Rapid Response Team Adult For All Adults at Fairview Ridges Hospital

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Rapid Response Team Adult For All Adults at
Fairview Ridges Hospital
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Rapid Response Team for all Adults at FRH

• Whether you are in a public area like the gift
  shop or the lobby or admitting
• Or a pt care area like radiology, lab or in a
  patient room
• Inpatient Outpatient Volunteer - Visitor
• Any Adult!
• If your concerned - We are concerned

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• What is the Rapid Response Team?
• The Rapid Response Team (RRT) is a group of
  healthcare professionals who respond quickly with
  critical care skills to a threatening clinical
  situation.
• Our Goal
• To recognize early warning signs of a patient who
  may be on the way to having a cardiac or
  respiratory arrest
• To prevent deaths in patients who are failing
  outside intensive care settings

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Why do we need a RRT?

• We give exceptional care at Fairview Ridges
  Hospital but our patients are sick and can
  quickly show signs of getting worse. This team
  is here to respond anytime you may feel concerned
  that your patient is getting worse and you need
  more resources.
• Research shows that if we can get a team to the
  patient earlier, we can avoid an adverse health
  event such as a cardiac or respiratory arrest

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• Who can call
• the Rapid Response Team?
• The RRT can be called by any staff member who is
  worried about a patient
• You may be an AFR and have a patient waiting in
  admitting who gets sweaty and vomits complaining
  of chest pain.
• You may be a Rad Tech in Radiology and a patient
  shows acute change of mental status
• You may be an RN in LD with a laboring patient
  who suddenly drops her heart rate or BP
• You might be a housekeeper or nutrition aide who
  sees blood all over the floor when you walk in
  the room
• any staff member can call
• If your concerned were concerned!

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How do I call the Rapid Response Team?

• Dial 111
• Ask the operator to page the RRT and give your
  location
• An overhead RRT announcement will be sounded
• A simultaneous text page will be sent to team
  members
• The RRT will show up within 5 minutes

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• Who is our Rapid Response Team
• for Adults?
• Flying Squad RN
• ICU RN
• Respiratory Therapist
• Hospitalist or House Physician
• They bring their different set of eyes to
• help you with the situation

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• We want you to call!!!
• If in doubt call!
• Feel confident to call!!!
• We will be nice when you call!!!
• We will come quickly when you call!!
• It seems simple but it makes a difference!!!
• We will follow up with you after you call to
  thank you for calling!
• If Your Concerned - Were Concerned!!!

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What are the signs to look for?

• Acute change in Heart Rate (lt40 or gt160 bpm)
• Acute change in systolic BP (lt80 or gt200)
• Acute change in Respiratory Rate (lt8 or gt24 per
  min)
• Acute change in saturation (lt85) despite oxygen
  therapy for gt 5 minutes
• Acute change in LOC,a new seizure, sudden loss of
  movement or weakness of face arm or leg
• Acute onset of new pain or dramatic increase in
  pain
• If you need additional critical care trained
  resources
• You are uncomfortable or concerned about a
  patient or a member of their family is

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Why does this make a difference?

• The Institute for Healthcare Improvement (IHI)
  says that if we have a RRT we will save more
  patients lives.
• We will
• have more effective communication between care-
  givers using SBAR
• break down the barriers and culture issues around
  communication and calling and receiving help
• improve recognition of those important signs of a
  failing patient almost all patients who code show
  signs within 8 hours of the event that could have
  been treated earlier with better outcome
• Provide the Pt and the RN a team with a different
  set of eyes to rapidly evaluate and begin active
  treatment of a problem

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What the Facts?

• Recent Australian Study (MERIT)
• showed unexpected deaths decreased by over 30
• Showed cardiac arrests outside of the ICU
  decreased by over 50
• Fairview Ridges Pilot Experience (1 month pilot)
• Showed cardiac arrests outside of the ICU
  decreased by 100 (we cannot expect this for a
  whole year, we should expect a greater than 50
  decrease)
• We had over 20 RRTs in our pilot (it is too early
  to see our unexpected death rate yet but we
  believe we have made a difference)
• Many of the patients did not transfer to the ICU
  but were stabilized in their room
• We heard comments like
• what did we ever do without the RRT
• I felt like part of the team when they arrived,
  they were glad that I called.
• My patient and his family loved it, they felt so
  cared for by our team

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We have kids and babies at FRH what about them?

• Later this month we will be rolling out more RRTS
• These teams will have slightly different makeups
  depending on the patient population
• In addition to the RRT - ADULT
• By the end of the year we will have 3 more teams
• RRT Peds (specially designed to meet the needs
  of our pediatric patients)
• RRT Infant (specially designed to meet the
  needs of our babies under 1 month)
• RRT OB (specially designed to meet the needs
  of pregnant patients especially who come in very
  sick or hurt to our Emergency Room)

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What is SBAR Communication?

• It enhances predictability how were going to
  talk with each other Crisp to the point
  Promotes critical thinking
• Similar in structure to the SOAP model
  (subjective/objective/ assessment/plan) that is
  taught in medical school
• Keys points when using SBAR
• Situation the punch line, give it in 5-10
  seconds
• Background the context, objective data, the
  numbers, how did we get here
• Assessment what is the problem ?
• Recommendation what do we need to do and when ?
  

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What is SBAR Communication?

• Used in the nuclear submarine service for concise
  and accurate communication
• S situation whats the situation?
• B background how did we get here ? the
  context
• A assessment what do I think the problem is?
• R recommendation what are we going to do to
  fix it?
• Nurses are trained to be narrative and
  descriptive you dont make diagnoses
• Physicians are trained to be problem solvers
  what do you want me to do just give me the
  headlines

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What does SBAR sound like?

• S Hi Dr. Smith - This is Jessica, I'm Mr.
  Jones RN on MS 3 at FRH, Mr. Jones in room 337
  is really having trouble breathing
• B He was admitted yesterday from the ED and has
  severe COPD, has been going downhill and is now
  acutely worse. His RR are 40, his O2 sat is down
  to 74 on oxygen
• A His breath sounds are way down on the right
  side I think he has a pheumothorax
• R I really need you to come and see him now, he
  is in real trouble, He needs a chest tube. When
  will you be here? Is there anything that I can
  do while I wait for you to get here

situation
background
assessment
recommendation
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How do I call that Rapid Response Team again?????

• Dial 111
• Ask the operator to page the RRT and give your
  location
• An overhead RRT announcement will be sounded
• A simultaneous text page will be sent to team
  members
• The RRT will show up within 5 minutes

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Who is the RRT Action Group?

• Our team members are
• Mark Lundstedt (Flying Squad),
• Sue Farris (Respiratory Therapy),
• Dr Peter Sandgren (hospitalist),
• Maribeth Larson (Perfit),
• Gail Summerville (ICU CNS),
• Terry Salz (Telemetry ANM),
• Liz Betland (Manager Cardiopulmonary),
• Lynn Taylor (NM Peds),
• Sue Shaft (NM SCN)
• Paula Welford (Pt Care Admin), Helen Strike
  (Admin)
• We meet once a month and attend action team
  meetings with ICSI every 2 months for the next
  year

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What if I have questions or concerns?

• Please make sure that you get your questions or
  concerns are addressed quickly.
• Please call or email
• Terry Salz (team leader) at 952 892 2319
  tsalz1_at_fairview.org
• Helen Strike (team sponsor) at 952 892 2104
  hstrike1_at_fairview.org
• Dr Peter Sandgren (physician sponsor) at
  psandgr1_at_fairview.org

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Where can I read more information about RRT and
100K Lives campaign?

• http//www.ihi.org/IHI/Programs/Campaign/
• http//public.uhc.edu/uhcmail/ihi/rrt.htm