Rapid Response Team

Lighthouse Development Team

Opportunities Most hospitalized patients with cardiac arrest have abnormal physiological values

recorded in the hours preceding the event• A patient’s baseline condition begins to deteriorate a mean of 6.5 hours before an unexpected

critical event or actual cardiac arrest (5)

• Schein et al found that 70% of patients show evidence of respiratory deterioration within 8 hours of arrest (6)

At a minimum, the measurement of key clinical indicators must be obtained accurately and recorded with appropriate frequency (7)

Communication of patient deterioration can be improved and physician notification of patient’s condition worsening may only occur in 25% of cases

Ongoing program management and performance improvement is essential to the sustainability of RRT’s

(5) Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J. 2002;324:387-390

(6) Schein. Chest. 1990;98:1388-1392.(7) ILCOR Consensus Statement. Recommended Guidelines for Monitoring, Reporting, and Conducting Research on Medical Emergency Team, Outreach, and Rapid Response Systems: An Utstein-Style Scientific Statement.(8) Franklin. Crit Care Med. 1994;22:224-247.

RRTModule Overview

• The following slides show examples of the proposed online documentation and communication screens to be displayed within the patients electronic medical record.

• Summaries and executable knowledge shown are populated and triggered by electronic clinical documentation.

Review Patient• Mews/Pews scoring assessments

are collected leveraging existing electronic nursing clinical documentation.

• Diagnostic results are collected and displayed in the clinical repository.

• If any result/assessment is out of set parameters, alerts are triggered.

Process Recommendations:• Standardize Triggering Criteria and

Protocol• Daily RRT Rounding

Executable Knowledge:• Rule: MEWS/PEWS Scoring/notification

• RRT Patient Screening/Scoring:• Bedside Clinician: Document Clinical

Assessment• MEWS/PEWS

• Summary View :• Review physiologic parameters

• RRT Dashboard:• Facilitate daily rounding• Amend/filter screening criteria

Change parameters to meet patient’s clinical concerns

PEWS Documentation

PEWS Documentation

RRT Execution- Real Time Notification

High Risk Patients “At Risk Patients” are automatically

recognized by the system and are• In need of additional

assessment.• In need of additional

intervention.Clinicians are notified in real time

Executable Knowledge—Alert when..• Alert/Notify: MEW/PEWS

Scoring/notification• “At Risk” Patients: based on worsening trend of

scoring criteria• Linked with RRT summary page

• Rule: RRT Low Grade Fever Rule• Increase Vital sign assessment Frequency

• SBAR MPage: RRT activation criteria• SBAR communication checklist• Ability to active RRT and Notify Physician

• Summary View:• Clinical Early Warning• Activating and alerting of RRT events

• RRT Dashboard:• Stratified view of risk levels and key

indicators

Recognize

RRT Response

Clinician or System Trigger to Activate RRT!

RRT assessment, intervention, and disposition

Option to communicate with attending Physician

Executable Knowledge:• Alert/Notifications: RRT Activate• Care Plan:

• Suggested with activation

• SBAR Summary page:• RRT Intervention/SBAR with “standing

orders”

• Early Warning/RRT events are recorded• RRT Record• Code Blue Record

Respond

RRT Intervention Care Plan/OrdersetWhat gets triggered?

• Vital Signs (initially and as indicated) o Blood pressure, heart rate,

respiratory rate, temperature, oxygen saturation

• Nursing Orders: o P.O.C. Blood glucose, Cardiac

monitor o IV Patent IV access IV fluid: Normal

saline at _________mL/hour• Respiratory:

o Clear and maintain airway, Oxygen therapy to stabilize patient and maintain oxygen of %

o via ____nasal cannula ____mask

o Ventilation assistance with positive pressure ventilation

• Medications o Albuterol _____mg nebulizer as needed for

respiratory distress o Nitroglycerin 0.4 mg sublingual for chest pain.

May repeat every 5 minutes for total of 3 doses o Naloxone (for narcotic reversal) (0.2-0.4 mg) IV

IM or subcutaneously as needed for respiratory depression

o Flumazenil (benzodiazepine reversal) 0.2 mg IV; may dose every 60 seconds for a total of 4 doses as needed for respiratory depression (maximum is 1 mg)

o D50 IV or other hypoglycemic agents • Lab/Diagnostic Tests:

o Chest x-ray (AP Portable)o Other imaging studies o EKGo HGB/HCT CBC Glucose Electrolytes

(Na+, K+, Cl -,CO2) BUN/Creatinine o Arterial blood gases

RRT Execution: RecoverTreat and measure

Standardized Documentation of RRT Activities and Outcomes

Communication of patient status with RRT, Staff Nurse, Physician, ICU etc.

Recover Process Recommendations:

• RRT Debriefing: Staff, Patient, Family

• Communication Protocol: Physician Notification

Executable Knowledge:• Documentation:

• Patient Chart: Rapid Response Team Record /Code Blue

• Summary Page: SBAR Documentation

• Physician Documentation: RRT Record

• Notification:• Physician

• Summary View : • Significant Events

Component• Communication of event

record to care team

RRT Dashboard, Summary page and Communcation page

• Provides a summary view of all patients that require monitoring.

• Available anywhere• Ability to drill down

through results

• Ability to graph and trend results

• Ability to send results to physician – real time.

RRT Population Based Dashboard

RRT Population Based Dashboard

RRT Population Based Dashboard

RRT Inpatient View

Inpatient Summary

RRT Communication Summary SBAR

RRT Communication Summary SBAR

RRT