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rapid response team
- 1. D R /Z E I N A B E L N A G A R L E C T U R E R O F P S Y C H I A T R Y A I N S H A M S U N I V E R S I T Y RAPID RESPONSE SYSTEMS/ TEAM
- 2. ∎ WHAT IS THERAPID RESPONSE TEAM? A RRT – known by some as the Medical Emergency Team – is a team of clinicians who bring critical care expertise to the patient’s bedside or wherever it is needed
- 3. WHY SHOULD YOUCARE? ∎ People die unnecessarily every day in our hospitals ∎ It is likely that each of you can provide an example of a patient who, in retrospect, should not have died during his or her hospitalization ∎ There are often clear early warning signs of deterioration
- 4. DOES IT WORK?BEFORE …..AFTER No. of cardiac arrests 63 …..22 Deaths from cardiac arrest 37….. 16 No. of days in ICU post arrest 163 ….33 No. of days in hospital after arrest 1363…. 159 Inpatient deaths 302…. 222
- 5. NATIONAL PATIENT SAFETYGOAL ∎ Goal 16: Improve recognition and response to changes in a patient’s condition ∎ 16A. The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening
- 6. IMPLEMENTATION ∎ the Institutefor Healthcare Improvement (IHI) recommends: • Engaging senior leadership • Identifying key staff for RRTs • Establishing alert criteria and a mechanism for calling the RRT • Educating staff about alert criteria and protocol • Using a structured documentation tool • Establishing feedback mechanisms • Measuring effectiveness • can be customized to meet your institutions’ needs and resources
- 7. IMPLEMENTATION TEAM MEMBERS MultidisciplinaryTeam • Nursing • Quality Management • Respiratory • Communications • Physicians • Pharmacy
- 8. RRS STRUCTURE Activator(s) canbe: ∎ Floor staff ∎ A technician ∎ The patient ∎ A family member ∎ Specialists ∎ Anyone sensing the acute deterioration
- 9. RRS STRUCTURE ∎ Activator(s)are responsible for calling the Responder(s) if a patient meets the calling criteria ∎ Responders must reinforce the Activator(s) for calling: “Why did you call?” vs. “Thank you for calling. What is the situation?” Remember: There are no “bad calls”!
- 10. RRS STRUCTURE Responders 1. cometo the bedside: 2. assess the patient’s situation 3. determine patient disposition, which could include: • Transferring the patient to another critical care unit (e.g., ICU or CCU) 4. A handoff back to the primary nurse/primary physician 5. Revising the treatment plan Activators may become Responders and assist in stabilizing the patient
- 11. CRITERIA FOR CALLINGRRT • Acute change in heart rate < 40 or > 130 bpm. • Acute change in systolic BP < 90 or > 180mmHg. • Acute change in RR < 8 or > 28 per minutes. • Acute change in SaO2 < 90% despite oxygen. • Acute change in consciousness or cognition, or seizures. • Acute change in urine output < 50ml in 4 hours.
- 12. TEAMWORK & RRS ∎The RRS has all these barriers to effective care: 1. Conflict 2. Distractions 3. Fatigue, Workload 4. Misinterpretation of cues 5. Lack of role clarity 6. Inconsistency in team membership 7. Lack of time 8. Lack of information sharing
- 13. ACTIVATORS MUST KNOWTHE ROLES AND RESPONSIBILITIES OF RESPONDERS AND VICE VERSA Activator needs... Responders need... ICU requires... ICU requires... Administration requires... Patient needs...
- 14. TRANSITION SUPPORT (“BOUNDARY SPANNING”) 1.Manage data 2. Monitor transitions 3. Educate staff on situation and roles 4. Ensure data recording 5. Assist in role orientation
- 15. EXAMPLE OF ONERRS ∎ Activators call Responders using a pager Who are the Responders? ∎ ICU Physician ∎ICU Charge Nurse ∎ Nurse Practitioner (if available) ∎ RRS coordinator ∎Transportation service ∎ For Pediatric Unit, chaplain’s office, security, and respiratory therapist are also included
- 16. EXAMPLE OF ONERRS Training ∎ using Situation-Background-Assessment- Recommendation (SBAR) ∎ Single-discipline training sessions ∎ Data Collection includes reporting: Who called the response team and what criteria were used? (Task-oriented checklist by roles) ∎ Who responded and in what timeframe? ∎ What was done for the patient? ∎ What are the top 5 diagnoses seen in the RRS?
- 17. EXERCISE I: LET’SIDENTIFY YOUR RRS STRUCTURE Think about the four components of the RRS: Activators, Responders, Improve Quality QI and Administrative ∎ Who are the Activators? ∎ What are the alert criteria? ∎ How are Responders called? ∎ What do Activators do once Responders arrive? ∎ Who are the Responders? ∎ How many Responders arrive to a call? ∎ What is each person’s role?
- 18. EXERCISE I: LET’SIDENTIFY YOUR RRS STRUCTURE What are the common challenges facing your RRS? ∎ Patient deterioration? ∎ System activation? ∎ Patient handoffs? ∎ Patient treatment? ∎ Evaluation of the response team?
- 19. RRS EXECUTION ∎ Usingthe scenario provided, identify the five phases of the RRS and what tools and/or strategies were used during each phase ∎ Detection ∎ Activation ∎ Response, Assessment, and Stabilization ∎ Disposition ∎ Evaluation
- 20. RRS ACTIVATION: SBAR ACTIVATORROLE ∎ SBAR provides a framework for team members to effectively communicate information to one another ,following information: ∎ Situation―What is going on with the patient? ∎ Background―What is the clinical background or context? ∎ Assessment―What do I think the problem is? ∎ Recommendation/Request―What would I recommend/request? Remember to introduce yourself...
- 21. SYSTEM EVALUATION: Integrated Sensemaking Approach ∎ What can go wrong? ∎ What are the consequences? ∎ How do things go wrong? ∎ How likely are they? ∎ What went wrong? ∎ Why did it go wrong?
- 22. SYSTEM EVALUATION: SENSE MAKINGTOOLS ∎ Proactive approaches ∎ Failure Modes and Effects Analysis (FMEA) ∎ Probabilistic Risk Assessment (PRA) ∎ Reactive approaches ∎ Root Cause Analysis (RCA)
- 23. Sign Score Remarks SystolicBP (mmHg) ≤70 mmHg+3 71-80 mmHg+2 81-100 mmHg+1 101-199 mmHg0 ≥200 mmHg+2 Heart rate (beats per minute) <40 bpm+2 41-50 bpm+1 51-100 bpm0 101-110 bpm+1 111-129 bpm+2 ≥130 bpm+3 Respiratory rate (breaths per minute) <9 bpm+2 9-14 bpm0 15-20 bpm+1 21-29 bpm+2 ≥30 bpm+3 Temperature in °C (°F) <35°C / 95°F+2 35–38.4°C / 95–101.1°F0 ≥38.5°C / 101.3°F+2 AVPU Score (Alert, Voice, Pain Unresponsive Alert 0 Reacts to voice+1 Reacts to pain+2 Unresponsive+3 Modified Early Warning Score (MEWS) for Clinical Deterioration The MEWS can be used on all hospitalized patients to allow for the early detection of clinical deterioration and potential need for higher level of care.
- 24. Interpretation • A score≥5 is statistically linked to increased likelihood of death or admission to an intensive care unit. • For any single physiological parameter scored +3, consider higher level of care for patient. MANAGEMENT • Once the MEWS identifies a patient at risk of deterioration, the medical team will need to identify the cause and address it accordingly.
- 25. CRITICAL ACTIONS • Thisscore can be used by any healthcare worker with proper training in how to use it and interpret the results. N. B.: It is meant to be used on a regular basis rather than once on admission.
- 26. • The ModifiedEarly Warning System (MEWS) is a tool designed to identify patients with declining conditions. • It was originally designed for nurses. • MEWS is based on the principle that clinical deterioration can be seen through subtle changes.
- 27.