Transcript LWW PPT Slide Template Master

Chapter 14:
Rapid Response Teams and
Transport of the Critically Ill
Patient
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Rapid Response Team (RRT) Calling
Criteria
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Example of a Rapid Response Team
Protocol
See Figure 14-1.
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Gaining Administrative Buy-in When
Developing a RRT
• Institute for Health Care Improvement findings support
RRT as a way to decrease length of stay and save costs.
• Chart audits of in-hospital arrests and events leading to
arrests support the need for RRT.
• Need support from administration so ICU nurses on RRT
are freed up to make calls as needed
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Team Structure of RRT
• Members: experienced ICU nurse and others (respiratory
therapist, nurse practitioner, hospitalist or intensivist,
physician assistant)
• Members must be ready to go to the emergency
immediately.
• Members must be onsite.
• The critical care nurse must be willing to respond and
educate.
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Communication Tools and Protocols Used
By RRT
•
Protocol provides guidelines to ensure each member
understands and performs assigned duties.
•
Communication tools provide rapid report and ability to
audit for continuous improvement.
–
SBAR (situation, background, assessment,
recommendation)
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Training for RRT
•
Policies and protocols for RRT
•
ACLS training and training in triage
•
Roles and responsibilities of each team member and the
staff nurse
•
Use of communications tools, such as SBAR
•
Chain of command
•
When palliative care is appropriate
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Training for Staff About Using RRT
•
Policy and procedure for using RRT
•
Staff nurse responsibilities
•
Reminders on what to do when an emergency occurs
(badge reminders, pocket cards, etc.)
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Calling Criteria and the Mechanism to
Activate the RRT System
•
Make sure calling criteria are readily available to all staff
(badge reminders, pocket cards, posters, sticker on
every medical record or Kardex).
•
Make sure the activation number is also available on all
of the information above.
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Feedback Mechanisms For Continuous
Improvement of RRT
•
Establish tracking mechanism to determine RRT
effectiveness
–
Patient outcomes (chart audits)
–
Satisfaction surveys from staff using RRT
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Evaluation of RRT Effectiveness
•
Codes per 1,000 discharges
•
Codes outside the ICU
•
Number of times the RRT system was used and the
number of admissions to ICU, number of hospital days
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SBAR Communication Tool
See Box 14-3.
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Interfacility Transfer Algorithm
See Figure 14-2.
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Advantages and Disadvantages of Ground
Versus Air Transport
Advantages
Disadvantages
Ground transport
•Carry more
equipment and staff
•No weight restrictions
•Longer estimated
time of arrival (ETA)
•Hard to provide
interventions on
bumpy road
Air transport
•Shorter ETA
•Crew has specialized
training
•Weight limitations
•Less staff and
equipment
•Weather and altitude
restrictions
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Question
The critical care nurse is preparing for the arrival of a
patient via ground critical care transport. Which of the
following should the nurse consider first when setting up
for the transfer?
A. The time the patient is not in the hospital
B. Travel time needs to be considered as top priority
C. Equipment and supplies the patient will need
D. Arrival time of the family
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Answer
C. Equipment and supplies the patient will need
Rationale: The transport team will take back their
equipment, and the equipment may be different from
the facility’s, so the nurse needs to be prepared for the
switchover. This is a top priority in the choices provided.
The other statements are important for determining
issues such as how much time the nurse has to prepare
for the patient, and making sure to include the patient’s
family on their arrival after settling in the patient. The
patient is in a mobile critical care unit, so out-ofhospital time is less of an issue.
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Emergency Medical Transfer Active Labor
Act Flowchart
See Figure 14-3.
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Key Factors of an Effective Interfacility
Transfer
• Determine benefits versus risks of the transfer
• Determine appropriateness of accepting facility
• Provide interfacility transfer report
• Evaluate transfer process for continuous quality
improvement
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Case Study 1
A 44-year-old man needs to be flown to a level I trauma
center to undergo surgery and further stabilization.
Phase 1: What role should the ED physician and RN provide
in terms of notifying and gaining acceptance from the
receiving facility and completing the institution’s transfer
list?
Phase 2: What items from the chart and tests should the
RN get ready? What should the RN include in the transfer
report to the transport team and the RN at the receiving
facility?
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Case Study 1 (cont.)
Phase 3: What should the transport RN and team do during
this phase? What role should the RN at the receiving
facility play to prepare for the patient?
Phase 4: What steps should the transport team take during
the turnover process at the receiving facility? What steps
should the RN at the receiving facility take during this
phase?
Phase 5: What continuous quality indicators should be
considered during this phase for the transport team, the
receiving facility, and the facility that sent the patient?
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Guidelines for Accompanying Personnel
for Interfacility Transfer
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Equipment Necessary for Interfacility
Transport
• Airway and ventilation/resuscitation equipment
• ACLS medications
• Monitor/defibrillator/external pacemaker
• IV pumps and tubing
• Equipment for stabilization of neck and spine
• Equipment to monitor vital signs
• Communication equipment
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Case Study 2
A 64-year-old patient in the cardiac care unit develops
sustained ventricular tachycardia with a weak thready
pulse and hypotension. The dysrhythmia is not
responding to medications and only temporarily responds
to cardioversion. The electrophysiologist wants to
perform electrophysiology studies in the cardiac cath lab,
which is seven floors down, and the patient may need a
implantable defibrillator.
1.What are the indications for intrafacility transport?
2.What process should be used during the transport?
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Question
The nurse is preparing a patient for air transport to another
facility. The client is diagnosed with an inferior wall MI
and has a history of vertigo. The nurse should:
A. Provide a transdermal scopolamine patch
B. Remove the nasogastric tube
C. Position the patient supine and raise the legs on a pillow
to take pressure off the abdomen
D. Provide oxygen by a tight-fitting mask
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Answer
A. Provide a transdermal scopolamine patch
Rationale: The transdermal scopolamine patch will lower
the risk for motion sickness. The patient needs to be
side-lying and the head of the bed needs to be
elevated. The oxygen needs to be provided in a less
confining manner, such as a nasal cannula, so if the
patient vomits, there is less risk of aspiration. The
patient has a nasogastric tube in place to decompress
the stomach and lessen the risk for aspiration, so the
tube needs to stay in place during the transport.
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Question
Which of the following trauma patients is not a candidate
for high-altitude air transport to the level I trauma
center?
A. A patient requiring neurosurgical intervention
B. A patient who was deep sea diving, hit a reef, and was
buddy breathing and has decompression sickness
C. A patient with an open pelvic fracture who received 7
units of packed red blood cells to stabilize BP
D. A patient bitten by a rattlesnake; ground travel time is
60 minutes
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Answer
B. A patient who was deep sea diving, hit a reef, and was
buddy breathing and has decompression sickness
Rationale: High-altitude flying will worsen the
decompression sickness. In decompression sickness,
nitrogen bubbles are trapped in the bloodstream and
could lead to an air embolus. The patient would need
either ground transport or low-altitude transport (<1,000
feet) to a trauma center with a hyperbaric chamber for
treatment. The other three patients could benefit from
the speed of air transport.
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