Vol. 10 Issue 17
Rapid Response Team Roles
Which specialties serve on a rapid response team is critical to its success
In December 2004, the Institute for Healthcare Improvement (IHI) introduced the 100,000 Lives Campaign. This 18-month campaign January 2005 to June 2006 identified several best practice initiatives intended to reduce patient harm and fatalities.1
s the campaign progressed, the IHI sought ways to save even more lives. Six patient safety initiatives were introduced, including the deployment of rapid response teams (RRT).1
Building upon the success of the 100,000 Lives Campaign, the current 5 Million Lives Campaign, introduced in December 2006 and ending in December 2008, continues the initial best practice initiatives and introduces six more.1,2
The IHI has partnered with several leading healthcare institutions, including the Joint Commission. This year, the Joint Commission's National Patient Safety Goals (NPSGS) are in alliance with the IHI's 100,000 and 5 Million Lives Campaigns.2,3This combined effort with other healthcare organizations will further assist in reducing medical injury to patients.
The NPSGS for all critical access hospital programs indicate a goal (goal 16) and sub-goal (goal 16A) can be interpreted as an RRT initiative. 2,3 oal 16 states to "improve recognition and response to changes in a patient's condition." Sub-goal 16A: "The organization selects a suitable method that enables healthcare staff members to directly request additional assistance from a specially trained individual(s) when the patient's condition appears to be worsening."
This latter statement "specially trained individual(s)" is particularly interesting.
In the hospital setting, specially trained individuals are abundant. Physicians, rounding on their patients, are collaborating with the bedside nurse who identifies and reviews the patient's plan of care. A nurse assesses his/her patients, performs interventions and evaluates the effectiveness of those interventions.
Collaborating with respiratory therapists (RTs) and pharmacists, the nurse naturally interacts with these valuable members of the healthcare team. Should these specially trained individuals be included as members of your RRT? Some questions to think about include the 24/7 availability of these professionals. Also, what would be their roles and responsibilities? Who takes the lead role? What interventions are appropriate to institute, within team members' scope of practice?
Assembling the Team
Establishing membership on your RRT is as important as developing the team's policies and procedures. Careful thought should go into identifying who responds and interacts with the bedside nurse.
Responders on the RRT should be specially trained individuals who possess advanced skills, knowledge and expertise in performing potential lifesaving interventions, e.g., airway management. Unlike a cardiopulmonary arrest team, RRT members intervene early, assisting the patient in avoiding a cardiac or respiratory arrest.
RRT members must respond promptly to a call. Pocket pagers and/or overhead pages are essential. Swift patient assessment and the administration of appropriate interventions are vital. The team approach to patient care management is essential for a successful rapid response team.
RRT composition may follow different models. Some models reported in the literature include: a critical care nurse and an RT; a critical care nurse and an intensivist; a critical care nurse and a physician assistant; and a critical care nurse and an advanced practice nurse (APN). 4,5
n a university teaching hospital the RRT may include a critical care nurse, an RT and a resident.4,5 At our institution, RRT membership follows two models. The first includes the critical care charge nurse, an RT and an APN. The critical care nurse and RT are available 24/7. The APN is available 7 a.m.-7 p.m. Monday-Friday.
Our second model consists of the critical care charge nurse, an RT and the house physician. The house physician is available 7 days a week from 7 p.m.-7 a.m. Other responders associated with the RRT include a pharmacist, a second critical care nurse, a second RT and/or a telemetry nurse.
The bedside RN activates the RRT when the patient's clinical condition is beginning to deteriorate.4,5 ecognizing unusual signs and symptoms for the patient is critical in securing the necessary help. By learning and utilizing the SBAR (situation-background-assessment-recommendations) technique, the bedside RN, in conjunction with the RRT responders, will be able to provide succinct information to the patient's physician that may determine the clinical outcome.4,5
At our institution, the APN must have a collaborative agreement with a physician to perform advanced practice nursing in the hospital setting. Our collaborative agreement clearly defines the scope of practice and determines which interventions could be initiated per our RRT protocol, e.g., ordering an arterial blood gas. In Illinois, a hospital-employed APN must have a collaborative agreement.
Also, the role of the RT on an RRT should not be underestimated. This highly skilled individual is proficient in assessment, delivering and evaluating pulmonary treatments and management .5,6 Identifying specially trained individuals and what their roles and responsibilities are is of utmost value in rapid response. Professional RRT members have the ability to swiftly assess the patient's status and intervene quickly. Together, the RRT is an effective approach to patient care management.
References for this article can be accessed at www.advanceweb.com/nurses. Click on Education, then References.
Barbara Gulczynski is a clinical nurse specialist in the critical care department at Advocate Good Samaritan Hospital, Downers Grove, IL.