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THE ALGORITHM OF RAPID RESPONSE

by Elizabeth A. Silverberg R.N.

Respond                                 

Assess

Provide support

Intervene

Delegate

Reassess

Educate

Support

Plan

Organize

Negotiate

Stabilize and transport

Evaluate

Carrying the beeper for a shift as a member of a rapid response team entails being ready at a moment’s notice to respond to the call for help from a nurse or family member concerned about a patient change of condition, no matter how subtle or seemingly inconsequential the clinical change may be. With a telecommunications alert to each member’s beeper the team is called into action, responding promptly to the scene, assessing the patient which includes a detailed report from the primary care nurse, physical assessment of the patient  as well as obtaining a full set of vital signs, placing the patient on a bedside monitor,. application of oxygen, intravenous access and providing emotional support as well as clinical support to the patient, family and nursing staff in care of the patient. The rapid response team is never being judgmental or belittling of the nurse’s fears or uncertainties and concerns in activating the team.

The rapid response team comprised of an intensive care unit nurse, respiratory therapist, physician and nursing supervisor collaborates with the nursing staff caring for the patient making necessary interventions to stabilize the patient. Delegation of tasks begins and is carried out by nursing staff involved in direct care of the patient as well as members of the rapid response team to stabilize the patient. The effectiveness and patient response is reassessed, clinical support continues, emotional as well as clinical. The family if present is included in the decision making process and if not a member of the team or physician responsible for the patient will call the family or health care proxy to notify them and verify resuscitation wishes of the patient if an untoward event should occur.. If a family member is present they may remain present in the room providing emotional support to the patient or escorted to a nearby location and updated by a member of the nursing staff. Open channels of communication are maintained between the family and healthcare providers.

Plans are discussed whether the patient can be maintained on the floor with the assist of the rapid response RN assisting in the care of the patient until the primary care nurse can reabsorb the patient into his or her patient assignment or the patient requires  a higher level of care in an available intensive care unit. Organization of the room as well as patient belongings to provide an environment conducive to patient continued monitoring on the floor, the development of a plan of care, as well negotiation regarding the logistics of the patient remaining in the present location or escalating the level of care to that of the intensive care unit occurs.                         

Stabilization of the patient for safe transport to the intensive care once a bed is available is pandemont and requires the efforts of the rapid response team to provide support for a safe and hemodynamically safe transfer. Intubation of the patient may have occurred as well as addition of vaso active and anti arrhythmic agents to stabilize the patient.

The primary care nurse calls report to the receiving nurse in the intensive care unit to allow preparation for the patient’s arrival. Upon arrival to the critical care unit members of the rapid response team may remain to help support the intensive care unit staff in further stabilization of the patient and assisting until the unexpected admission can be safely absorbed into the staffing numbers for the remaining shift. The rapid response is documented by the staff nurse as from the floor the event occurred on, including date, time, what precipitated the call, pertinent vital signs,lab values as well as interventions and patient responses. The rapid response team members being responsible for documenting as well their arrival and their interventions, actions performed in stabilizing the patient. It is a team effort with one goal Evaluation of effectiveness of response team efforts and critiquing for improvement in future responses occurs after the event, as well as evaluation of floor nurse’s educational needs based on the scenario precipitating the call into action.

All in a day’s work, an untoward event is averted, a life is saved, a nurse’s concern is validated, clinical support and education is provided  to the staff nurses on the floor of the occurrence and a evidence based practice is utilized to provide a standard of care that the JACHO mandates for patient safety.

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