1 TITLE/DESCRIPTION: DEPARTMENT: PERSONNEL: Rapid Response Team (RRT) Patient Care Services RN s and RT s EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15 Purpose: A group of select health care professionals available 24 hours a day, who provide urgent care to non-icu patients by stabilizing the patient s condition or transferring the patient to a higher level of care to meet their physiologic needs. Policy: Team Members: The team members must be available to respond immediately when called. ICU team members must attend didactic instruction and have demonstrated necessary assessment and critical care skills. Other team members include the house Supervisor (when available) and Respiratory Therapists. Supplies and Equipment: Supplies and equipment needed to respond to a Rapid Response call are kept in a RRT bag. The contents of the bag are as follows: ABG syringe Yankeur Nasal Cannula Aerosol Mask Non-Rebreather Mask Nasal Trumpet (Adult and Pediatric) Oral Airways:(Adult and Pediatric) Oral/Trach suctioning catheters #5, #8, #10, and #14 Fr Oxygen flowmeter Aerosol Nebulizer Portable EKG monitor Small Suction Regulator Suction tubing Angiocath sizes 22g, 20g, 18g, 16g J-loop Butterfly needle Chlorascrub Swabs Small Tegaderm Plastic/Paper Tape
Lubricant (water soluble) ECG and 12 lead electrode pads Blood Tubes: purple, red, yellow, blue, green, pink Blood culture bottles Blood culture prep kits Syringes 3ml, 12 ml, 60 ml catheter tip Needles Tourniquet Saline flush vials 2x2 gauze Method of Activation: If a staff nurse feels that a patient needs intervention or if a patient s physiologic parameters fall outside the ranges, then the staff nurse may activate the RRT by dialing x 3333 for the hospital operator and give the patient s room number. The operator will notify the RRT by overhead page. Ordering a Rapid Response Team Evaluation: The order for the Rapid Response Team Evaluation will be entered in electronic medical record by the staff nurse. Criteria to Initiate an Adult Call: Heart rate less tha 40, greater than140 Blood pressure less than 80, greater than 180 Respiratory rate less than 10, greater than 28 Saturation requiring increasing need for oxygen Level of conscious: altered, difficulty speaking, weakness, seizure New, sudden pain Or staff worried about patient Criteria to Initiate a Pediatric Call: General Criteria for any Pediatric Patient New onset difficulty breathing SOB unresponsive to treatment New Pulse Ox < 90% for 5 min when sleeping Pulse ox < 92% while awake Demonstrated need to increase oxygen in oxyhood Acute loss of consciousness Unexplained decrease in consciousness Seizure Significant bleeding Color chg (pt or ext) pale, dusky, gray, blue Failure to respond to treatment Staff worried about patient Neonate HR < 100 unless other parameters set by physician HR > 200 RR < 20 or > 75 breaths/min Sys BP < 50 mm Hg 2
3 Infant (6 months) HR < 80 or > 200 RR < 20 or > 70 breaths/min Sys BP < 60 mm Hg Toddler (2 years) HR < 65 or > 180 RR < 16 or > 60 breaths/min Sys BP < 65 mm Hg Pre-school (5 years) HR < 50 or > 160 RR > 50 breaths/min Sys BP < 70 mm Hg School age (7 years) HR < 50 or >150 RR > 45 breaths/min Sys BP < 75 mm Hg Adolescent HR < 40 or > 140 RR > 40 breaths/min Sys BP < 85 mm Hg Rapid Response Team Order Set The RRT assesses the patient, determines appropriate interventions, and initiates diagnostic studies or treatment from the order set. Adult Order Set Admit: Transfer to Telemetry Transfer to ICU Nursing Orders: Finger Stick BG Foley Cath Recommend Consult to: Pulmonologist-Intensivist Cardiologists Neurologists Gastroenterologists N/G Tube Insertion N/G Tube Irrigation Semi Fowlers Position Initiate IV IV Orders: Sodium Chloride 0.9% 250 ml Sodium Chloride 0.9% 500 ml Sodium Chloride 0.9% 1000 ml Lactated Ringers 1000 ml
4 Pharmacy Orders: Potassium Chloride Eff Tab 50 meq po once for K < 3.6 Potassium Chloride Inj. 40 meq IVPB once for K < 3.0 Potassium Chlorine Inj. 20 meq IVPB once for K 3.0 3.6 Magnesium Sulfate Inj. 16 meq IVPB once for Mg < 1.5 Insulin Human R 20 units subcutaneous once BG > 400 Insulin Human 20 units IV once BG > 400 Dextrose 50% Inj. Once BG < 60 Naloxone Inj. 0.4 mg IV now Aspirin Tab 325 mg PO now Lorazepam Inj. 2 mg IV now Morphine Inj. 2-4 mg IV now Nitroglycerin 1/150 tab (0.4 mg). Sublingual every 5 minutes for chest pain Nitroglycerin Drip 50 mg/250 ml D5W Dopamine 800 mg/250 ml D5W Respiratory Therapy: Oxygen Therapy: Nasal Trumpet Oral Airway Suction Orally Suction Endotracheal Respiratory Meds: Albuterol 0.083% UD Inh Soln 2.5 mg by Nebulizer once Ipratropium 0.02% UD Inhal Soln by Nebulizer once Albuterol UD 2.5 mg/ipratropium UD by Nebulizer once Racemic Epinephrine 2.25% UD Inh 0.5 ml by Nebulizer once Lab: Potassium Blood Gas Studies/Lytes/H&H Basic Metabolic Panel B Type Natiuretic Peptide (BNP) CPK MASS CKMB Troponin I Magnesium Protime Partial Prothrombin Time Complete Blood Count with Diff Blood Culture Ammonia Lactic Acid Radiology: XR Chest AP Only Stat CT Head w/o Contrast Stat Electrodiagnostics:
5 Electrocardiogram Stat Pediatric Order Set Admit: Transfer to Special Care Nursery Nursing Orders: Finger/heel stick BG Foley catheter insertion Recommend consult to Cardiology Associates Neonatology N/G tube insertion N/G tube irrigation Neuro checks Semi Fowler s position Trendelenberg position Initiate IV IV Orders: Sodium Chloride 0.9% 100 ml IV Sodium Chloride 0.9% 250 ml IV Sodium Chloride 0.9% 500 ml IV Lactated Ringers 500 ml IV Pharmacy Orders: Calcium gluconate 10% 1-2 meq/100 ml IV fluid (0.45 meq/ml) Potassium chloride 10 meq/liter IV Potassium chloride 20 meq/liter IV Dextrose 25% 250-500 mg/kg/dose IV Naloxone inj. 10 mcg (0.1 mg/kg) IV Diazepam 0.2 to 0.5 mg IV (children 1 month to 5 years) Diazepam 1 mg IV (children > 5 years) Dopamine drip 2-20 mcg/kg/min IV Ativan 0.25 mg IV Respiratory Therapy: Oxygen therapy Pulse oximetry (continuous) Respiratory Medications: Albuterol 1.5 to 5 mg per nebulizer Xopenex 0.63% 1 vial per nebulizer Racemic Epinephrine 2.25% 10 drops per nebulizer 2-3 inhalations Laboratory: BMP CBC with diff Potassium Calcium
6 Blood gas studies Blood culture Radiology: Babygram Chest X-ray AP only Electrodiagnostics: Electrocardiogram Documentation: Documentation is based upon SBAR (Situation, Background, Assessment, and Recommendation). The documentation tool is located in Sunrise (Rapid Response Team Record). MD Notification: Every effort to contact the attending physician will be made by the staff nurse in cases where the RRT is called to a patient Duties After the Call: Restock bag, complete evaluation, and report off to the next RRT member. Patient Follow-up: For those patients who are stabilized and remain on the floor, a member of the RRT will reassess the patient within 2 hours after the initial assessment and document a follow-up visit. Patient/Family Participation: Information will be given to the patient/family member at time of hospital admission. If the patient/family notices a change in the patient s condition, experiences a breakdown in how care is being given, or tries to express their concern without the validation that they have been heard, they may dial 0 and notify the hospital operator that they need help. The hospital operator will over-head page the RRT to the patient s room. Measure of Effectiveness: An event log will be kept to record each RRT call. An evaluation will be done by the ICU nurse for each RRT call. The evaluation will be given to the ICU Clinical Educator for review, data collection, and to determine the effectiveness of the RRT. Other Considerations: The RRT provides emergency care only for the patient. The staff nurse will remain the primary care giver unless the patient is to be transferred to a higher level of care. The RRT nurse will communicate any findings and changes in plan of care to the primary nurse.