Poster Presentation
Sunday, November 4, 2007
10:30 AM - 11:45 AM
Sunday, November 4, 2007
1:30 PM - 2:45 PM
NP Led Rapid Response Team and Triggers Utilized by the Professional Nurse
Robert Carl Coghlan, PhD-ABD, RN, BSN, MSN, MA, CNS, FNP1, Thinh H. Tran, MD2, Pam Guillory, RN, MBA2, Mechelle Williams, MSN, ACNP3, Mary Rios, BSN, MSRN1, Ken Hargett, RRT, RCP4, Tory Schmitz, RN, MSN, CCRN, CNAA-BC5, and Linda Pullen, RN2. (1) Nursing, The Methodist Hospital, Houston, TX, USA, (2) Performance Improvement, The Methodist Hospital, Houston, TX, USA, (3) Nurse Pracitioner Program, The Methodist Hospital, Houston, TX, USA, (4) Respiratory Therapy, The Methodist Hospital, Houston, TX, USA, (5) Medical Intensive Care Unit, The Methodist Hospital, Houston, TX, USA
| Learning Objective #1: discuss the outcomes of a Nurse Practitioner led Rapid Response Team. |
| Learning Objective #2: identify triggers that prompted the bedside nurse to activate the Rapid Response Team. |
According to the Institute for Healthcare Improvement (IHI), Rapid Response Teams (RRT) can have an impact on failures in planning (including assessments, treatments, and goals), failure to communicate (patient-to-staff, staff-to-staff, staff-to-physician, etc), and failure to recognize deteriorating patient conditions. These fundamental problems can often lead to a failure to rescue. We developed a RRT led by Nurse Practitioners (NP) who could autonomously treat patients without the limitation of protocols or physician standing orders.
A list of triggers was developed to provide education and encourage the bedside nurse to utilize their judgment when activating the team. The triggers were both subjective and objective in nature. If the bedside nurse felt that in his or her judgment, without any other objective findings the patient would benefit from a RRT consult, it was a sufficient rationale to notify the team. Before implementation, all in-patient units were educated on the RRT’s purpose and the possible nurse triggers for activating the RRT. The RRT was phased-in over five months with house-wide inpatient coverage (approximately 805 beds) 24/7 by the middle of the fifth month.
Evaluation forms were completed by the RRT immediately following the intervention as to why the team was activated, location of the patient, and interventions. The nurse who requested the consult also completed a customer satisfaction form. We performed a 100% review of all patients where the RRT was requested during the five-month implementation phase.
To date, the RRT has been activated 240 times with the trigger “staff worried” cited the most at 92 instances, or 38.8% of the time. Respiratory changes accounted for 61 requests or (25.4%), followed by 56 requests (23.3%) for changes in the oxygen saturation, 49 requests (20%) for changes in the level of consciousness, 37 requests (15%) for blood pressure changes, and 33 requests (13.7%) related to changes in heart rate. Many of the requests for RRT intervention cited more than one of the triggers, such as “change in blood pressure” and “staff worried.” The RRT team assessed all patients, and if necessary, received interventions, such as additional lab work or x-rays. The majority of the patients seen, 62%, remained on the unit; resulting in decreased levels of inappropriate transfers to the ICU. The other 38% were appropriately assessed and treated prior to further deterioration or cardio-pulmonary arrest event. The interventions were utilized as a teaching experience to continue the development of a collaborative model amongst NPs, the nursing staff and physician staff.
Staff nurses who completed the customer satisfaction forms rated the RRT favorably and described the outcomes of the patients as “improved.” Nurses appreciated the collaboration with the NP and viewed them as an expert resource to care for their patients.
Initially the RRT consisted of a Nurse Practitioner and a Respiratory Therapist. After the first two months of implementation an EKG Technician was added to the team to reduce the EKG (a frequent RRT intervention) time delay. Future plans for the RRT include expansion to the post-anesthesia care units and outpatient areas.
We learned from the implementation of the RRT nurses can and will utilize early, subjective data to reduce patient’s failure to rescue. The NP led RRT model allowed for the immediate treatment interventions without the limitations and delays of strict RN “practice protocols” and fostering the NP’s growing role in improving patient safety.