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Rapid response team

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Ahmad Thanin
Ahmad Thanin

The document describes a Rapid Response Team (RRT) and its purpose and functions. An RRT is a multidisciplinary team that provides critical care expertise to patients outside of ICU who show signs of deterioration. The key purposes of an RRT are to assess and stabilize deteriorating patients, provide support and early interventions to prevent further decline, and communicate with physicians. An effective RRT process includes detection of issues, team activation, response and assessment at the bedside, interventions and stabilization, and disposition/evaluation. The document outlines roles and responsibilities of the RRT, calling criteria, and how to structure, implement, and measure the effectiveness of an RRT.

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Rapid Response Team - RRT Ahmad Thanin
Definition • is a formally designated multidisciplinary team that assesses and manages a patient who has demonstrated early signs of deterioration in clinical status, prior to the development of progressive and irreversible deterioration. rapid response team • is a group of clinicians that nurses and other hospital staff can call upon at any time to provide critical care expertise at the bedside of a patient whose condition is deteriorating rapid response team
WHAT IS Its PURPOSE? To provide support and counseling to healthcare workers outside the critical care units To provide critical care expertise, support and early interventions to patients who show signs of deterioration outside the critical care units and communicate with responsible physician in order to improve patient’s outcome
RAPID RESPONSE PROCESS Detection Activation Response, Assessment, Intervention and Stabilization Disposition Evaluation
What Is the Role of the Rapid Response Team? Assess Stabilize Assist with communication Educate and support Assist with transfer, if necessary Follow-up of discharged patients
Rapid Response • Respond. • Assess. • Provide support. • Intervene. • Delegate. Rapid • Reassess. • Educate. • Support. • Plan. • Organize. • Negotiate. • Stabilize and transport. • Evaluate. Response
Typical Rapid Response System Calling Criteria • Heart rate over 140/min or less than 40/min • Respiratory rate over 28/min or less than 8/min • Systolic blood pressure greater than 180 mmHg or less than 90 mmHg • Oxygen saturation less than 90% despite supplementation • Acute change in mental status • Urine output less than 50 cc over 4 hours • Staff member has significant concern about the patient's condition Any staff member may call the team if one of the following criteria is met: • Chest pain unrelieved by nitroglycerin • Threatened airway • Seizure • Uncontrolled pain Additional criteria used at some institutions:
Modified Early Warning Score (MEWS) The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients
Why is MEWS being Implemented? Most adverse events are usually preceded by early warning signs of preceded by early warning signs of clinical instability. Early signs are more often subtle changes in multiple parameters rather than a dramatic change in an isolated value. More informative “vital signs” could prevent failure to recognize early deterioration.
Modified Early Warning Score (MEWS) for Clinical Deterioration before calling RRT • PRESS HERE
Guidelines for nursing department SCORE 0 - 2 • continue the routine monitoring of the vital signs. 3 • Continue every 4-hour vital sign monitoring and calculate MEWS Score • If patient remain at score 3 for three consecutive reading, call the charge nurse to assess patient 4 • Inform charge nurse and patient’s physician • The charge nurse assesses the patient and notifies the nurse manager director of patient status • Increase vital sign monitoring frequency to 2 hours intervals and calculate the MEWS Score. • Measure intake and output and notify in charge nurse if urine out put fall below 100 ml every 4 hours. 5 • Inform patient's physician and request assessment of the patient by the physician • Increase frequency of vital sign monitoring including pulse oximetry hourly. • If patient remain 5 score 3 for three consecutive reading, request transfer to higher level of care +6 • Call RRT and the treating physician.. • transfer to higher level of care
Remember ( code blue is the proper call) Do not activate or call for Code RRT if the patient need resuscitation
RRT Vs. Code Blue ITEM RRT Code Blue Airway Present always Absent Breathing Present Always Absent Circulation Present Always Absent First Action Assessment CPR or D.C Shock Level Of consciousness Conscious or semi conscious Unconscious Medication Depend on patient situation Follow ACLS Algorithms GCS GCS decreases by 2 points over 2 hrs. Quick Drop of GCS .
How to Implement a Rapid Response Team Prior to testing and implementation of a Rapid Response Team, organizations may wish to consider the following: • Engage senior leadership support. • Determine the best structure for the Rapid Response Team. • Establish criteria for activation of the Rapid Response Team. • Establish a simple process for activating the Rapid Response Team. • Provide education and training. • Use standardized tools. • Establish feedback mechanisms. • Measure effectiveness
Engage Senior Leadership Support Make an explicit organizational commitment to establishing the Rapid Response Team. Make Educate the medical staff about the benefits of Rapid Response Team and put the myths to rest. Educate Craft a very clear and widely disseminated communication message from senior leadership. Craft
Determine the Best Structure for the Rapid Response Team ICU RN, RT, Intensivist or Hospitalist ICU RN and Respiratory Therapist (RT) ICU RN, RT, Intensivist, Resident ICU RN, RT, Physician Assistant ED or ICU RN
four key features of Rapid Response Team members The team members must be available to respond immediately when called. They must be onsite and accessible. They must have the critical care skills necessary to assess and respond. They must respond to every call with a smile on their face and a script that may include, “Thank you for calling. How can I help you?
THE MEMBERS OF A RAPID RESPONSE TEAM MAY INCLUDE: • Critical Care Nurse • Respiratory Therapist • Primary RN • Critical Care Physician • Nursing Supervisor
Mandatory certification for RRT Team members Basic Life Support Advanced Cardiac Life Support
Establish Criteria for Activating the Rapid Response Team, Example criteria include Staff member is worried about the patient Acute change in heart rate <40 or >130 bpm Acute change in systolic blood pressure <90 mmHg Acute change in respiratory rate <8 or >28 per min Acute change in saturation <90% despite O2 Acute change in conscious state
When does the team leave? At disposition? It really depends on the patient and the model you choose to use at your facility. May leave after the initial intervention. If your Rapid Response Team consists of RNs and RTs, one or more of the team members may stay with the patient until they go to ICU.
Rapid response team

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Rapid response team

  • 1. Rapid Response Team - RRT Ahmad Thanin
  • 2. Definition • is a formally designated multidisciplinary team that assesses and manages a patient who has demonstrated early signs of deterioration in clinical status, prior to the development of progressive and irreversible deterioration. rapid response team • is a group of clinicians that nurses and other hospital staff can call upon at any time to provide critical care expertise at the bedside of a patient whose condition is deteriorating rapid response team
  • 3. WHAT IS Its PURPOSE? To provide support and counseling to healthcare workers outside the critical care units To provide critical care expertise, support and early interventions to patients who show signs of deterioration outside the critical care units and communicate with responsible physician in order to improve patient’s outcome
  • 5. What Is the Role of the Rapid Response Team? Assess Stabilize Assist with communication Educate and support Assist with transfer, if necessary Follow-up of discharged patients
  • 6. Rapid Response • Respond. • Assess. • Provide support. • Intervene. • Delegate. Rapid • Reassess. • Educate. • Support. • Plan. • Organize. • Negotiate. • Stabilize and transport. • Evaluate. Response
  • 7. Typical Rapid Response System Calling Criteria • Heart rate over 140/min or less than 40/min • Respiratory rate over 28/min or less than 8/min • Systolic blood pressure greater than 180 mmHg or less than 90 mmHg • Oxygen saturation less than 90% despite supplementation • Acute change in mental status • Urine output less than 50 cc over 4 hours • Staff member has significant concern about the patient's condition Any staff member may call the team if one of the following criteria is met: • Chest pain unrelieved by nitroglycerin • Threatened airway • Seizure • Uncontrolled pain Additional criteria used at some institutions:
  • 8. Modified Early Warning Score (MEWS) The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients
  • 9. Why is MEWS being Implemented? Most adverse events are usually preceded by early warning signs of preceded by early warning signs of clinical instability. Early signs are more often subtle changes in multiple parameters rather than a dramatic change in an isolated value. More informative “vital signs” could prevent failure to recognize early deterioration.
  • 10. Modified Early Warning Score (MEWS) for Clinical Deterioration before calling RRT • PRESS HERE
  • 11. Guidelines for nursing department SCORE 0 - 2 • continue the routine monitoring of the vital signs. 3 • Continue every 4-hour vital sign monitoring and calculate MEWS Score • If patient remain at score 3 for three consecutive reading, call the charge nurse to assess patient 4 • Inform charge nurse and patient’s physician • The charge nurse assesses the patient and notifies the nurse manager director of patient status • Increase vital sign monitoring frequency to 2 hours intervals and calculate the MEWS Score. • Measure intake and output and notify in charge nurse if urine out put fall below 100 ml every 4 hours. 5 • Inform patient's physician and request assessment of the patient by the physician • Increase frequency of vital sign monitoring including pulse oximetry hourly. • If patient remain 5 score 3 for three consecutive reading, request transfer to higher level of care +6 • Call RRT and the treating physician.. • transfer to higher level of care
  • 12. Remember ( code blue is the proper call) Do not activate or call for Code RRT if the patient need resuscitation
  • 13. RRT Vs. Code Blue ITEM RRT Code Blue Airway Present always Absent Breathing Present Always Absent Circulation Present Always Absent First Action Assessment CPR or D.C Shock Level Of consciousness Conscious or semi conscious Unconscious Medication Depend on patient situation Follow ACLS Algorithms GCS GCS decreases by 2 points over 2 hrs. Quick Drop of GCS .
  • 14. How to Implement a Rapid Response Team Prior to testing and implementation of a Rapid Response Team, organizations may wish to consider the following: • Engage senior leadership support. • Determine the best structure for the Rapid Response Team. • Establish criteria for activation of the Rapid Response Team. • Establish a simple process for activating the Rapid Response Team. • Provide education and training. • Use standardized tools. • Establish feedback mechanisms. • Measure effectiveness
  • 15. Engage Senior Leadership Support Make an explicit organizational commitment to establishing the Rapid Response Team. Make Educate the medical staff about the benefits of Rapid Response Team and put the myths to rest. Educate Craft a very clear and widely disseminated communication message from senior leadership. Craft
  • 16. Determine the Best Structure for the Rapid Response Team ICU RN, RT, Intensivist or Hospitalist ICU RN and Respiratory Therapist (RT) ICU RN, RT, Intensivist, Resident ICU RN, RT, Physician Assistant ED or ICU RN
  • 17. four key features of Rapid Response Team members The team members must be available to respond immediately when called. They must be onsite and accessible. They must have the critical care skills necessary to assess and respond. They must respond to every call with a smile on their face and a script that may include, “Thank you for calling. How can I help you?
  • 18. THE MEMBERS OF A RAPID RESPONSE TEAM MAY INCLUDE: • Critical Care Nurse • Respiratory Therapist • Primary RN • Critical Care Physician • Nursing Supervisor
  • 19. Mandatory certification for RRT Team members Basic Life Support Advanced Cardiac Life Support
  • 20. Establish Criteria for Activating the Rapid Response Team, Example criteria include Staff member is worried about the patient Acute change in heart rate <40 or >130 bpm Acute change in systolic blood pressure <90 mmHg Acute change in respiratory rate <8 or >28 per min Acute change in saturation <90% despite O2 Acute change in conscious state
  • 21. When does the team leave? At disposition? It really depends on the patient and the model you choose to use at your facility. May leave after the initial intervention. If your Rapid Response Team consists of RNs and RTs, one or more of the team members may stay with the patient until they go to ICU.