Transcript Rapid Response Team

Lighthouse Development Team
Rapid Response Team
Opportunities
 Most hospitalized patients with cardiac arrest have abnormal physiological
values recorded in the hours preceding the event
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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)
(6)
(7)
(8)
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
Schein. Chest. 1990;98:1388-1392.
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.
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
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Mews/Pews scoring assessments  Process Recommendations:
are collected leveraging existing
• Standardize Triggering Criteria and
electronic nursing clinical
Protocol
documentation.
• Daily RRT Rounding
Diagnostic results are collected and
displayed in the clinical repository.  Executable Knowledge:
If any result/assessment is out of
• Rule: MEWS/PEWS Scoring/notification
set parameters, alerts are
• RRT Patient Screening/Scoring:
• Bedside Clinician: Document Clinical
triggered.
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Assessment
MEWS/PEWS
• Summary View :
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Review physiologic parameters
• RRT Dashboard:
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Facilitate daily rounding
Amend/filter screening criteria
 Change parameters to meet patient’s clinical
concerns
PEWS Documentation
PEWS Documentation
RRT Execution- Real Time Notification
Recognize
 Executable Knowledge—Alert when..
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Alert/Notify: MEW/PEWS Scoring/notification
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 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
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Rule: RRT Low Grade Fever Rule
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SBAR communication checklist
Ability to active RRT and Notify Physician
Summary View:
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Increase Vital sign assessment Frequency
SBAR MPage: RRT activation criteria
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“At Risk” Patients: based on worsening trend of scoring
criteria
Linked with RRT summary page
Clinical Early Warning
Activating and alerting of RRT events
RRT Dashboard:
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Stratified view of risk levels and key indicators
RRT Response
 Executable Knowledge:
Respond
• Alert/Notifications: RRT Activate
• Care Plan:
• Suggested with activation
• SBAR Summary page:
 Clinician or System Trigger to
Activate RRT!
 RRT assessment, intervention,
and disposition
 Option to communicate with
attending Physician
• RRT Intervention/SBAR with “standing
orders”
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Early Warning/RRT events are
recorded
• RRT Record
• Code Blue Record
RRT Intervention Care Plan/Orderset
What gets triggered?
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Vital Signs (initially and as indicated)
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o Blood pressure, heart rate, respiratory
rate, temperature, oxygen saturation
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Nursing Orders:
o P.O.C. Blood glucose, Cardiac monitor
o IV Patent IV access IV fluid: Normal
saline at _________mL/hour
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Respiratory:
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o Clear and maintain airway, Oxygen
therapy to stabilize patient and
maintain oxygen of
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via ____nasal cannula ____mask
o Ventilation assistance with positive
pressure ventilation
Medications
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Albuterol _____mg nebulizer as needed for
respiratory distress
Nitroglycerin 0.4 mg sublingual for chest
pain. May repeat every 5 minutes for total of
3 doses
Naloxone (for narcotic reversal) (0.2-0.4 mg)
IV IM or subcutaneously as needed for
respiratory depression
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)
D50 IV or other hypoglycemic agents
Lab/Diagnostic Tests:
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Chest x-ray (AP Portable)
Other imaging studies
EKG
HGB/HCT CBC Glucose Electrolytes (Na+,
K+, Cl -,CO2) BUN/Creatinine
Arterial blood gases
RRT Execution: Recover
Treat and measure
Recover
 Process Recommendations:
• RRT Debriefing: Staff, Patient,
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Family
Communication Protocol:
Physician Notification
 Executable Knowledge:
• Documentation:
 Standardized Documentation of
RRT Activities and Outcomes
 Communication of patient status
with RRT, Staff Nurse, Physician,
ICU etc.
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Patient Chart: Rapid Response Team
Record /Code Blue
Summary Page: SBAR Documentation
Physician Documentation: RRT
Record
• Notification:
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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