RRT RN - Greater Cincinnati Health Council


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RRT RN - Greater Cincinnati Health Council

  1. 1. Rapid Response Team The University Hospital Cincinnati, Ohio
  2. 2. 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
  3. 3. 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.
  4. 4. 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.
  5. 5. 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.
  6. 6. It empowers the bedside practitioner to take ACTION on 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.
  7. 7. 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.
  8. 8. 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.
  9. 9. RRT Critical Care Division Unit Assignments  Cardiology (CCU)  Cardiac Step Down  6 south  Cardiovascular diagnostic serves (2nd floor)
  10. 10. 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
  11. 11. 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)
  12. 12. 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
  13. 13. 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.
  14. 14. 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 Symptoms A = Allergies M = Medications P = Past medical and surgical history L= Last time the pt ate or drank E = Precipitating events ( what led up to this occurrence)
  15. 15. 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
  16. 16. 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).
  17. 17. Patient Information: Allergies: ____________________________________________________ Unit/Location:____________ Site: Time Called:________Time Ended:_____________ Ending Assessment: Pt. History/Comments:_______________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Team Members Responding: Comments: ________________________________ ___________________________________________ Report given to:_________________Time:_____ ___________________________________________ ___________________________________________ Name:______________________Date:________ ___________________________________________ Signature of person completing form/Date ___________________________________________ ___________________________________________ ___________________________________________ Final 9-20-05 See additional information in Progress Notes section of patient chart Date:______________ Action Primary Reason for Call: Specify:____________________________________________ Other Interventions:_________________________________ ______________________________________________ BP________HR_____ RR______SpO2______GCS______Temp______ Disposition of Patient _____________________________________________ ______________________________________________ Initial Assessment: BP________HR_____ RR______SpO2______GCS______Temp______Medications Administered: Addressograph Team not needed < 3 min. >10 min. Staff concerned/worried HR < 40 SBP <90 mmHgHR > 130 RR < 8 SpO2 < 90% (despite maximal O2 therapy) RR > 30 Increasing requirement for O2 reaching 50% or > Acute mental status change Acute significant bleed New SeizuresNew onset chest pain Other _________________ Oral airway Suctioned Nebulizer treatment Intubated NPPV (BIPAP/CPAP) Bag valve mask Increase O2 mask/nasal ABG CXR No intervention IV access initiated IV fluid bolus Blood Transfusion Monitor ECG Defibrillation Cardioversion No intervention Albuterol 2.5 mg HHN INH Ipratropium 500 mcg HHN INH Furosemide _______mg IV Morphine sulfate 2-4mg IV ASA 325mg PO x1 Lorazepam 1-2 mg IV/PO x1 Fall with injury S/SXStroke Vasopressors SL NTG 0.4mg every 5min x3 < 4 to 10 mins. TCHTUH SLE SLW TJH FHH CPR Patient stabilized; no transfer Assessment completed; no intervention needed Death Transfer to Telemetry Atropine 1mg IV ______________________ ______________________ Critical Care Nurse (circle one: SICU MICU CCU NSICU) Supervisor Respiratory Therapist Pharmacist Coordinator/Manager Other Physician(s) Transfer to ICU Condition worsened to arrest House Doctor/Hospitalist Transfer to progressive care Labs Sent Hemodynamic Compromise Respiratory Compromise Circulation Notified Primary Service Physician: _________________ (Name) Airway/Respiratory Initiate O2 Time Primary Service Physician Notified:________________ RRT Response Time: ______________________ Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____Time:_____ Initials:____Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____ Time:_____ Initials:____ Emergency Airway team called Code Team Called White - chart; Yellow - Quality Office (Fax 584-5737 attn: secretary); Pink - CPR Committee (M L 0723 attn: Dr. Hill); Canary - Originating Unit Rapid Response Team Record * This form is t o be complet ed by RRT Verified Patients ID Verified Correct Chart Verified Code Status Bar code Central Monitoring Unit (CMU)
  18. 18. 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
  19. 19. 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”
  20. 20. RRT If 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
  21. 21. 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.
  22. 22. 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.