotension (17%). ResuscitationResuscitation. 2004;62(2):137-141. 2004;62(2):137-141
  7. 7. The Aussie Answer
  8. 8. ““We can do better…”We can do better…” • Austin Hospital in Heidelberg, Victoria,Austin Hospital in Heidelberg, Victoria, AustraliaAustralia • pioneered by Ken Hillmanpioneered by Ken Hillman • began by studying patients who had majorbegan by studying patients who had major surgery at the hospital and then sufferedsurgery at the hospital and then suffered significant complications such assignificant complications such as reintubation, cardiac arrest or renal failurereintubation, cardiac arrest or renal failure • complication rates = 16 to 17 percent,complication rates = 16 to 17 percent, consistent with research elsewhereconsistent with research elsewhere
  9. 9. The Rapid Response Team is BornThe Rapid Response Team is Born • Proponents of a Rapid Response Team spentProponents of a Rapid Response Team spent months presenting their case to surgical andmonths presenting their case to surgical and medical units throughout the hospitalmedical units throughout the hospital • Established straightforward criteria of clinicalEstablished straightforward criteria of clinical instability, beginning simply with the staffinstability, beginning simply with the staff member being worried about the patient andmember being worried about the patient and other indicators such as acute changes in heartother indicators such as acute changes in heart rate, blood pressure, or level of consciousnessrate, blood pressure, or level of consciousness
  10. 10. Results???Results??? • Overall adverse outcomes: relative risk reduction 57.8%Overall adverse outcomes: relative risk reduction 57.8% • Respiratory failure: relative risk reduction 79.1%Respiratory failure: relative risk reduction 79.1% • Stroke: relative risk reduction 78.2%Stroke: relative risk reduction 78.2% • Severe sepsis: relative risk reduction 74.3%Severe sepsis: relative risk reduction 74.3% • Acute renal failure requiring renal replacement therapy:Acute renal failure requiring renal replacement therapy: relative risk reduction 88.5%relative risk reduction 88.5% • Emergency intensive care unit admissions: relative riskEmergency intensive care unit admissions: relative risk reduction 44.4%reduction 44.4% • Postoperative deaths: relative risk reduction 36.6%Postoperative deaths: relative risk reduction 36.6% • Duration of hospital stay after major surgery decreasedDuration of hospital stay after major surgery decreased from a mean of 23.8 days to 19.8 daysfrom a mean of 23.8 days to 19.8 days Critical Care Med. 2004 Apr;32(4):916-21Critical Care Med. 2004 Apr;32(4):916-21
  11. 11. Getting Started Kit:Getting Started Kit: Rapid Response TeamsRapid Response Teams How-to GuideHow-to Guide A national initiative led by IHI, the 5 Million Lives Campaign aims to dramaticallyA national initiative led by IHI, the 5 Million Lives Campaign aims to dramatically improve the quality of American health care by protecting patients from five millionimprove the quality of American health care by protecting patients from five million incidents of medical harm between December 2006 and December 2008. Theincidents of medical harm between December 2006 and December 2008. The How-to Guides associated with this Campaign are designed to share bestHow-to Guides associated with this Campaign are designed to share best practice knowledge on areas of focus for participating organizations.practice knowledge on areas of focus for participating organizations. For more information and materials, go toFor more information and materials, go to www.ihi.orgwww.ihi.org/IHI/Programs/Campaign/IHI/Programs/Campaign
  12. 12. Differences MET can make:Differences MET can make: • 50% reduction in non-ICU arrests50% reduction in non-ICU arrests BMJ.BMJ. 2002;324:387-3902002;324:387-390 • Reduced post-operative emergency ICUReduced post-operative emergency ICU transfers (58%) and deaths (37%)transfers (58%) and deaths (37%) Critical Care MedicineCritical Care Medicine. 2004;32:916-921. 2004;32:916-921 • Decrease from 30% to 4% of patient arrestsDecrease from 30% to 4% of patient arrests prior to ICU transferprior to ICU transfer Anesthesia.Anesthesia. 1999;54(9):853-8601999;54(9):853-860 • 17% decrease in overall incidence of in-hospital17% decrease in overall incidence of in-hospital cardiopulmonary arrestscardiopulmonary arrests Quality & Safety in health care. 2004;13(4):251-254Quality & Safety in health care. 2004;13(4):251-254
  13. 13. You are a nurse on a general medical/surgical unit. One of your four patients is seriously ill and you are worried that her condition is slowly worsening. You are appropriately implementing the chain of command on your patient’s behalf, but the process seems slow and you have other patient needs to attend. Meds to be given, dressings to change, discharge paperwork to complete… Imagine…Imagine…
  14. 14. Suddenly (or not…)Suddenly (or not…) The entire course of your day is changed when a family member of the patient you were worried about cries down the hall that her mother has stopped breathing… The Mayday team is called… Statistically, at best, she has a 50/50 chance for recovery…
  15. 15. Failure to RescueFailure to Rescue Three main causes:Three main causes: • Failures in planningFailures in planning – (assessments, treatments, goals)(assessments, treatments, goals) • Failure to communicateFailure to communicate – (patient to staff, staff to staff, staff to(patient to staff, staff to staff, staff to physician, etc.)physician, etc.) • Failure to recognize deteriorating patientFailure to recognize deteriorating patient conditioncondition
  16. 16. MET Evolution at MUSCMET Evolution at MUSC It’s a process…It’s a process…
  17. 17. MUSC’s MET historyMUSC’s MET history • Began as a small task force with interest in the “idea”Began as a small task force with interest in the “idea” • Sheila Scarbrough, RN, MSN began role as Critical InterventionsSheila Scarbrough, RN, MSN began role as Critical Interventions Manager in July 2006Manager in July 2006 • Policy development, networking, collaborating with interdisciplinaryPolicy development, networking, collaborating with interdisciplinary teamsteams • Education component developed with the Simulation Center inEducation component developed with the Simulation Center in October 2006.October 2006. • MET training for ICU nurses, MDs, pharmD’s, RT’s (i.e. code teamMET training for ICU nurses, MDs, pharmD’s, RT’s (i.e. code team members) in December 2006members) in December 2006 • Trail of MET responses began January 3, 2007 on 6E, 7E, and 8ETrail of MET responses began January 3, 2007 on 6E, 7E, and 8E • Expanded to 8W in March and 10W in AprilExpanded to 8W in March and 10W in April • Also in Children’s hospitalAlso in Children’s hospital • Future plans: Careful planning and implementation is crucial toFuture plans: Careful planning and implementation is crucial to success!!!success!!!
  18. 18. Nurses Make the DifferenceNurses Make the Difference • Majority of MET initiation is nurse driven –Majority of MET initiation is nurse driven – nurses recognize the s/s, nurses make thenurses recognize the s/s, nurses make the call for the MET teamcall for the MET team • At MUSC, a critical care nurse from theAt MUSC, a critical care nurse from the MICU will answer the MET pager and isMICU will answer the MET pager and is an integral part of the METan integral part of the MET
  19. 19. SBARSBAR • Addresses all 3 causes of Failure toAddresses all 3 causes of Failure to RescueRescue • A crucial tool to improve communicationA crucial tool to improve communication between caregivers and improve patientbetween caregivers and improve patient outcomesoutcomes • Gives MET a concise and completeGives MET a concise and complete picture of the patient’s conditionpicture of the patient’s condition • Information given allows team to interveneInformation given allows team to intervene quickly and appropriatelyquickly and appropriately
  20. 20. Role Delineation for NursesRole Delineation for Nurses General floor:General floor: • utilizes assessment skills to follow algorithm forutilizes assessment skills to follow algorithm for intervention,intervention, • works with patient’s primary team,works with patient’s primary team, • makes the call to the MET if the patient meetsmakes the call to the MET if the patient meets criteria,criteria, • remains with patientremains with patient • prepares for MET arrival,prepares for MET arrival, – have chart available,have chart available, – significant PMH, allergiessignificant PMH, allergies – most recent VS, labs, recent medications, proceduresmost recent VS, labs, recent medications, procedures – SBARSBAR
  21. 21. Role Delineation for NursesRole Delineation for Nurses • ICUICU • Arrives with advanced monitoring equipment –Arrives with advanced monitoring equipment – brings ICU to the patientbrings ICU to the patient • Receives information from primary care nurseReceives information from primary care nurse • Completes initial assessment to include pertinentCompletes initial assessment to include pertinent VS and lab workVS and lab work • Continues to provide critical care as appropriateContinues to provide critical care as appropriate • Documents accurately on MET formDocuments accurately on MET form
  22. 22. FYIFYI • Physicians collaborate to determine furtherPhysicians collaborate to determine further intervention and patient dispositionintervention and patient disposition • MET is NOT the BATMET is NOT the BAT – You can call BOTH at the same time!You can call BOTH at the same time! • MET is NOT the Mayday teamMET is NOT the Mayday team – If patient is in a life threatening situation, a MaydayIf patient is in a life threatening situation, a Mayday will be called.will be called. – Goal is to intervene BEFORE the patient reaches thisGoal is to intervene BEFORE the patient reaches this point.point.

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